Nonspecific Arthritis Research Articles

Topical issues of diagnosis and treatment of arthropathy associated with tonsillitis. (Literature review)

The problem of chronic tonsillitis (CT) and its complications remains one of the most urgent in modern otorhinolaryngology today. The high probability of developing associated diseases, such as rheumatic heart disease, nonspecific arthritis and glomerulonephritis, emphasizes the high importance of this nosological unit both in the practice of an otorhinolaryngologist and doctors of other specialties. Reactive arthritis occupies a special place among the complications of CT. Acute rheumatic fever (ARF) used to be the most common disease that was associated with streptococcal tonsillitis and was accompanied by reactive arthritis. Since 1959, patients with ARL have become less common, but cases of "aseptic" arthritis in patients with acute tonsillitis continued to be recorded, however, they did not have any other major criteria to confirm the diagnosis of ARL. This type of arthritis is called "Post-streptococcal reactive arthritis" (PSRA). Despite the fact that this disease has been known since the middle of the XIX century, there is very little information about its etiology and pathogenesis in the literature. The main symptoms of PSRA are usually similar to the articular syndrome in classical reactive arthritis and are clinically manifested by acute asymmetric non-migrating polyarthritis. Laboratory diagnosis of PSRA, in particular, the determination of titers of streptococcal antibodies plays an important role in confirming the diagnosis. A special place is occupied by the differential diagnosis of PSRA with rheumatic diseases (RH). The main diagnostic laboratory markers of RH are antinuclear antibodies, rheumatoid factor and antibodies to citrullinated proteins. Joint syndrome in PSRA is often stopped when nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed only in combination with antibacterial drugs. If arthritis does not respond to long-term treatment with antibiotics and NSAIDs, and especially if the patient has a history of recurrent CT, a planned tonsillectomy is required to prevent the development of a chronic form of tonsillitis-associated arthritis. The article presents an analytical review of domestic and foreign publications on the topic of CT complicated by reactive arthritis. The possible diagnostic methods necessary to confirm the diagnosis and exclude a wide range of arthritis of a different etiology are described.

Diagnostic Problem in a Patient with Tuberculosis Arthritis

Extra-pulmonary tuberculosis (TB) remains a big public health problem worldwide. Although TB most commonly affects the lungs, any organ or tissue can be involved. TB arthritis is a rare form of extra-pulmonary TB. TB arthritis usually manifests as mild and non-specific arthritis. A 35-year-old male was admitted to the emergency room of Dr. Soetomo General Academic Hospital Surabaya due to pain of left knee since two days prior to admission. His symptom began on previous six months with the swelling of the left knee that gradually worsened so that he had an antalgic gait. Radiological examination of left knee joint showed inflammatory arthritis, accompanied by joint effusion and soft tissue swelling. USG examination of the left knee showed the presence of non-specific left knee arthritis. Patient underwent debridement. Anatomical pathology examination of the tissue obtained at the time of debridement, showed the TB granulomatous inflammation. The Ziehl-Nielson stain of left knee tissue also showed the TB granulomatous inflammation. Patient was then treated with analgesics and anti-TB drugs. The intensive phase of anti-TB therapy was planned to be 2 month, then evaluated and followed by continuation phase for about 7 months. The knee joint is the third most common site of osteoarticular TB after spine and hip. Insidious onset of pain which, in some patients may be present for years, is the usual presentation. The joint is usually warm, and wasting of the thigh muscles is usually marked. Synovial hypertrophy and effusion are present in most patients. The gold standard for diagnosis of TB arthritis is synovial biopsy, with positive results in 80% of cases. It shows caseating granulomas, lymphocytes, and giant cells with caseation, which are characteristics of TB arthritis. Synovial biopsy is generally recommended in any arthritis where clinical evaluation and routine investigations do not give a clear diagnosis.

