A 65-year-old woman developed erythema, papules and nodules over the body. Some nodules of her auricles and hands like string beads. Besides, she suffered from symmetrical swelling and pain of multiple joints, morning stiffness with deformity of joints; She had elevated erythrocyte sedimentation rate and C reactive protein levels; Her rheumatoid factor and antinuclear antibody were positive; Joints destruction was found with X-ray imaging; Skin pathology showed Dermal infiltrate of abundant histiocytes, part of them with a ground-glass appearance; A CD68 immunohistochemical stain was positive and the cells were negative for S100, CD1a. These findings were diagnostic evidences of multicentric reticulohistiocytosis (MRH). The patient received high-dose of glucocorticoids combinated with immunosuppressive agents, and achieved a satisfactory effect. MRH was a rare multisystem disease characterized by papulonodular mucocutaneous and destructive arthritis, and its pathogeny was not yet completely understood. The typical lesions of MRH were hard papules or nodules that usually occured on the hands, face and arms. Classic coral bead appearance from periungual cutaneous nodules that were characteristic of MRH. MRH was an inflammatory joint disease, affecting almost all the appendicular joints and characterized by joint multiple, symmetrical, destructive, progressive disability. Joints destruction of the distal interphalangeal joints was a unique feature of MRH. In addition to skin and joints, it could also involve other systems. There were no diagnostic laboratory markers for MRH. Laboratory examinations had often been found to be non-specific. Imageological examination mainly showed bone and joint destruction. Skin biopsy was the best test to diagnose MRH, the typical histopathological findings included an infiltrate with histiocytes and multinucleated giant cells with a ground-glass appearing in eosinophilic cytoplasm, and the immunohistochemical stain was positive for CD68. The diagnosis was typically made based on the clinical presentation, supportive radiographic findings and skin biopsy. MRH was easily possible to mistake for other more common autoimmune conditions, such as rheumatoid arthritis, psoriatic arthritis, osteoarthritis, and dermatomyositis, but the distinctive clinical, radiographic, and histologic features could aid in differentiating these diseases. MRH could mimic other rheumatic diseases, besides, it could also coexist with cancer or other autoimmune disorders. There was no standardized treatment for MRH. However, Nonsteroidal anti-inflammatory drugs, glucocorticoid, Immunosuppressant, biologic medications, and bisphosphonates had been used with varying degrees of curative effect. Treatment with glucocorticoid combined with immunosuppressants were effective for rash and arthritis, early use of them should be strongly considered, and refractory cases could be treated with biological agents. By reporting a MRH case and reviewing literature, this paper aims to help the clinicians improve the understanding of this rare disease, and suggests that when one diagnosis cannot explain the whole picture of the disease, and further evidence should be sought to confirm the diagnosis.
Aged ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Humans ; Osteoarthritis ; Radiography

PURPOSE: To analyse clinical result of total knee arthroplasty without patellar resurfacing who had moderate to severe patellofemoral arthritis. MATERIALS AND METHODS: Unilateral knee joints of 54 cases, diagnosed to be moderate to severe patellofemoral arthritis on the basis of Ahlback's radiographic evaluation score of patella on preoperative plain radiography among the patients undergone the total knee arthroplasty due to primary degenerative osteoarthritis at this hospital between January 2000 and March 2004, were subject to this study. Patellar resurfacing was not performed in any cases. Likewise, the knee score of Hospital for Special Surgery and Feller's patellar score were used in clinical assessment preoperatively, and was used two years after the operation. RESULTS: The knee score of Hospital for Special Surgery was increased from 55.1 (35~78) to 82.8 (67~95), and also Feller's patellar score was increased from 19.1 (11~24) to 28.3 (18~30) after operation. Mild anterior knee pain was observed in 5 cases (9.3%) after the operation, but medication was needed in just 2 cases. The 42 cases (77.8%) could normally go up and down stairs without holding the rail. CONCLUSION: The total knee arthroplasty without patellar resurfacing, performed for the patients diagnosed with moderate to severe patellofemoral arthritis related with the indication for patellar resurfacing, derived satisfactory outcomes.
Arthritis* ; Arthroplasty* ; Humans ; Knee Joint ; Knee* ; Osteoarthritis ; Patella ; Radiography

PURPOSE: To evaluate value of post-contrast 3-Dimensional fat suppressed Spoiled GRASS (FS SPGR) in detectiong subtle bony erosion and tenosynovitis of hands and wrists due to early rheumatoid arthritis. MATERIALS AND METHODS: Fourteen MR iraagings of the hands and wrists were performed in 7 early rheu- matoid arthritis without any abnormalities in plain radiography and in 7 healthy volunteers. All subjects underwent MR sequence of coronal 3D FS SPGR with and without contrast enhancornear in 1.5T MR unit. We evaluated the number of the bony erosion and tenosynovitis respectively in pre- and post-contrast FS SPGR images. RESULTS: The abnormal enhancing areas were not demonstrated in 7 healthy volunteers. Seven patients had 25 bony erosions in pre-contrast FS SPGR and 52 bony erosions with tenosynovitis (n=10) in post-contrast FS SPGR. Enhancing joint spaces were shown in 8 cases CONCLUSION: Post-contrast FS SPGR was better than pre-contrast FS SPGR in the evaluation of early rheumaotid arthritis and is valuable as a baseline study.
Arthritis ; Arthritis, Rheumatoid* ; Hand ; Healthy Volunteers ; Humans ; Joints ; Magnetic Resonance Imaging* ; Poaceae ; Radiography ; Tenosynovitis ; Wrist

