Clinical Signs Of Synovitis Research Articles

Safety and Efficacy of Radiosynoviorthesis: A Prospective Canadian Multicenter Study.

Radiosynoviorthesis is approved in several European countries and the United States to treat refractory synovitis in many inflammatory joint diseases, such as rheumatoid arthritis, spondyloarthropathies, and other arthritic joint diseases. No radiopharmaceuticals for radiosynoviorthesis are currently approved in Canada. The aim of this Health Canada-approved trial was to demonstrate the safety and efficacy of radiosynoviorthesis. Methods: Between July 2012 and November 2017, we conducted a multicenter, prospective, interventional Canadian trial. Patients (n = 360) with synovitis refractory to standard treatments after failing 2 intraarticular glucocorticoid injections were included. They were followed up at 3, 6, and 12 mo. Outcome measures included adverse events (AEs) and clinical signs of synovitis (pain, swelling, and joint effusion) measured with the Health Assessment Questionnaire Disability Index, the Disease Activity Score, and the Visual Analog Scale. Results: In total, 392 joints were treated, including those reinjected after 6 mo (n = 34). Of these, 83.4% (327/392) were injected with [90Y]Y-citrate for the knees and 9.9% (39/392) with [186Re]Re-sulfide for medium-sized joints. Of the joints treated, 82.7% (324/392) were knees. Fifty-five AEs, most of them of mild grade, occurred and resolved without sequelae and were not life-threatening. The incidence of radiosynoviorthesis-related AEs was 9.4% (34/360). The proportion of patients showing an improvement in synovitis symptoms after radiosynoviorthesis was significant at 3 mo and was maintained up to 12 mo (P < 0.001). Conclusion: This study confirmed the safety of radiosynoviorthesis in the treatment of patients with synovitis refractory to standard treatments. There is evidence of sustained clinical efficacy at 12 mo, suggesting that radiosynoviorthesis is an effective treatment for improving synovitis symptoms.

Silicone radial head prostheses: the clinical course and treatment of failure—a case series

Silicone radial head prostheses (SRHP) have a reputation of acceptable initial function but failure in the medium to long term as a result of the disintegration of the silicone material. Damaged SRHP can result in a silicone-induced synovitis and destruction of the joint. Early removal of damaged SRHP may prevent joint destruction. Literature is scarce; there are no studies describing early symptoms associated with clinical failure of SRHP and very few studies on appropriate treatment of destructed SRHP. The aim of this study was to describe the clinical course of failing SRHP and to provide practical guidance for treatment. Fifteen consecutive cases of failed SRHP, operated between 2005 and 2020, were retrospectively reviewed, using patient logs, radiographic results, and a questionnaire. Relevant data concerning pre- and postoperative complaints, function, and surgical details were gathered. Using the questionnaire, retrospective and current patient reported outcomes including Single Assessment Numeric Evaluation (SANE) scores, pain, instability, and range of motion were analyzed. The average time between implantation of the SRHP until outpatient presentation was 16 years. The average recalled SANE score before start of complaints was 8.6 out of 10 points. In 4 patients, the onset of complaints was preceded by a trauma. Five patients had symptoms for more than a year, and 9 patients for several months. Progressive pain in the elbow and/or wrist and mechanical symptoms were early and prominent symptoms of failure. Clinical signs of synovitis were frequently present. The majority of patients had a slow but progressive onset of complaints over several months before presentation. Twelve of 15 cases of failed SRHP were surgically treated. Fragmentation of the implant, osteoarthritis, and synovitis were found in all surgically treated cases. Both surgical removal and synovectomy alone, and revision to a new radial head prosthesis resulted in good medium-term outcomes with a mean SANE score of 7.3 points at 8.4 years of follow-up. Postoperative extension lags and mild instability were frequently mentioned as a reason for reimplantation of a metallic radial head implant and removal of the radial head alone, respectively. Both patients and physicians should be aware of early symptoms of a failing SRHP. Adequate recognition, radiographic evaluation, and early intervention may favor outcomes of failing SRHP. Surgical removal is easy to perform. In selected cases, revision of the radial head prosthesis may be considered. Both of these treatment strategies resulted in satisfying outcomes.

Comparison of Serum Amyloid A Measurements in Equine Synovial Fluid With Routine Diagnostic Methods to Detect Synovial Infection in a Clinical Environment.

