Iliopsoas bursa of the rheumatoid hip joint. A case report and review of the literature

Summary Presented is the case of a 63-year-old woman, with a 30-year history of rheumatoid arthritis, whose hip was completely destroyed and accompanied with enlargement of the iliopsoas bursa. Preoperative diagnosis was confirmed by computed tomography, magnetic resonance (MR) imaging and arthrography. She was treated by resection of the iliopsoas bursa and total prosthetic replacement of the hip joint. The pathogenesis is uncertain. In the literature, enlargement of the iliopsoas bursa with rheumatoid arthritis, osteoarthritis, pigmented villonodular synovitis, and synovial chondromatosis had been reported. Nevertheless, a correct preoperative diagnosis of the enlargement of the iliopsoas bursa is very difficult. MR imaging with enhanced Gadolinium-DTPA (Gd-DTPA) is proposed as the most useful examination for preoperative diagnosis.     

Magneic resonance imaging of the wrist in rheumatoid arthritis: Comparison with other inflammatory joint diseases and control subjects

Summary The aim of this study was to evaluate magnetic resonance images (MRI) of the wrist of rheumatoid arthritis (RA) patients. MRI and plain X-ray of the wrists were performed in 15 patients with RA, 7 patients with another chronic inflammatory joint disease (CIJD), and 10 control subjects. Patients had only minor changes on plain X-ray. Coronal T1 weighted spin echo sequences were performed before and after an intravenous pulse of gadolinium (GD). Contiguous 3 mm thick slices were obtained. Synovitis was frequently objectivized in the two groups of patients. MRI detected far more erosions and central bone geodes than plain X-ray. Geodes were frequent among controls while cortical bone erosions were frequent in patients. Most of the erosions were enhanced after GD injection in the RA patients but not in the 2 other groups. Thus MRI is not only useful in diagnosing inflammatory changes of the wrist but also in distinguishing early stage RA from other CIJD.     

Bilateral fast MR imaging of the rheumatoid wrist

Summary To evaluate the structural changes in the carpal tunnel and possible intrinsic median nerve damages in RA patients, quantitative bilateral magnetic resonance imaging (MRI) of the wrists was performed by means of a fast imaging sequence. Thirty-three women with RA and 42 controls were examined. The length of the carpal tunnel, the carpal tunnel volume/wrist volume (CTV/WV) ratio and the signal intensity of the nerve were calculated in both groups, bilaterally. The CTV/WV ratio was 0.12 in the patients and 0.11 in the control group (p=0.007). A negative association was found between disease duration and carpal tunnel volume/wrist volume ratio (p=0.049). Mean distal latency in the right motor median nerve was 3.0±0.4 msec (patients) and 3.4±0.6 msec (controls) (p=0.002). Mean values in the right sensory branch were 1.2±0.1 msec (patients) and 1.4±0.3 (controls) (p=0.01). The lack of association between the size of the carpal canal and neurophysiological parameters found in this study may suggest a possible protection of the median nerve by the increased canal size in patients with RA.     

Multilating rheumatoid arthritis associated with sarcoidosis: A case report

Summary We describe a case of sarcoidosis with opera-glass fingers and outstanding flexion deformity of both knees. Histological examination of skin eruptions and transbronchial lung biopsy revealed the existence of noncaseating epithelioid granuloma. However, the synovial tissue showed chronic inflammation consistent with rheumatoid arthritis without any epithelioid lesions.     

MRI of knee arthritis in rheumatoid arthritis and spondylarthropathies

Summary The knees of fifty-two patients suffering from rheumatoid arthritis (RA), 22 patients with seronegative spondylarthopathies (SA) as well as of 20 healthy volunteers were examined by magnetic resonance imaging (MRI). Osseous erosions (RA 52%-SA 18%; P<0.005), Baker cysts (RA 56%-SA 12%; P<0.005), pannus formation (RA 67%-SA 36%; P<0.05), and cartilage thinning with narrowing of the joint space (RA 46%-SA 18%; P<0.05) proved to be more frequent MRI findings in patients with RA. Additionally, in patients with RA erosions were more extensive. Follow-up MRI examinations of 19 patients revealed an improvment in MRI changes in SA within an average interval of 6 months. No substantial changes were noted in 7 of 13 RA patients. Quantitative and qualitative MRI findings of knee arthritis differ in patients with RA and SA and this was statistically significant. However, as there is considerable overlap of the MRI and radiographic changes in both groups the discriminating diagnostic value in the individual case was limited.Dedicated to Professor Dr. W. Wenz on his 65th birthday     

