Arthritis damages the cartilage within joints, resulting in degenerative changes, including loss of function and joint instability. Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the spine and bone-to-tendon attachment area within the sacroiliac joint leading to back pain and progressive spinal stiffness. In the final stages, AS causes hyperkyphosis-a condition closely tied to the human leukocyte antigen-B27 gene. Rheumatoid arthritis is a chronic, systemic autoimmune disease characterized by the simultaneous inflammation of the synovium of multiple joints, leading to joint damage (e.g., destruction, deformation and disability). In the past, nonsteroidal anti-inflammatory drugs or conventional disease-modifying antirheumatic drug (DMARDs) have been used for the treatment of these autoimmune diseases, but biologic DMARDs have recently been introduced with excellent results. Gout is a chronic inflammatory disease that causes an alteration of joints resulting in severe pain. Specifically, gout is associated with an accumulation of uric acid within the body resulting from dysregulated purine metabolism, causing recurrent paroxysmal inflammation in the joints. Allopurinol and febuxostat are the primary treatment options for individuals with gout. It is necessary to have an accurate understanding of the pathogenesis, pathological ecology and treatment of AS, rheumatoid arthritis, and gouty arthritis, which are the representative diseases that may cause inflammatory arthritis.
Allopurinol ; Antirheumatic Agents ; Arthritis ; Arthritis, Gouty ; Arthritis, Reactive ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Back Pain ; Cartilage ; Diagnosis* ; Ecology ; Febuxostat ; Gout ; Humans ; Inflammation ; Joint Diseases* ; Joint Instability ; Joints* ; Leukocytes ; Metabolism ; Sacroiliac Joint ; Spine ; Spondylitis, Ankylosing ; Synovial Membrane ; Uric Acid

Biopsy has proved to be of value in the diagnosis of many inflammatory and malignant diseases, and needle biopsy of the synovial membrane in arthritis is well established and often employed as the final diagnostic aid in patient with joint disease. Authors have carried out synovial needle biopsy in 76 joints with Franklin-Silverman needle used commonly in liver biopsy. The results obtained were as followa; 1) Of seventy five biopsies attempted, adequate amount of tiasue was obtained in 51 of 53 knee cases (96.2%), 11 of 14 wrists (78.6%). 3 of 5 elbows (60%), 1 of 3 ankles (33.3%). Adequate amount of tissue was obtained in 66 cases and the overall succese rate was 88%. 2) Histopathological diagnosis was made in 53 of 75 cases (70.7%). In 12 cases, correct specimens were obtained but proved to be incompatible with the diagnosis done by either clinical data or open biopsy. 3) Histopathological diagnoses were made in 25 of 35 cases of rheumatoid arthritis (71.4%) 14 of 18 cases of tuberculous arthritis (77.8%), 7 of 13 cases of degenerative arthritis (53,8%), 4 of 6 cases of suppurative arthritis (66.7%), 2 cases of traumatic arthritis (100%), and one case of villonodular synovitis (100%). 4) The complications resulting from this proedure were pare; mild transient hemarthrosis was found in only 5 cases We also discovered that for an accurate diagnosis multiple specimens should be obtained because otherwise the specimens were too small to interprete histopathologically. In addition we concluded that the success rate depended not upon the sorts of needle used but rather more upon the biopsy technique. Franklin-Silverman needle biopsy proved to be a simple, safe and reliable procedure for diagnosis of the synovial diseases in which conventional arthrotomy is inadvisable and other diagnostic procedures are inadequate.
Ankle ; Arthritis ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Biopsy ; Biopsy, Needle ; Diagnosis ; Elbow ; Hemarthrosis ; Humans ; Joint Diseases ; Joints ; Knee ; Liver ; Needles ; Osteoarthritis ; Synovial Membrane ; Synovitis ; Wrist