Synovial fluid analysis is utilized to diagnose septic synovitis. However, not all cases are clearly and rapidly discernible with the diagnostic tools available in the laboratory. Serum amyloid A (SAA), an acute phase protein, has been shown to be elevated in synovial fluid from inflamed synovial structures. The goal of this study is to describe the correlation between two diagnostic tests measuring equine SAA levels in septic and non-septic synovial structures and to understand the correlation between an elevated SAA result and synovial sepsis. Prospective estimation of sensitivity (Se) and specificity (Sp) of two tests, handheld and ELISA, measuring SAA in synovial fluid was completed in 62 horses presented with injured synovial structures. The comparison was made to a reference diagnosis based on white cell count, percentage of neutrophils, intracellular bacteria and bacterial culture on synovial fluid. Handheld test levels were classified as: 4 lines visible—SAA level negative; 3 lines visible—SAA level mild; 2 lines visible—SAA level moderate; and 1 line visible—SAA level severe and compared to the numerical value obtained with ELISA test. The ELISA SAA test had an area under the curve of 0.88 (0.78–0.98). An ELISA cut-off of 23.95 μg/mL maximized Se and Sp. This cutoff gave a Se of 0.93 (0.66–1.00) and Sp of 0.77 (0.63–0.88). The handheld test was highly correlated with the ELISA SAA test (Spearman rank correlation 0.96) and at a cutoff of moderate or higher for positive results gave identical Se and Sp. Se and Sp of synovial fluid SAA are very reliable when clinical signs of synovitis are present for >6 h. This test, in conjunction with traditional methods, can assist practitioners to rapidly diagnose and expedite appropriate intervention of synovial sepsis.

Arthroscopically Assisted Evacuation of Brodie’s Abscess of Distal Femur

Brodie’s abscess is a type of subacute osteomyelitis. Opinions differ as to whether treatment should be surgical or medical for these classic lesions. Failure of symptoms to resolve after six weeks of antibiotics or worsening of the condition during treatment should be followed by surgical treatment. Clinical signs of subperiosteal pus or synovitis indicate that the subacute infection has transformed into an acute component, and it must be drained surgically. Surgical treatment is comprised of evacuation and curettage for small lesions and evacuation, packing with cancellous bone chips, for large cavities. When clinical signs of synovitis are present, with a possibility of pus within a joint, arthrotomy is performed. Arthroscopically assisted evacuation of Brodie’s abscess from the distal femur has never been reported in the literature.We report a case of a 23-year-old female who presented with pain and swelling over the left knee for four months. There was diffuse swelling in the knee; tenderness was present over medial femoral condyle and range of motion (ROM) of the knee was five to 45 degrees at the time of presentation. X-ray and magnetic resonance imaging (MRI) revealed Brodie’s abscess on the lateral aspect of the medial femoral condyle. The patient was treated with the evacuation of pus and curettage of the cavity using an arthroscope. After two weeks, the patient had mild pain with knee ROM from zero to 45 degrees, and at the one-month follow-up, the knee ROM improved to zero to 90 degrees. At the two-year follow-up, the patient had no pain, with knee ROM from zero to 120 degrees.

Effect of chondroitin sulfate on cartilage volume loss and subchondral bone marrow lesions in osteoarthritis knee

Chondroitin sulfate (CS) is a major component of the extracellular matrix of many connective tissues, including cartilage, bone, skin, ligaments, and tendons. The aim of this work was to study the effect of CS treatment for short time (6 months) clinically and using MRI on cartilage volume loss, subchondral bone marrow lesions (BMLs), and synovitis in patients with primary knee osteoarthritis (OA). A total of 50 patients with primary knee OA and clinical signs of synovitis were included in this study. They were divided into two treatment groups. Group 1 included 30 patients who received two capsules of CS (structum capsule 500 mg) once daily for 6 months. Group 2 included 20 patients who received placebo once daily for 6 months. Clinical, radiological, and laboratory assessments were performed for all patients. Cartilage volume loss, subchondral BMLs, and synovial membrane thickness were assessed with MRI at baseline and after 6 months for both groups. The CS group showed significantly less cartilage volume loss compared with the placebo group after 6 months for the global knee, lateral compartment and tibial plateaus. However, there were no significant differences in the medial compartment and trochlea between the two groups. Significantly lower BML scores were found for the CS group compared with theplacebo group after 6 months, and there were no significant differences in synovial membrane thickness between the two groups. Disease symptoms were similar in both groups. CS treatment significantly reduces the cartilage volume loss and subchondral BMLs in primary knee OA after 6 months of treatment. These findings suggested a joint structure-protective effect of CS.

A8: Juvenile Idiopathic Arthritis with Dry Synovitis: Clinical and Imaging Aspects in a Cohort of 10 Patients