Long-term results of knee synovectomy in early cases of rheumatoid arthritis

Summary Five hundred and eight cases of early synovectomy of the knee in rheumatoid arthritis are reported from nine clinics in a retrospective multi-center follow-up study. Observation time covers at least ten years in each case. Sixty-five per cent of the cases are reported as being subjectively and objectively good. The mean roentgenological grade, according to Larsen, was 1.7 preoperatively and 2.7 at follow-up.A multi-center retrospective study presented by European Rheumatoid Arthritis Surgical Society (ERASS) at the Tenth European Congress of Rheumatology in Moscow 1983.     

磁共振成像在类风湿关节炎患者膝关节病变研究中的意义

目的　初步探讨磁共振成像 (MRI)技术在类风湿关节炎 (RA)患者膝关节病变临床诊断中的应用价值。方法　对 2 0例RA患者的 34个膝关节进行多种序列成像并分析其MRI表现。结果　MRI可清晰显示RA膝关节的滑膜增生及血管翳形成、关节软骨破坏、骨质受侵、关节囊积液、半月板及韧带异常、窝囊肿形成以及皮下结节等改变 ,并能通过血管翳的信号和强化程度判断疾病是否处于活动期。结论　与X线相比 ,MRI对RA的骨质侵蚀破坏更为敏感 (P <0 0 1)。MRI能直接显示RA患者膝关节不同时期的各种改变 ,有助于疾病的早期诊断和临床分期     

Therapeutic approaches of German and Turkish physicians to rheumatoid arthritis and to osteoarthritis of the knee

Summary Our objective was to compare the therapeutic approaches of German and Turkish physicians to rheumatoid arthritis (RA) and to osteoarthritis (OA) of the knee, by means of a mailed survey. The survey contained four case histories representing a mild, a moderate and a severe case of RA and a case of OA of the knee. One hundred and thirty-two physicians from Germany (internal medicine based (IR) and orthopaedics based (OR) rheumatologists) and thirty-three from Turkey (rheumatologists and physical medicine and rehabilitation specialists (PT) participated in the study.German respondents would give more disease-modifying drugs (DMARD) in early RA (48.7% vs 18.2%, p<0.05), whereas their Turkish colleagues would prescribe more analgesics, ultrasound and kryotherapy in OA of the knee (63.6% vs 22.1%, 30.3% vs 6.5% and 24.2% vs 0.0% respectively p<0.05). German physicians chose more exercise, physical and occupational therapy, radiation synovectomy and surgery in all cases. In OA of the knee German OR's would recommend less analgesics, but more local steroids, chondroprotective agents and surgery than the other groups.We may conclude that clinical practice of RA and OA of the knee differs considerably in Germany and Turkey. Cultural, social, educational and economic factors could influence the decisions of the physicians.     

Comparative study of fat-suppressed Gd-enhanced MRI of hands in the early stage of rheumatoid arthritis (RA) and non-RA

The object of this work was to evaluate the usefulness of fat-suppressed gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) for the diagnosis of early-stage rheumatoid arthritis. Forty wrists of patients who had suffered from stiff or swollen hands for 1–12 months were examined prospectively by MRI. Rheumatoid arthritis (RA) was proven in 21 patients, and the other 19 patients were not classified as having RA. Hypertrophy of the synovial membrane and tendon sheaths were evaluated by fat-suppressed Gd-enhanced MRI, and bone erosions were also evaluated by T1-enhanced MRI. These results were compared between two groups. Seventeen of 19 patients (89.5%) in the non-RA group showed little or no synovial hypertrophy, while 17 of 21 patients (81%) in the RA group showed moderate to severe hypertrophy of the synovial membrane. Little or no tenosynovitis was found in 14 of 19 patients (73.7%) in the non-RA group, while 14 of 21 patients (66.7%) in the RA group had moderate to severe tenosynovitis. No bone erosion was found in the non-RA group, while a few bone erosions were found in 10 of 21 patients (47.6%) of the RA group. Fat-suppressed, Gd-enhanced MRI was useful in differentiating early-stage RA from non-RA when all patients had some symptoms in their hands. Received: June 20, 2000 / Accepted: October 25, 2000     

