Progressive bilateral lipoma arborescens of the knee complicated by juvenile spondyloarthropathy: A case report and review of the literature |
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Authors: | Jing Xue Anthony J. Alario Scott D. Nelson Huaxiang Wu |
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Affiliation: | 1. Department of Rheumatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, P.R. China;2. Department of Pediatrics, University of Massachusetts, Worcester, MA;3. Department of Pathology and Laboratory Medicine, Santa Monica-UCLA Medical Center, CA |
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Abstract: | ObjectivesTo report an unusual case of lipoma aborescens (LA) presented in a patient with treatment-responsive juvenile spondyloarthropathy (JSPA) and to summarize the clinical manifestations, therapy and prognosis of LA by literature review.MethodsWe report an atypical case of a 17-year-old patient with an initial presentation of juvenile spondyloarthropathy, whose inflammatory condition was improved successfully by traditional anti-rheumatic drugs and an anti-TNF alpha agent but developed progressive swelling of bilateral knees. Lipoma arborescens were diagnosed in each knee by synovial biopsy obtained by arthroscopic surgery. Fifty-one cases of LA have been reported and are reviewed in detail.ResultsClinically, LA could present as monoarthritis or oligoarthritis. The lateral compartment of the knee is the most common site of involvement. Several cases were reported as a comorbidity of inflammatory diseases, but were not improved by anti-inflammatory therapy. Most patients were diagnosed by classic MRI and biopsy findings. The lesions can be managed by open or arthroscopic surgery, but a minority of the cases may have reoccurrence in the same or opposite joint.ConclusionsLA is a very rare lesion of the synovial and bursal tissue with an unknown etiology. It is considered to be a benign proliferation of the synovial fat associated with trauma, degenerative or inflammatory conditions. LA should be considered as a secondary or comorbid condition in inflammatory arthropathies if other joints respond well to intensive therapy and one or more do not. |
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Keywords: | Lipoma arborescens Juvenile spondyloarthropathy (JSPA) Juvenile idiopathic arthritis (JIA) Diagnosis Therapy |
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