Septic arthritis requires an early diagnosis and proper treatment to prevent the destruction of articular cartilage and joint contracture. This paper presents a rare case of septic arthritis of the acromioclavicular joint that was treated with arthroscopic debridement and resection of the distal clavicle.
Acromioclavicular Joint/radiography/*surgery ; Arthritis, Infectious/radiography/*surgery ; *Arthroscopy ; Clavicle/surgery ; Humans ; Male ; Middle Aged

We report a case of calcium pyrophosphate dihydrate crystal deposition disease (CPDD) presenting as an acute polyarthritis. A 66-yr-old woman was admitted with a 5-day history of fever and multiple joint pain including wrists, elbows, shoul-ders, knees, and ankles developed 5 days before admission. Her plain radiographs of wrists, elbows, shoulders, knees, and ankles showed chondrocalcinosis. The pubic symphysis, lumbar intervertebral discs, and both hip joints, which were asymptomatic, also had calcium deposits. The compensated polarized microscopic examination of the joint fluid, aspirated from the right knee revealed intracellular and extracellular weakly positive birefringent crystals, confirming the CPDD. This case showed that CPDD may manifest as an acute polyarthritis mimicking acute onset rheumatoid arthritis.
Acute Disease ; Aged ; Arthritis/*radiography/radionuclide imaging ; Chondrocalcinosis/*radiography/radionuclide imaging ; Diagnosis, Differential ; Female ; Humans

The role of acromioclavicular (A-C) arthritis in stage 2 and 3 impingement syndromes was investigated in this study. Twenty-seven patients with stage 2 and 3 impingement syndrome were evaluated both clinically and radiologically for the presence of A-C arthritis. Patients with A-C arthritis who were treated by conservative or surgical methods were rated before and after therapy according to the University of California at Los Angeles (UCLA) shoulder rating scale. The follow-up period ranged from 7 to 16 months, with an average of 13 months. A-C arthritis was diagnosed in 21 of 27 patients (one grade 2 and 20 grade 3, according to Kellegren). Clinical and radiological evaluation of these 21 patients revealed A-C joint pain and a positive lidocaine injection test in all (100%), a positive horizontal adduction test in 20 (95.2%), decreased joint space in 18 (85.75%) and osteophytes in 11 (52.4%). Surgical treatment was considered for 12 A-C arthritis patients; and distal clavicle resection was performed in 11 of these cases. The average score measured by the UCLA rating scale increased from 13 to 28 in the group treated with surgery (satisfactory result), and from 10 to 13 in the group treated with conservative therapy (unsatisfactory result). The results of this study may be interpreted as demonstrating that A-C arthritis is a common etiologic factor in chronic impingement syndromes and its co-existence has a strategic importance in the choice of treatment method. Surgical resection of the distal clavicle should be considered in the presence of this pathology since this technique provides excellent results in pain relief and appears to be superior to conservative therapy in these cases.
Acromioclavicular Joint*/radiography ; Acromioclavicular Joint*/pathology ; Adult ; Aged ; Arthritis/radiography ; Arthritis/pathology ; Arthritis/complications* ; Arthrography ; Cartilage, Articular ; Human ; Male ; Middle Age ; Shoulder Impingement Syndrome/complications*

Although little attention has been paid to the less common rheumatoid involvement of the thoracic and lumbar regions, some studies have shown that rheumatoid synovitis with erosive changes can develop in these diarthrodial joints. We report a patient with seropositive rheumatoid arthritis (RA) involving the thoracic and lumbar vertebra with a collapse of the T12 vertebra, who was treated with percutaneous vertebroplasty. In this case of a painful pathological fracture due to RA, percutaneous vertebroplasty was found to be helpful in eliminating the pain. The paper presents the histological evidence, the pathogenesis and treatment of the thoracolumbar lesions affected by RA with a review of the relevant literature.
Arthritis, Rheumatoid/blood/complications/*pathology/radiography ; Female ; Fractures, Compression/etiology/radiography/surgery ; Humans ; Lumbar Vertebrae/*pathology/radiography ; Middle Aged ; Thoracic Vertebrae/*pathology/radiography ; Vertebroplasty

Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.
Aged ; Arthritis, Infectious/*microbiology/radiography ; Bursa, Synovial/*microbiology/radiography ; Candida/isolation & purification ; Candidiasis/*microbiology/radiography ; Foreign Bodies/*etiology ; Humans ; Male ; Shoulder Joint/*microbiology/radiography

Femoral mononeuropathy (FMN) as an extraarticular finding of rheumatoid arthritis (RA) is a phenomenon which has not been reported previously. We report a 53-year-old female patient with RA, presenting FMN findings during the course of the disease. On examination, right quadriceps and iliopsoas muscles showed grade 3 weakness on the Medical Research Council (MRC) scale. Sensory examination revealed sensory loss in the right medial leg and thigh. Patellar tendon reflex was absent in the right side. A diagnosis of a partial right femoral neuropathy was confirmed using nerve conduction study and electromyography. The probable mechanism of FMN was thought to be vasculitis.
Arthritis, Rheumatoid/*complications/radiography ; Electromyography ; Female ; Femoral Neuropathy/complications/*diagnosis/therapy ; Hand/radiography ; Humans ; Middle Aged ; Neural Conduction

No abstract available.
Adult ; Arthritis, Rheumatoid/*diagnosis/radiography ; Female ; Humans ; Incidental Findings ; Predictive Value of Tests ; Thoracic Vertebrae/*abnormalities/radiography ; Tomography, X-Ray Computed