类风湿关节炎310膝次膝关节镜镜下分析

目的 探讨类风湿关节炎(RA)膝关节病变的关节镜下表现.方法 回顾分析2005年12月至2008年2月佛山市第一人民医院223例RA住院患者310膝次膝关节镜术中镜下所见,分析RA膝关节病变的特征.结果 310膝次中的305膝次(98.4%)有不同程度的滑膜增生,探查膝关节各区域以内侧间隙、髁间窝、外侧间隙滑膜增生明显增多,分别为274(88.4%)、267(86.1%)和258(83.2%)膝次,髌上囊滑膜增生最少见,为152膝次(49.0%);296膝次增生滑膜的镜下表现为珊瑚或棉絮样,9膝次表现为苔藓样增生.301膝软骨可见不同程度软骨变性或缺损,股骨内、外髁软骨变性合并软骨破坏或缺损分别为124、163膝.单纯软骨变性63膝.51膝的前交义韧带部分断裂,5膝次完全断裂,后交叉韧带部分断裂23膝,1膝次完伞断裂.内侧半月板撕裂、基本或完全消失的膝次分别为234、38膝次,外侧分别为214、45膝次.结论 RA膝关节多有滑膜增生,髁间窝及内、外侧问隙最多见,髌上囊相对较少;增生滑膜形态以珊瑚或棉絮样为主.RA膝关节软骨破坏常见,股骨内、外髁处最为明显;部分膝关节可见前、后交义韧带部分或完伞断裂;大部分RA膝关节有半月板病变.     

The rheumatoid heel: Its relationship to other disorders in the rheumatoid foot

Summary Fourhundred and eight rheumatoid feet are studied. The percentage of talalgia is 3.7%; for inferior exostosis it is 29.6%, and 30.8% for posterior exostosis. Posterior demineralisation is present in 12%, whereas for bony erosion it is 8.1%. Plantar spurs are very closely associated to flattened feet (p<0.0001). Likewise a very noticeable statistical association is noted between postero-superior calcaneilis and tarsal arthritis (p<0.0001), and calcaneitis was more frequent among marked valgus (p<0.001). These results are compared with findings of other works. Therapeutic consequences are evoked.     

Efficacy of radiosynovectomy of the knee in rheumatoid arthritis: Evaluation with magnetic resonance imaging

The intra-articular injection of a radiopharmaceutical agent (radiosynovectomy) produces a reduction of the synovial inflammatory process. The inflammed synovial membrane can be identified with magnetic resonance imaging after the intravenous administration of gadolinium (MRI-Gd). A 6-month prospective study was carried out in 10 patients with rheumatoid arthritis after radiosynovectomy of the knee. The efficacy was evaluated with clinical parameters and MRI-Gd. A progressive amelioration of synovial effusion, pain, articular range of mobility, total leucocytes count in synovial fluid and synovial membrane thickness through MRI-Gd was observed. The global efficacy was considered to be good in six patients, fair in three and bad in one. The study shows for the first time that MRI-Gd allows the evaluation of the response of the synovial membrane to radiosynovectomy.     

CT and MRI evaluation of tenosynovitis of the rheumatoid hindfoot

Summary Thirty-nine patients with rheumatoid arthritis who had presented with tarsitis before, were investigated at the level of the rearfoot. The first 17 patients had CT with previous tenography when it was possible; the following 22 patients had MRI with gadolinium injection. Tendon involvement appeared in 52,9% of the cases on CT, and in 90% of the feet on MRI; therefore, in case of clinical or radiological signs of tarsitis, it appears that tendon involvement must be suspected. With the two procedures the tibialis posterior tendon lesions were very predominant. In the majority of the patients (31/39), there was associated involvement of two or more tendons. If there is a ruptured tendon, the authors think that one must be cautious with surgical tendinous transfer; indeed, the long-term results of this surgical procedure present a strong probability of being compromised in rheumatoid arthritis which is a progressive disease.     