Turner's syndrome (TS) is characterized by short stature and gonadal dysgenesis. It is often associated with systemic manifestations, such as cardiovascular, gastrointestinal, and musculoskeletal disorders. Although very rare, it is possible for TS to accompany autoimmune disease, including thyroid disease, inflammatory bowel diseases, diabetes mellitus, psoriatic arthritis, and juvenile rheumatoid arthritis. A 39-year-old woman was referred for symmetric polyarthritis of her hands and feet. She had been diagnosed with Turner's syndrome with 46,XO,-X,+fragment before the age of 22 years and had developed autoimmune hypothyroidism treated with thyroid hormone replacement. At the time of first visit, she had polyarthralgia with morning stiffness for more than 3 months. The musculoskeletal examination revealed symmetrical polyarthritis affecting the metacarpophalangeal, proximal interphalangeal, and metatarsophalangeal joints, fulfilling the ACR 1987 revised criteria for rheumatoid arthritis (RA). Here, we present an unusual case of RA associated with TS. It is important to pay meticulous attention to patients with TS so that inflammatory arthritis is not neglected and the diagnosis is not delayed.
Adult ; Arthralgia ; Arthritis ; Arthritis, Juvenile Rheumatoid ; Arthritis, Psoriatic ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Diabetes Mellitus ; Female ; Foot ; Gonadal Dysgenesis ; Hand ; Humans ; Hypothyroidism ; Inflammatory Bowel Diseases ; Metatarsophalangeal Joint ; Thyroid Diseases ; Thyroid Gland ; Turner Syndrome

Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in the synovial membrane, periarticular structures, skeletal muscle and perineural sheath. Eventually, the joints are destroyed, ankylosed and deformed. Therefore, the aim of treatment is to keep the inflammatory process at a minimum, thereby preserving joint motion, maintaining the health of muscle supplying motor power about the joint, and preventing secondary joint stiffness and deformity. Surgical treatment in rheumatoid arthritis has progressed and there have been advances in the relief of pain and increase in the range of motion. For the period of 15 years from January 1973 to December 1987, 55 cases of rheumatoid arthritis who received surgical treatment were reviewed and the results of clinical observation were as follows : 1. Among 977 patients of rheumatoid arthritis, 76 sites in 55 patients were operated on. 2. Sites of operation were the knee in 33 cases, hip in 20 cases, wrist and finger in 12 cases, ankle in 5 cases, elbow in 5 cases, and cervial spine in 1 case. 3. Operative methods were 40 cases of joint replacement, 27 cases of synovectomy, 4 cases of fusion, and 2 cases of tenotomy and capsulectomy. 4. Postoperative results were good in 19 patients, satisfactory in 16 patients, unsatisfactory in 5 patients, and poor in 2 patients. 5. The clinical stage at the time of joint replacement was not related to the end results of the operations. 6. Causes of unsatisfactory and poor results were preoperative flexion contracture and Felty's syndrome.
Adult ; Ankle ; Arthritis, Rheumatoid ; Congenital Abnormalities ; Contracture ; Elbow ; Felty Syndrome ; Fingers ; Hip ; Humans ; Joints ; Knee ; Middle Aged ; Muscle, Skeletal ; Range of Motion, Articular ; Spine ; Synovial Membrane ; Tenotomy ; Wrist

Recently, gout prevalence is increasing, but in Vietnam the knowledge of gout is not enough. Objectives: (1) Describe clinical X-ray manifestations of bone and joint damage related to chronic gout. (2) Identify suggestive factors to make diagnosis of bone and joint damage related to chronic gout. Methods: The cross-study included 54 patients with chronic gout presented in the Rheumatology Department of Bach Mai Hospital from March-2003 to June-2004. All of them were diagnosed gout according to the criteria of Bennett and Wood-1968 and had tophi nodules. Results: The common findings are polyarthritis (79.6%), lower limbs are involved more common than upper limbs (75-80% of patients had ankle, knee, first metatarsophalangeal joint arthritis) and symmetric arthritis (60% to 70%). All patients had a history of acute gout. 80% of patients had chronic gout presented in X-ray images, including joint space narrowing, erosion, new bone formation at the edge of a gradually expanding tophus. Important factors can be considered of chronic gout were male, middle age, symmetric arthritis of lower limbs, tophi nodules. Conclusions: Suggestive factors and X-ray of bone and join contribute to earlier diagnosis of bone and joint damage in chronic gout.
Gout ; Arthritis ; Juvenile Rheumatoid ; Bone and Bones

Septic arthritis of the temporomandibular joint (TMJ) is a rare disease. The most common symptoms of this disease are acute malocclusion, limited mouth opening, swelling, and tenderness of affected TMJ. These symptoms are often confused with internal derangement of the articular disc, rheumatoid arthritis, retrodiscitis, or osteoarthritis. Therefore, differential diagnosis by image examination is required. Usually, antimicrobial treatment and surgical drainage by needle aspiration, arthroscopy, or arthrotomy are effective treatment approaches. In this study, a patient who was diagnosed with septic arthritis was treated with arthrocentesis and antibiotics without significant complications. We present a case report with a review of the literature.
Anti-Bacterial Agents ; Arthritis, Infectious* ; Arthritis, Rheumatoid ; Arthrocentesis ; Arthroscopy ; Diagnosis, Differential ; Drainage ; Humans ; Malocclusion ; Mouth ; Needles ; Osteoarthritis ; Rare Diseases ; Temporomandibular Joint*