Mask parathyroid adenoma in morbid obese woman with secondary adrenal insufficiency

Abstract Introduction Primary hyperparathyroidism (PHPT) and metabolic syndrome (MS) are independently increase cardiovascular morbidities; however, this association is still controversial. The pathogenic mechanisms of MS among PHPT are not completely clear and the association with calcium metabolism is being studied, since calcium is pivotal for many metabolic processes. The association between these entities is complex and may be a source of additional morbidity and mortality. Objective is to highlight the mask features of parathyroid adenoma in morbid obese woman with secondary adrenal insufficiency. Clinical case A 33-year-old female presented with discomforting polyarthralgia and weight gain for the last 2 years that was labelled as nonspecific arthritis and treated by multiple intra-articular injections of glucocorticoids. After a careful history and examination with baseline analysis, she was discovered to have MS (dysglycemia, high insulin resistance and hypertension). A feature glucocorticoid induced adrenal insufficiency was documented and work up for any evidence of osteoporosis was initiated. A high parathyroid hormone with hypercalcemia was documented and an established osteoporosis was evident. Furthermore, a large left side parathyroid adenoma was observed by a neck sonography and confirmed by a four-dimension computed tomography of the neck. Surgical exploration with excision of the parathyroid adenoma was performed, following which the patient recovered uneventfully. The patient was initially managed as a case of MS with secondary adrenal insufficiency due to glucocorticoid misuse. Although not suspected initially, an extensive work up for osteoporosis screening and accidental hypercalcemia increase the chance of high index of suspicion for hyperparathyroidism. Further investigations then revealed the presence of a solitary parathyroid adenoma with coexistent hyperparathyroidism which was then managed surgically. Conclusion Despite the majority of PHPT is asymptomatic and over masked by MS, Active surveillance for any evidence of hypercalcemia and bone metabolism have to be judged carefully to reduce further morbidity and mortality.

Five cases of seronegative persistent inflammatory monoarthritis improved with biological therapy.

Persistent inflammatory monoarthritis is defined as inflammation of one joint that continues for longer than 3 months. Most cases remain as nonspecific arthritis after several years. Persistent inflammatory monoarthritis is difficult to diagnose and treat in the early stage because there are no criteria for diagnosis and treatment. We report five seronegative persistent inflammatory monoarthritis cases that affected the left knee, right knee, left knee, left ankle, and right knee. All patients underwent joint punctures; two patients received steroid injections in the affected joint. The bacterial and mycobacterial culture were negative in all patients. Two patients received oral steroids, and two patients were administered nonsteroidal anti-inflammatory drugs; however, their symptoms did not improve, and one patient experienced progression of joint destruction. We investigated the usefulness of biological disease-modifying antirheumatic drugs for the treatment of seronegative persistent inflammatory monoarthritis. We obtained a remarkable improvement effect and prevented the advance of joint destruction.

DIAGNOSTICS AND TREATMENT OF PURULENT ARTHRITIS OF THE STERNOCLAVICULAR JOINT

Summary. Inflammatory lesion of the sternoclavicular joint (SCJ) is a rare disease that requires surgical treatment. Traditional radiography reveals osteolysis and osteosclerosis, however, at the onset of the disease, such changes are absent. Difficulties in diagnosing this disease require further study of the problem and the development of new therapeutic and diagnostic approaches.
 Aim of the work: to study the role of sonography in the diagnosis of purulent arthritis of SCJ and the choice of treatment tactics.
 Materials and methods. Prospective single-center study of 28 cases of acute nonspecific arthritis of SCJ. The patients were divided into 2 groups: the first included patients who received drug therapy, the second included patients subject to surgical treatment.
 Results and discussion. Ultrasound scanning of SCJ identified 3 sonographic variants of the lesion: exudative, destructive with synovial hyperperfusion, and destructive with synovial hypoperfusion.
 The duration of hospital stay in both groups did not differ statistically: 12 (12; 13.5) vs 14 (12; 14) days, p = 0.194.
 Analysis of long-term results in patients of the first group established the progression of the disease with the development of osteomyelitis or recurrence of arthritis in 3 cases (30 %). Among the patients of the second group, no complications or recurrence were detected during the indicated observation period.
 Conclusion. Sonography is diagnostically significant in the diagnosis of SCJ arthritis. It allows you to determine the group of patients subject to mandatory surgical correction. Intravenous drug addiction associated with bacteremia is a predictor of poor drug treatment outcomes and an indication for active surgical tactics.

Balneotherapy for Musculoskeletal Pain Management of Hot Spring Water in Southern Ethiopia: Perceived Improvements.

