215 - Miscellaneous arthropathies

Abstract

Early diagnosis of synovial sarcoma requires that any soft tissue tumor of the lower limb be investigated by gadolinium-enhanced MRI. Acute lymphoblastic leukemia in children, hairy cell leukemia and angioimmunoblastic lymphoma in adults can present as polyarthritis. Paraneoplastic syndromes include arthritis and vasculitis associated with myelodysplastic syndromes or solid cancers, palmar fasciitis and polyarthritis, and adult polymyositis or dermatomyositis. Treatment of acquired hypophosphatemic osteomalacia requires localization and ablation of the very small causative mesenchymal phosphaturic tumor. Multicentric reticulohistiocytosis presents with characteristic small cutaneous nodules and is associated with a severe symmetric erosive polyarthritis involving the distal interphalangeal joints. Whipple disease often presents as a migratory arthritis. T. whipplei can be detected in saliva, feces, or affected tissues by polymerase chain reaction, and can be eradicated by treatment with appropriate antibiotics. Palindromic rheumatism is an intermittent arthritis that affects one or a few joints for hours to several days, and can evolve into rheumatoid arthritis or lupus. SAPHO syndrome presents with all or some of the following features: synovitis, acne, pustulosis, hyperostosis, and osteitis. Osteosclerotic hyperostosis, especially of the anterior chest wall, exhibits increased radionuclide uptake on bone scanning. Localized synovial diseases include pigmented villonodular synovitis or tenosynovitis, and primary synovial osteochondromatosis. Gout and apatite crystal arthritis or periarthritis may affect renal failure patients; beta-2 microglobulin amyloidosis now occurs infrequently with use of biocompatible dialysis membranes. Gadolinium-induced fibrosis (nephrogenic systemic fibrosis) now is prevented by avoiding use of gadolinium-containing contrast for MRI and other imaging studies in patients with chronic kidney disease.