Background/Purpose:Dry synovitis is considered to be a rare form of JIA, incompletely understood and following a potentially destructive course. Since its first description only a few reports mention this entity within the spectrum of JIA. We aimed to describe the clinical and radiological manifestations, and the course of dry synovitis and to compare it with classical RF negative polyarticular JIA.Methods:A retrospective study of 10 patients in 3 pediatric rheumatology centers who presented with 1. progressive, symmetric polyarticular stiffness with limitations and without clinical synovitis, 2. radiologic signs of articular damage and 3. Absence of inflammatory parameters (CRP, ESR). Neuromuscular conditions and metabolic storage/bone disorders were excluded. This cohort was compared with 35 consecutive patients with classical polyarticular RF negative JIA. Clinical, laboratory and imaging (X‐rays, MRI) data of both groups were reviewed.Results:The dry synovitis cohort included 4 boys and 6 girls. The median (range) age at first manifestation and diagnosis were respectively 4.3 yrs (1.1–8.9) and 7.3 yrs (2.8–14). Presenting signs comprised delayed motor development and/or progressive articular stiffness. Pain complaints emerged with time. Clinical examination showed a symmetric polyarticular involvement without clinical signs of synovitis. CRP was normal and ESR &lt; 8mm/h. In 9/10 patients ANA were absent. Radiological imaging (wrist, ankles and/or pelvis) showed osteopenia, advanced bone age, cartilage loss and/or bone erosions in all patients. MRI revealed synovial thickening in 9/10 patients; bone edema was variably present and bone erosions were demonstrated in 8/10 patients. Treatments comprised NSAIDs (n = 8/10), corticosteroids (n = 8/10), methotrexate (n = 9/10), anti‐TNF (n = 6/10), IL‐1 receptor antagonist (n = 1/10) and resulted in some subjective improvement. However articular limitations persisted and imaging showed progressive (osteo)articular damage. The comparison of the dry synovitis with polyarticular JIA patients showed that the age at disease onset was comparable in the 2 groups. Significant differential features found in the dry synovitis cohort were higher diagnostic delay, increased number of joint involvement and contractures, lack of swelling and tenderness, and lack of increased acute phase response (CRP, ESR) and ANA.Conclusion:From our data, we conclude that ‘dry synovitis’ can be considered as a clinical descriptive term referring to the development of progressive symmetric polyarticular limitations. We show that MRI is usefull in demonstrating underlying subclinical inflammation and in combination with clinical features and standard X‐rays helpful in the differential diagnosis with mucopolyssaccharidosis, neuromuscular disorders and bone dysplasia. Clinical as well as radiological evolution seem to be refractory to the current JIA therapy and to be different among patients diagnosed with ‘dry synovitis,’ suggesting that this clinical manifestation may represent a heterogeneous spectrum of joint and/or bone disorders. The exact nature of this entity and a possible contribution of a metabolic or intrinsic bone disorder into its pathogenesis remain to be determined.

FRI0070 Ultrasound doppler activity correlates with systemic autoimmunity and swollen joints in a healthy population at risk for rheumatoid arthritis

BackgroundDiagnosing rheumatoid arthritis (RA) early and identifying pre-clinical RA has become a high-stakes undertaking. In RA patients, musculoskeletal ultrasound (US) is more sensitive than clinical assessment for synovitis detection. Whether...

SAT0483 Dry Synovitis: A Unique Entity? A Multicenter Study

BackgroundDry synovitis (DS) is considered to be a rare form of juvenile idiopathic arthritis (JIA), incompletely understood and following a potentially destructive course. Since its first description only a few...

SAT0526 ICG-Enhanced Fluorescence Optical Imaging (FOI) Detects Typical Inflammatory Changes in Subjects with Arthralgia and Psoriasis

BackgroundEarly diagnosis of psoriatic arthritis (PsA) is a major challenge. ICG-enhanced fluorescence optical imaging (FOI) is a novel technology that enables detection of inflammation in the hands with high sensitivity...

Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI

ObjectiveTo determine the effect of chondroitin sulphate (CS) treatment on cartilage volume loss, subchondral bone marrow lesions (BML), synovitis and disease symptoms in patients with knee osteoarthritis (OA).MethodsIn this pilot...

Intraarticular corticosteroid injection into rheumatoid arthritis knees improves extensor muscles strength

Eleven arthritic knee joints in seven patients with rheumatoid arthritis were studied before and after intraarticular injection of a corticosteroid preparation. Extensor muscle torque and quantitative electromyography increased on days 7 and 14 after treatment, indicating that muscle function had been inhibited by synovitis. Clinical signs of synovitis, such as pain, range of motion and knee circumference, also improved. Synovial fluid withdrawal alone improved extensor muscle torque. Joints with instability and/or radiological cartilage involvement also improved.

Clinical synovitis and radiological lesions in rheumatoid arthritis. A prospective study of 25 patients during treatment with remission-inducing drugs.

The joints of hands and feet of 25 patients (1150 joints) with rheumatoid arthritis were compared, joint by joint, clinically and radiologically, over 2 years of treatment with remission-inducing drugs. Joints with clinical signs of synovitis decreased from 47% to 17% (p less than 0.001), while the number of joints with radiological lesions increased from 23% to 27% (p less than 0.01). Definite radiological progression of bone lesions was seen in 7% of the joints. Joints with clinical synovitis had a higher risk of progressive bone damage than joints without clinical synovitis (p less than 0.001) and joints in which the clinical signs of synovitis persisted during the study had a higher risk of progressing bone lesions than joints in which the clinical synovitis subsided (p less than 0.001). Progressive bone damage was seen more often in swollen joints than in tender joints without swelling or joints without clinical signs of synovitis (p less than 0.001), the difference in radiological progression between the latter two groups being non-significant. Twenty-one per cent of the joints with progressive bone lesions had no clinical signs of synovitis during the period.