Background: Balneotherapy and hydrotherapy offer interesting treatment alternatives and are commonly used as additional interventions in the management of musculoskeletal disorders and pain management. Therefore, the aim of this study was to assess the effect of balneotherapy on musculoskeletal disorder pain and its perceived improvement among users of hot spring water in Southern Ethiopia. Methods: A single-arm cohort study and convenient sampling method were used to select 1337 study participants from four hot springs in Southern Ethiopia. A structured questionnaire, a physical examination, and laboratory blood tests were used to collect data. Data were entered using Epi data and transferred to SPSS 25 for cleaning and analysis. Descriptive analysis was made. Results: A total of 1279 participants were included in the study, giving a response rate of 96%. The majority of these patients have multiple health problems. Of all, 1137 (88.9%) of the patients were visiting the hot springs for joint pain followed by muscle pain 669 (52.2). Out of all cases of joint pain, 132 (11.6%) were clinically diagnosed with rheumatoid arthritis, and 5.3% were confirmed as having the disease based on a laboratory test. Of the total number of study participants, 1064 (83.2%) reported complete relief from the complaints they had at the start of the bath. Conclusions: Hot spring baths for three and more days have significant therapeutic effects on patients with musculoskeletal disorders, including rheumatoid arthritis. Physicians who are currently working in the area of diagnosis and treatment of patients in government and public facilities of the southern region should consider hot spring bath treatment for those patients with complaints of musculoskeletal pain, nonspecific arthritis, and rheumatoid arthritis. A hot spring bath is beneficial for everyone because it is a natural treatment with few side effects and a low cost.

Radioisotope Synoviorthesis in the Control of Refractory Synovitis in Castilla-La Mancha. A 10-year Experience.

To describe the experience in the performance of radioisotopic synoviorthesis for arthritis refractory to other treatments in our hospital. Observational, descriptive and cross-sectional study protocolised through the review of the database of radioisotopic synoviorthesis performed between 2007 and 2017. Previous clinical data were collected (age, sex, pathology, previous treatments, previous infiltration and affected joint), and progress at 6 months after administering the isotope. An Excel database was created for a frequency analysis with SPSS 21. 30 radiosynovitis interventions were performed. The most frequent pathologies in this order were: pigmented villonodular synovitis (40%), rheumatoid arthritis (23.3%), spondyloarthritis (13.3%), osteoarthritis (10%) and nonspecific arthritis (6.7%), followed by systemic lupus erythematosus and gout. After 6 months, 56.7% of the patients improved compared to 36.7% who remained the same. Likewise, none of them presented complications related to the procedure. Six point six percent of the patients were lost to follow-up. In patients with episodes of recurrent arthritis with associated joint effusion in one or two joints, refractory to systemic treatments, to local infiltrations with corticosteroids and for patients for whom other treatments may be contraindicated, we must consider the possibility of performing an isotope radiosinoviortesis, as it is a simple, safe technique with a success rate of more than 50%.

ОПЫТ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ТУБЕРКУЛЕЗНОГО И НЕСПЕЦИФИЧЕСКОГО АРТРИТА МЕТОДОМ ДВУХЭТАПНОЙ АРТРОПЛАСТИКИ С ИСПОЛЬЗОВАНИЕМ АРТИКУЛИРУЮЩИХ ЦЕМЕНТНЫХ СПЕЙСЕРОВ, НАСЫЩЕННЫХ АНТИБИОТИКАМИ

The objective : to analyze the results of surgical treatment of tuberculosis and non-specific arthritis of large joints of extremities by two-stage endoprosthesis replacement using cement articulating spacers saturated with antibiotics. Subjects and methods . The prospective single-center cohort trial included 36 clinical cases in 35 patients with purulent destructive arthritis of the hip, knee, and shoulder joints, who underwent two-stage surgery from 2010 to 2018. This method implied using cement articulating spacers at the first stage of surgery followed by replacement with a prosthetic implant. Joint tuberculosis was diagnosed in 7 (20.0%) patients, all other cases were non-specific arthritis. Results . In all 36 cases, patients underwent a full cycle of two-stage endoprosthesis replacement of joints affected by tuberculosis or non-specific infection resulting in pronounced destructive changes. In 33 clinical cases of the patients (91.67%), a positive outcome was observed with restoration of joint and extremity function in general with persistent eradication of the infection. An unfavorable outcome was obtained in 3 patients due to development of periprosthetic infection and loosening of the implant, 2 of them had tuberculous arthritis.