Juvenile idiopathic arthritis (JIA) is a broad spectrum of disease defined by the presence of arthritis of unknown etiology, lasting more than six weeks duration, and occurring in children less than 16 years of age. JIA encompasses several disease categories, each with distinct clinical manifestations, laboratory findings, genetic backgrounds, and pathogenesis. JIA is classified into seven subtypes by the International League of Associations for Rheumatology: systemic, oligoarticular, polyarticular with and without rheumatoid factor, enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Diagnosis of the precise subtype is an important requirement for management and research. JIA is a common chronic rheumatic disease in children and is an important cause of acute and chronic disability. Arthritis or arthritis-like symptoms may be present in many other conditions. Therefore, it is important to consider differential diagnoses for JIA that include infections, other connective tissue diseases, and malignancies. Leukemia and septic arthritis are the most important diseases that can be mistaken for JIA. The aim of this review is to provide a summary of the subtypes and differential diagnoses of JIA.
Arthritis ; Arthritis, Infectious ; Arthritis, Juvenile* ; Arthritis, Psoriatic ; Child ; Connective Tissue Diseases ; Diagnosis ; Diagnosis, Differential* ; Genetic Background ; Humans ; Leukemia ; Rheumatic Diseases ; Rheumatoid Factor ; Rheumatology

Radiation synovetomy with various radiopharmaceuticals has been used to alleviate pain and swelling of rheumatoid arthritis and related joint diseases for more than 40 years. It is an attractive alternative to the surgical synovectomy for the management of the various joint diseases. Recently, the development of new radiopharmaceuticals labeled with 90Y, 32P, 186Re, 188Re, 153Sm, 165DY and 166Ho, for the effective management of synovial inflammation and related arthritic problems are gaining attention. In this article the general concepts and the clinical application of radiation synovectomy are reviewed.
Arthritis ; Arthritis, Rheumatoid ; Inflammation ; Joint Diseases ; Joints* ; Radiopharmaceuticals

No abstract available.
Arthritis, Juvenile* ; Rheumatoid Factor*

OBJECTIVE: To assess the disease course and prognostic factors in juvenile idiopathic arthritis (JIA). METHODS: We performed a retrospective study of 136 patients between 1990 and 2000. Patients were classified with respect to the International League of Associations for Rheumatology (ILAR) criteria and prognostic factors were evaluated according to the different subtypes. Poor outcome measures were persistent disease, joint destruction and physical disability. RESULTS: There were 73 males and 63 females and the mean follow up period was 5 years (range 2~25). Predictors of persistent disease in the systemic onset type were polyarticular involvement, symmetric arthritis, and the presence of active systemic disease at 6 months. A poor outcome in the oligoarticular onset type correlated with polyarticular extension, joint erosion, chronic arthritis (duration>6 months), relapse, high antinuclear antibody (ANA) titers (>1:160), persistently high erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). Polyarticular extension was associated with chronic arthritis, involvement of small joints at disease onset, and positive HLA-B27. Predictors of persistent disease in the polyarticular type were chronic arthritis, relapse, and the presence of anemia at disease onset. The risk of joint destruction correlated with sex (female>male), polyarticular involvement, polyarticular extension, chronic arthritis, persistently high ESR or CRP, high ANA titers (>1:160), relapse, and positive rheumatoid factor. CONCLUSION: Factors predictive of severity in JIA were identified and prognosis was related more to the disease course than the onset type of JIA. So early diagnosis and more aggressive treatment of patients with poor prognostic features could improve functional outcome.
Anemia ; Antibodies, Antinuclear ; Arthritis ; Arthritis, Juvenile* ; Blood Sedimentation ; C-Reactive Protein ; Early Diagnosis ; Female ; Follow-Up Studies ; HLA-B27 Antigen ; Humans ; Joint Diseases ; Joints ; Male ; Outcome Assessment (Health Care) ; Prognosis ; Recurrence ; Retrospective Studies ; Rheumatoid Factor ; Rheumatology