Case report: rheumatoid arthritis occurring during observation after surgery for localized pigmented villonodular synovitis

Abstract

In the rare case presented here, arthroscopic resection was performed after a diagnosis of localized pigmented villonodular synovitis (LPVS) of the knee, but the disorder recurred after about 1 year as the diffuse form, and synovectomy was performed through a medial parapatella incision. Subsequently, rheumatoid arthritis (RA) occurred during the postoperative observation period. The course of this case is interesting because of the combination of the two diseases. In cases of PVS, the possibility of RA should always be considered.     

间接磁共振关节造影在色素沉着绒毛结节性滑膜炎中的应用

目的探讨间接磁共振关节造影在色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)中的诊断价值。资料与方法回顾性分析12例经手术及病理证实的PVNS患者的常规MRI、间接磁共振关节造影(indirect MR arthrography,I-MRa)资料。结果12例PVNS患者中关节滑膜呈弥漫性增生肥厚者10例,局限性2例。常规MR表现为T1WI等信号,T2WI高信号2例;T1WI、T2WI均为低信号9例。I-MRa表现为在关节积液的极高信号背景下增生肥厚滑膜呈中等强化的高信号,并对周围正常组织有不同程度的侵蚀。结论I-MRa与常规扫描序列相结合,不仅能更清晰地显示出病变累及的范围和程度,而且还可以显示滑膜对关节骨质的侵蚀、反映病变的血供等病理改变,从而可进一步提高PVNS定性及分期的准确性。     

Control of the synovium in haemophilia

Summary. Adequate factor substitution is a prerequisite for successful conservative or operative treatment of haemophilic synovitis. Subsequent prophylactic factor substitution can prevent further joint problems in the future. Orthopaedic treatment regimes are dependent on the classification of the synovitis and the stage of the arthropathy. Synovitis can be classified into acute and chronic forms. The arthropathy is classified according to Arnold and Hilgartner. When the synovitis has already become chronic, early arthroscopic synovectomy is recommended in order to prevent the otherwise inexorable progress of the arthropathy. Failure to treat in the early phase of the pathology causes problems in the correction of further stages. The progression of the joint disease can be shown both clincally and radiologically as the arthropathy develops, and influences the treatment.     

Radiological assessment of haemophilic arthropathy with emphasis on MRI findings

Summary.  Medical imaging of haemophilic joints is important for detecting abnormalities, grading their severity and selecting the appropriate therapy. The plain-film scoring systems for staging joint disease that were developed prior to the availability of magnetic resonance imaging (MRI) are inadequate for planning modern prevention and treatment. MRI is capable of delineating all of the soft tissue findings long before they are evident on plain radiographs. In this paper, an MRI scoring system is presented along with examples of joint effusion, haemarthrosis, synovial hypertrophy, haemosiderin deposition, erosions, cysts and cartilage loss. MRI is a powerful tool in the diagnosis, staging and treatment of patients with haemophilic joint disease.     

Arthroscopic view of transient synovitis of the hip joint: a case report

We present a case of a 13-year-old male patient with hip pain and limp. Inconclusive investigations and persistent symptoms resulted in the patient undergoing hip arthroscopy. At arthroscopy, a large focal cartilaginous defect of the femoral head with synovitis was seen and synovial biopsy confirmed the diagnosis. Arthroscopic debridement of the lesion, synovectomy and non-weight bearing for 6 weeks resulted in relief of symptoms. Transient synovitis is a common diagnosis in young children, but the extent of damage to the femoral head has not been previously described. Transient synovitis may not always respond to symptomatic treatment and hip arthroscopy may be useful in detecting the actual lesion and plan the treatment.     

The Irritable Hip Syndrome in Children: A Long-Term Follow-up

This paper gives the results of a long-term follow-up study of 101 children with “Irritable Hips” who were admitted to the Mater Children's Hospital, Brisbane, Queensland, between 1962 and 1972.

The case notes and the laboratory data from their original presentation have been reviewed and all the children were recalled for clinical and radiological examination. Clinical abnormalities were found on eighteen occasions but none could be proved to be related to the child's episode of transient synovitis. Radiological changes were found on four occasions. Two of these were related to the disease in question, but two were probably coincidental findings. One case of Perthes' disease was found and one case of coxa magna, and these long-term complications are more likely to be found in patients with prolonged symptoms or radiological abnormalities on admission.     

膝创伤性滑膜炎的实验与防治研究

1987年开始设计并进行大白鼠及家兔膝创伤性滑膜炎动物模型的实验研究和临床防治研究。动物实验结果表明;关节过度运动之后,关节腔内压升高及氧分压下降是导致创伤性滑膜炎的重要原因之一;双氧水关节腔内灌注冲洗可升高关节腔内氧分压,促进滑膜组织修复。临床应用双氧水及生理盐水灌冲关节腔的方法治疗军训所致膝创伤性滑膜炎病人53例,总有效率达94.7％。     

Kinetics of salicylates in blood and joint fluid

Summary Samples of blood and joint fluid from 30 patients who had taken buffered acetylsalicylic acid were examined for concentrations of total salicylates (TSA), acetylsalicylate (ASA) and salicylate (SA). The data were arranged in groups according to diagnosis of the joint disease. Analysis of the data did not show significant difference in the kinetics of TSA into blood. In groups the time to first appearance of 0.3 mg/l averaged 6.3 min for TSA; these values averaged 7.7 min for ASA and 10.9 min for SA. Close to maximum concentrations in blood averaged 18.9 mg/l for TSA, 3.3 mg/l for ASA, and 23.3 mg/l for SA. The time for first appearance of 0.3 mg/l of total salicylates in joint fluid ranged from 10 to 34 min with an average of 18.1 min; the values of ASA averaged 19.4 min and those of SA 21.9 min. The maximum concentration in joint fluid averaged 15.7 mg/l for TSA, 2.5 mg/l for ASA, and 14.5 mg/l for SA. Transport of salicylates from blood to joint fluid showed a pattern consistent with the type of joint disease. Support was found for the hypothesis that diffusion was the major factor in the movement of salicylates from blood to joint fluid.This study was partly supported by grants of U.S. Public Health Service AM 01431 and Bristol-Myers Company.     

Localized Regressive Articular Cartilage Changes in the Hip Joint of the Rabbit following an Induced Synovitis

A talcum induced synovitis in the hip joint of the rabbit, which is known to cause articular cartilage hyperplasia followed by femoral head protrusion and joint incongruency, has in the present experiment also been shown to lead to localized regressive articular cartilage changes. The articular cartilage of the hip joints in 40 rabbits was examined histologically, at intervals, following induction of such a talcum synovitis. Regressive changes in the form of loss of surface chondrocytes and glycosaminoglycans sometimes accompanied by fibrillation, were found in the area of the femoral head articular cartilage which had become flattened following the head protrusion. Chondrocyte cloning facilitated subsequent cartilage repair. The biomechanical disturbance in the joint following the induced synovitis is felt to have caused the regressive changes. The experiment is considered to have some significance in connection with Legg-Calve-Perthes' Syndrome (L.C.P.S.) in children.     

Expression of c-kit protooncogene in human hepatocellular carcinoma

Using comparative genomic hybridisation, DNA copy number changes were investigated in 15 cases of pigmented villonodular synovitis of the knee joint. Additionally DNA content was analysed by flow cytometry. Screening revealed numerical chromosomal imbalances in five of the examined cases. A total number of 18 gains were detected. The most frequent gains involved subregions of chromosomal arms 22q and 16p and 16q. No losses were found. One of the cases showed an aneuploid DNA-pattern, which actually proved to be the case with the most numerical chromosomal changes.