Combination of Serological Tests (Anti-CCP Antibody, Rheumatoid Factor IgM ELISA and Latex Test) are more Useful in Detection of Rheumatoid Arthritis

Rheumatoid arthritis is a polyarticular and chronic inflammatory disease occurring throughout the world. To prevent significant joint damage, early diagnosis and proper treatment is of paramount importance. Though patients are diagnosed clinically supported by radiography and serological tests, early disease may present with non-specific arthritis and absence of specific radiographic findings. Though anti-CCP antibody is used for the diagnosis and may be found in early disease, recently some variability of results has been observed in some studies. In this context present study was carried out to combine anti-CCP antibody, rheumatoid factor IgM ELISA and Latex agglutination test to observe the combined specificity and sensitivity of the tests and the tests were compared with each other to examine the correlation between them.

Prevalence of rheumatic diseases in Raramuri people in Chihuahua, Mexico: a community-based study.

This study aimed to determine the prevalence of musculoskeletal (MSK) pain and rheumatic diseases in the Raramuri population (also known as Tarahumaras) who are an indigenous group in the northern state of Chihuahua in Mexico. We used the Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology. An analytical cross-sectional study was conducted including indigenous Raramuri aged ≥18 years from communities settled in Chihuahua City. Subjects with positive MSK pain were evaluated by primary care physicians and rheumatologists. Demographic and occupational factors such as gender and job type associated with rheumatic disease were investigated. A total of 380 indigenous Raramuri (mean age 33.6 ± 13.1 years; 37.9 % male) were interviewed. Seventy-six individuals (20 %) reported MSK pain in the last 7 days. Pain intensity was reported as “severe” and “the most severe” in 30 % of the cases. Fifty-six individuals (14.7 %) reported pain in the past and 86 (22.6 %) had either past or current pain. The prevalence of rheumatic diseases was 10.5 %. Diagnosed diseases were osteoarthritis (6.6 %), low back pain (1.6 %), spondyloarthritis (0.8 %), rheumatoid arthritis (0.5 %), non-specific arthritis (0.5 %), rheumatic regional pain syndromes (0.3 %), and fibromyalgia (0.3 %). Rheumatic disease was associated with the following variables: age (odds ratio (OR) 1.04, 95 % confidence interval (CI) 1.02–1.08; p = 0.006), family history of rheumatic symptoms (OR 6.9; 95 % CI 2.6–18.7; p < 0.001), and Health Assessment Questionnaire-Disability Index (OR 28.9; 95 % CI 2.8–289.7; p < 0.001). A high prevalence of non-traumatic MSK pain suggests the need for a rheumatic disease prevention program in the Raramuri people in Chihuahua, Mexico.

A Case of Primary Bone Marrow Diffuse Large B-cell Lymphoma Presenting with Polyarthritis

Polyarthritis is a common manifestation of rheumatologic disorders; however, paraneoplastic arthropathies also arise as polyarthritis or polymyalgia, particularly in patients with myelomas, lymphomas, acute leukemia, and solid tumors. Because paraneoplastic syndromes, in some instances, might be manifested before a cancer diagnosis, they are difficult to diagnose and are often misdiagnosed. We experienced a 63-year-old female patient who had nonspecific arthritis on both hands and feet accompanied by fever. She had been diagnosed as rheumatoid arthritis and treated with prednisolone and disease modifying anti- rheumatic drugs (DMARDs) including methotrexate and anti-tumor necrosis factor agents. Her arthritis did not respond with anti-rheumatic treatment and diffuse large B-cell lymphoma was diagnosed by bone marrow biopsy. After 6 cycles of chemotherapy, her arthritis was improved as well as underlying lymphoma. (J Rheum Dis 2016;23:256-260)

A Tongue Lesion as a Sign of a Systemic Disease.

Amyloidosis is the extracellular fibril deposition of a variety of proteins, many of which circulate as plasma ingredients. It is a disease difficult to identify due to its nonspecific symptoms and manifestations. Amyloidosis of the tongue, either isolated or part of the systemic disease, is rare and its features resemble those of a tumor. We report the case of a patient with amyloidosis who presented with a tongue lesion, weakness, nonspecific arthritis, and dyspnea on exertion that resulted in multiorgan system failure.