The effect of methylprednisolone pulse therapy on methotrexate treatment of rheumatoid arthritis

Summary We randomly assigned 30 active rheumatoid arthritis (RA) patients who started oral methotrexate (MTX, 7.5 mg/week) treatment, into 3 groups. Group I received no additional corticosteroids; Group II was treated with 3 oral pulses of 100 mg prednisolone and Group III with 3 intravenous pulses of 1000 mg methylprednisolone (MP) on alternate days during the first week. Parameters of disease activity were measured at the start, after 10 days and at regular intervals up to 1 year. In Group I maximal improvement occurred after 18 weeks and in Group III after 6 weeks. This effect was sustained during the study. The initial effects in Group II were not as strong as in Group III and of shorter duration. No serious side effects were noticed. Our results suggest, that MP-pulse therapy seems to be useful in bridging the gap between the introduction of MTX and the response to this drug. Furthermore, we found that patients who were HLA-DR4-positive showed a better clinical response after 1 year than HLA-DR4-negative patients.     

Total knee arthroplasty for rheumatoid knee with bilateral,severe flexion contracture: report of three cases

Abstract

The treatment of patients with severe flexion contracture of the rheumatoid knee, deprived of ambulation for long periods of time, is challenging. Based on three cases, we indicate the potential risks of posterior dislocation of the knee after total knee arthroplasty. In this pathological condition, surgeons must carefully select the type of implant in order to avoid this serious complication. We also emphasize the importance of working on disuse muscle atrophy of trunk (back, abdominal) and lower limbs, both of which play an integral role in ambulation. The personality of each rheumatoid patient should be carefully considered when considering surgical and rehabilitation options.     

The therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy in the rheumatoid knee

The purpose of the present study was to retrospectively evaluate the therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy (MISAA). From 1995 to 2003, MISAA was performed on 30 knees of 18 rheumatoid arthritis patients. The mean follow-up period was 74.4 months. Radiographic assessment according to Larsen's radiological classification, the conversion ratio to total knee arthroplasty (TKA), and postoperative change of the range of flexion were evaluated retrospectively. There were 10 knees in grade I, 14 knees in grade II, and 6 knees in grade III, preoperatively. All the knees in grade I and 8 of 14 knees in grade II maintained the same grade until the latest follow-up. The other 6 knees in grade II and all the knees in grade III deteriorated to grade IV and were converted to TKA after MISAA. The mean range of flexion significantly increased postoperatively except the knees that were converted to TKA. MISAA is effective for rheumatoid knees in grade I or II, and improves range of flexion.     

The therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy in the rheumatoid knee

Abstract

The purpose of the present study was to retrospectively evaluate the therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy (MISAA). From 1995 to 2003, MISAA was performed on 30 knees of 18 rheumatoid arthritis patients. The mean follow-up period was 74.4 months. Radiographic assessment according to Larsen's radiological classification, the conversion ratio to total knee arthroplasty (TKA), and postoperative change of the range of flexion were evaluated retrospectively. There were 10 knees in grade I, 14 knees in grade II, and 6 knees in grade III, preoperatively. All the knees in grade I and 8 of 14 knees in grade II maintained the same grade until the latest follow-up. The other 6 knees in grade II and all the knees in grade III deteriorated to grade IV and were converted to TKA after MISAA. The mean range of flexion significantly increased postoperatively except the knees that were converted to TKA. MISAA is effective for rheumatoid knees in grade I or II, and improves range of flexion.     

Total knee arthroplasty for rheumatoid knee with bilateral, severe flexion contracture: report of three cases

The treatment of patients with severe flexion contracture of the rheumatoid knee, deprived of ambulation for long periods of time, is challenging. Based on three cases, we indicate the potential risks of posterior dislocation of the knee after total knee arthroplasty. In this pathological condition, surgeons must carefully select the type of implant in order to avoid this serious complication. We also emphasize the importance of working on disuse muscle atrophy of trunk (back, abdominal) and lower limbs, both of which play an integral role in ambulation. The personality of each rheumatoid patient should be carefully considered when considering surgical and rehabilitation options.     

3.0T MRI在克罗恩病中的临床应用和价值

克罗恩病（CD）是病因未明的胃肠道慢性肉芽肿性疾病。传统X线小肠钡灌检查可清晰显示CD腔内病变和黏膜细节。磁共振成像（MRI）具有快速三维后处理能力,可清晰反映肠壁和肠腔外病变。随着3．0T高场强MRI投入临床应用．其对肠道疾病的诊断价值成为了临床争论的热点。本文就3．0TMRI在CD诊断中的临床应用和价值作一综述。