The impact of arthritis on the physical function of a rural Maya-Yucateco community and factors associated with its prevalence: a cross sectional, community-based study.

This study aims to evaluate the impact of arthritis on the physical function of people living in a Maya-Yucateco rural community and to assess the association of known modifiable risk factors with the prevalence of overall arthritis and its main types (osteoarthritis and rheumatoid arthritis). Using a cross-sectional, community-based census design, data collected from the adult population (≥18 years) of the Municipality of Chankom, Yucatán, México, were analyzed (n = 1523). Participants’ physical function was assessed using a culturized version of the health assessment questionnaire disability index. Social, physical, and behavioral factors linked to overall arthritis, osteoarthritis, and rheumatoid arthritis, were assessed through the “Community-Oriented-Program-for-the-Control-of-Rheumatic-Diseases [COPCORD]” questionnaire. A physiatrist and a rheumatologist confirmed all osteoarthritis and rheumatoid arthritis cases using the American College of Rheumatology criteria. Arthritis was confirmed in 169 cases (22 %, 95 % confidence interval (CI) 19–25) of those assessed for musculoskeletal symptoms (n = 779): osteoarthritis = 144, rheumatoid arthritis = 17, and non-specific arthritis = 8. Arthritis was associated with a higher prevalence of disability after controlling for age, gender, and number of comorbidities (odds ratio = 4.0, 95 % CI 3.0–6.0). Higher level of wealth was associated with lower arthritis prevalence (odds ratio = 0.9, 95% CI 0.8–0.9). Higher body mass index was associated with higher hip and/or knee osteoarthritis prevalence (odds ratio = 1.1, 95 % CI 1.03–1.1). Arthritis is highly associated with disability in the Mayan people living in Chankom. The prevalence of arthritis in Chankom is associated with social factors, such as people’s level of wealth, while the prevalence of low-extremity osteoarthritis is associated with people’s body mass index.

A95: The Risk of Dyslipidemia in Pediatric Arthritis Patients Is Similar to That of Adult Patients With Arthritis

Background/Purpose:Patients with autoimmune diseases run a higher risk for dyslipidemia due to chronic inflammatory processes and immune dysregulation. This phenomenon has been recognized to a certain extent in adult arthritis patients but has not been previously explored in pediatric arthritis patients. The objective of this study is to compare the frequency of dyslipidemia in children with Juvenile Rheumatoid Arthritis (JRA), children with Non‐Specific Arthritis (NOSA), adults with Rheumatoid Arthritis (RA), and adults with Osteoarthritis (OA). Determining differences amongst these groups is important in understanding the connection between arthritis and dyslipidemia risk, especially in the pediatric population.Methods:After IRB approval, patient's in this retrospective data base study were gathered from chart review of consecutive patient's with JRA, NOSA, RA, and OA who presented to the pediatric rheumatology and adult rheumatology clinics at an academic center. Outcomes of interest that were compared included total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), cholesterol: HDL ratio, non‐HDL, and very low density lipoprotein (VLDL). Other demographic information compared included patient age, sex, and use of biologic DMARD. Comparisons between groups were made using the Fisher's Exact Test and multiple testing adjustments were made by controlling for the False Discovery Rate.Results:There were 32 pediatric patients (40.6% male) ranging from age 2–17 (median 11 years). Out of 32 pediatric patients, 22 had JRA and 10 had non‐ specific arthritis (NOSA). Furthermore, there were 82 adult patient's (18.3% male) ranging from age 30–85 (median 63 years). Out of these, 49 had diagnosis of RA while 33 had diagnosis of OA. In the pediatric cohort, more JRA patients than NOSA had abnormal LDL values (68.2% and 0.0%, p value = 0.005) and non‐HDL values (50.0% and 0.0%, p value = 0.05). Other lipid parameters were not significantly different. Between the pediatric cohort and adult cohort, the pediatric cohort had greater percentages of abnormal LDL (46.9% and 19.5%, p value = 0.05), TG (93.8% and 24.4%, p value &lt;0.001), and VLDL (62.5% and 15.9%, p value &lt;0.001). No significant difference in lipid parameters between patients with RA and OA. There was also no significant difference in lipid parameters between those with or without RF/CCP positivity, male sex, or biologic DMARD use.Conclusion:Pediatric JRA patients were more likely to have an abnormal lipid panel, specifically LDL and non–HDL, as compared to NOSA patients. Interestingly, pediatric patients had higher rates of abnormal LDL, triglycerides, and VLDL. This suggests that the concern for dyslipidemia in the adult population should also be shown to pediatric patients with JRA. Additional studies are needed to determine whether modification of cardiovascular risk in pediatric patients with chronic inflammatory disease is beneficial in preventing clinically significant premature atherosclerosis.

Management of the nontraumatic hot swollen joint

To audit the management of nontraumatic hot swollen joints presenting to a large UK university teaching hospital and to design a simple emergency department (ED) algorithm to improve patient care based on existing guidelines and our experience. Prospective audit. Between 2 February and 8 May 2009, 77 patients were enrolled. Median age was 58 years (range 19-89 years) and 57% were male patients. The most commonly affected joint was the knee (38%), with the knee, wrist, ankle, hip and elbow comprising 87% of affected joints. Thirty-three (43%) joints were aspirated; no organisms were found on microscopy or cultured in any aspirates; crystals were found in eight aspirates. Twenty-four patients were admitted. Gout was the most common final diagnosis in 14 (18%) patients, with cellulitis being the next most common diagnosis (n=9; 12%). Bursitis (n=7; 9%), nonspecific arthritis (n=7; 9%) and reactive arthritis (n=6; 8%) were also not uncommon. Four (5%) patients were treated for possible septic arthritis. It was noticed that many patients spent a long time in the ED waiting firstly for a decision to aspirate, and secondly for a senior clinician to perform this. Patients presenting with nontraumatic hot swollen joints are common and the knee, wrist, ankle, hip and elbow are commonly affected. Joint aspirate is required to rule out septic arthritis, should be considered early and appropriate personnel called, and can show the presence of gout or pseudogout. Septic arthritis should still be considered in patients with a negative aspirate in whom there is high clinical suspicion. Our simple ED algorithm may improve patient care.

Evaluation of clinical efficacy and safety of Herbal liniment (Rumalaya liniment) in orthopedic patients

This study was planned to evaluate the efficacy and safety of Herbal liniment in orthopedic disorders. One hundred patients of either sex in the age group of 10 to 63 years were enrolled in the study after they fulfilled the inclusion and exclusion criteria. Patients applied Herbal liniment over the affected area, twice daily with gentle rubbing for a period of one month. Statistical analysis of changes in various parameters from baseline values was evaluated by Wilcoxon Signed Rank test. This study indicated that there was a significant reduction in pain, joint tenderness, joint swelling, mobility restriction and early morning joint stiffness. In patients with periarthritis shoulder joint, osteoarthritis knee joints, and nonspecific arthritis, there was moderate reduction of pain. There were no adverse events reported or observed during the entire period. Source of support: The Himalaya drug company, Bangalore.

Multiple rice body formation accompanying the chronic nonspecific tenosynovitis of flexor tendons of the wrist

Rice body formation is generally a rare disorder related to rheumatoid arthritis. It can also be observed in cases of systemic lupus erythematosus, seronegative arthritis, infectious arthritis (tuberculosis, atypical mycobacterial infection), nonspecific arthritis, and osteoarthritis. It is generally located within joints or bursae. Multiple rice bodies of tendon sheaths are rarely encountered. Rice body formation may also be encountered without underlying systemic disorders. We present a case of multiple rice body formation that accompanied chronic nonspecific tenosynovitis of the flexor tendons of the wrist.

Tuberculosis of the knee joint: a case report

Tuberculosis may develop in the skeletal system apart from its primary location, the lungs. A 22-year-old male patient presented with complaints of severe pain and swelling in the left knee and difficulty in walking. The symptoms first appeared 12 years before and he underwent open surgical debridement and arthroscopic debridement at two other centers, at which time aspiration cultures taken from the knee yielded no growth. Physical examination showed a painful left knee with swelling, increased temperature, effusion, and limited range of motion. Based on history, physical examination, radiological studies, and laboratory findings, knee osteoarthritis was considered secondary to nonspecific septic arthritis and knee arthrodesis was performed. At surgery, marked destruction of articular cartilage and synovial hypertrophy were observed. In addition, a cavitary lesion was detected, about 1 x 1 cm in size, in the lateral femoral condyle without articular involvement. Biopsy cultures taken from the lesion showed growth of Mycobacterium tuberculosis in the third week. This enabled a diagnosis of tuberculosis of the knee joint and antituberculous drug therapy was instituted. At six months postoperatively, the patient was on antituberculous treatment and had a painless knee.

Safety of Celecoxib in Patients With Ulcerative Colitis in Remission: A Randomized, Placebo-Controlled, Pilot Study

The safety of selective cyclooxygenase-2 inhibitors in patients with ulcerative colitis in remission is unknown. We performed a placebo-controlled pilot trial to evaluate the safety of celecoxib in patients with ulcerative colitis in remission who had a present or past history of nonspecific arthritis, arthralgia, or other condition amenable to nonsteroidal anti-inflammatory drug therapy. A total of 222 patients with ulcerative colitis in remission were randomized to receive oral celecoxib 200 mg or placebo twice daily for 14 days. Remission was defined as a total Mayo Clinic score of 2 points or less and an endoscopic score of 1 point or less. Disease exacerbation was defined as a total Mayo Clinic score of 5 points or more and an increase in the endoscopic score of 1 point or more. The primary analysis was disease exacerbation through day 14 among patients who underwent randomization, had at least 1 dose of study drug, and had both endoscopy and Mayo Clinic disease activity index scores at the baseline and final assessments. Three percent of patients in the celecoxib group experienced disease exacerbation through day 14, as compared with 4% in the placebo group (P = .719). Eleven percent of patients in each group experienced a bowel-related adverse event (P > .20). Therapy with celecoxib for up to 14 days did not have a greater relapse rate than placebo in patients with ulcerative colitis in remission who had a present or past history of nonspecific arthritis, arthralgia, or other condition amenable to nonsteroidal anti-inflammatory drug therapy.

SAFETY OF CELECOXIB IN PATIENTS WITH ULCERATIVE COLITIS IN REMISSION

Purpose: To compare the incidence of flare and changes in mucosal histology in ulcerative colitis patients in remission who were randomized to receive either celecoxib 200 mg bid or placebo. Methods: This was a multicenter, parallel-group, double-blind study of patients with clinically (total Mayo Clinic score <3) and endoscopically quiescent (Mayo flexible sigmoidoscopy score 0 or 1) ulcerative colitis who were receiving maintenance therapy and who had either present or past history of nonspecific arthritis, arthralgia, or other conditions requiring nonsteroidal anti-inflammatory drug (NSAID) therapy. Patients were randomized to celecoxib 200 mg bid or placebo for 14 days. On Day 14 or early termination, patients underwent repeat flexible sigmoidoscopy (with a mucosal biopsy at US sites), clinical evaluation, laboratory tests, and physical examination. Primary endpoint was the percentage of patients whose disease exacerbated after treatment (flare) defined as a total Mayo Clinic score of ≥ 5 and an increase in Mayo flexible sigmoidoscopy score of ≥ 1 point. Mucosal biopsies were graded for inflammation and expression of immunoreactive COX-2. Results: Celecoxib- (n = 112) and placebo-treated (n = 110) patients had similar baseline characteristics. Of these, 110 celecoxib- and 107 placebo-treated patients had at least 1 dose of study drug, and both sigmoidoscopies and Mayo Clinic scores at baseline and final assessment. The mean change in total Mayo Clinic score in the placebo group was 0.44 compared with 0.28 (P= 0.37) for celecoxib. The incidence of adverse events in each treatment arm further supports the GI safety of celecoxib. In the 107 patients (celecoxib [n = 53] and placebo [n = 54]) who had a biopsy, the majority of specimens were grade 1 (chronic inflammatory filtrate). The change from baseline in histopathology scores in the placebo group reflected an increase in disease severity, while the celecoxib group change showed a slight decrease. Measures of COX-2 expression were similar in both groups at both baseline and final assessments. Conclusions: Celecoxib 200 mg bid for 14 days is as safe as placebo in patients with ulcerative colitis in remission who require NSAID therapy. This was confirmed by clinical, sigmoidoscopic and histopathologic assessments.