Periarticular Edema Research Articles

Endocrine alterations in patients with pachydermoperiostosis.

Pachydermoperiostosis (primary hypertrophic osteoarthropathy, PHO) usually due to biallelic loss-of-function variants in HPGD and SLCO2A1, has some features overlapping with acromegaly and often referred to endocrinologists. A detailed endocrine assessment is not available for these patients. To assess the genetic and endocrine characteristics of PHO patients referred to endocrine centres with a possible diagnosis of acromegaly. Seventeen patients from 14 families in which acromegaly was excluded based on lack of elevated IGF-1 levels and/or GH suppression on an oral glucose tolerance test were assessed for HPGD and SLCO2A1 variants. Age at diagnosis was 26.2±9.0 years (mean±standard deviation, range 9-43). Digital clubbing was present in all patients. Periostosis (94%), arthralgia (88%), periarticular oedema (77%), pachydermia (82%) and coarsened facial features resembling acromegaly (71%) was present in the vast majority of the patients, while eyelash trichomegaly, blepharoptosis, high-arched palate, gingival hypertrophy, gastrointestinal symptoms and marfanoid habitus was seen in some. Nine patients (53%) had low IGF-1 levels, the rest of the patients had IGF-1 levels in the lowest quartile of the reference range. Oestradiol concentration was increased above the normal range in eight male patients (62%) with normal testosterone and prolactin levels. Biallelic HPGD (2/14 kindreds) or SLCO2A1 (eight novel) variants (12/14 kindreds) were found. Two patients had no identifiable pathogenic/likely pathogenic variant in HPGD or SLCO2A1. Their phenotype was not different from the other patients. We establish that low IGF-1 and elevated oestradiol levels are frequent features of PHO. Nine novel and five known pathogenic/likely pathogenic genetic variants were identified.

To study magnetic resonance imaging findings and inflammatory markers in inflammatory sacroiliitis

Objectives: The objectives of the study are to determine magnetic resonance imaging (MRI) findings in inflammatory sacroiliitis and assign scores and grades to it and to determine and correlate erythrocyte sedimentation rate, C-reactive protein (CRP), and human leukocyte antigen-B27 (HLA-B27) in various grades of sacroiliitis. Material and Methods: An observational cross-sectional study was conducted on 30 patients who clinically presented with features of sacroiliitis and underwent an MRI of sacroiliac joint (SIJ). Various inflammatory and structural findings on MRI were used to do Spondyloarthritis Research Consortium of Canada scoring and grading. Then inflammatory markers including erythrocyte sedimentation rate, CRP, and HLA-B27 were studied in various grades of sacroiliitis. Results: Inflammatory sacroiliitis affects commonly the age group of 21–40 years. Periarticular edema was the most common finding seen with the iliac aspect more commonly involved. The majority of the subjects were graded moderate (50%). Values of erythrocyte sedimentation rate and CRP levels were raised whereas HLA-B27 was positive in 9 patients (30%) of inflammatory sacroiliitis. Conclusion: Inflammatory sacroiliitis presents with a chief complaint of low back ache. MRI helps to grade it into mild, moderate, and severe. STIR is the most sensitive sequence for the detection of bone marrow edema with bilateral symmetrical involvement but the iliac bone of SIJ is more involved than the sacral side. Contrast-enhanced sequences and diffusion images add no significant statistical role in the diagnosis of bone marrow edema. Inflammatory laboratory parameters were increased in higher grades of sacroiliitis. HLA-B27, although not specific to inflammatory sacroiliitis, increases in higher grades of sacroiliitis.

The role of the traumatic factor and isomorphic reaction in the early diagnosis of psoriatic arthritis

Rationale: Evaluation of the role of the deep Koebner's phenomenon and traumatization seems to be a promising direction in the search of the solution for the delayed diagnosis of psoriatic arthritis (PsA) in patients with psoriasis. We have put forward the question if joint and ligament abnormalities induced by a trauma or persistent physical activity could be an analogue of the skin isomorphic reaction in psoriasis.
 Aim: To identify joint and ligament abnormalities in patients with psoriasis caused by mechanical stress and their association with the deep Koebner's phenomenon and PsA.
 Materials and methods: This was an open-label, non-randomized, comparative study in parallel groups in 80 in-patients with psoriasis (recruited in the Dermatovenereological clinic № 1, Ufa); the control group included 80 in-patients with PsA. All patients were assessed by a dermatovenereologist, including past history, severity of psoriasis, degree of PsA activity, special questionnaires and the presence of an isomorphic reaction in the skin and periarticular tissues. The joints with maximal physical activity were assessed by X-ray. PsA was diagnosed by a rheumatologist.
 Results: The patients from both groups were matched in terms of age, gender, and duration of psoriasis. Pain, joint stiffness and limitation of mobility were present not only in the PsA group, but also in the patients with psoriasis (35%, 27.5% and 26.2% of the patients, respectively). Despite most of the patients in the psoriasis group had no active complaints (65.0% vs. 0% in the control group, p 0.001), clinical signs of inflammation of the tendons and entheses and relevant history were found in 47.5% (68.7% in the control group, p = 0.007). Hand tendinitis was most prevalent symptom in both groups: 40.0% (32/80) in the psoriasis group and 63.7% (51/80) in the PsA group (p = 0.003). Achilles tendon lesions were found in 17.5% (14/80) and 52.5% (42/80) (p 0.001) and periarticular edema in 27.5% (22/80) and 63.7% (51/80), respectively (p 0.001). The combination of these signs with psoriatic plaques in this area was observed in 32.5% (26/80) and 92.5% (74/80) of the patients, respectively (p 0.001). The comparison of the clinical and X-ray data showed that 38 patients with psoriasis and newly diagnosed PsA had had an increased physical load on the affected joints, as well as signs of a deep isomorphic reaction (tendinitis, periarticular edema, or enthesitis near the involved joints). In both groups, the most common form of PsA was distal one (63.2% [24/38] of the patients with newly diagnosed PsA and 58.7% [47/80] of the patients with previously diagnosed PsA, p = 0.648).
 Conclusion: Involvement of the periarticular tissues, as well as early, including preclinical, X-ray abnormalities in the joints of patients with psoriasis can be associated with increased physical activity and the deep Koebner's phenomenon. Therefore, even if patients with psoriasis do not have any clinical manifestations of PsA and no complaints when seen by a dermatovenereologist, it is recommended to perform a detailed collection of past history data with clarification of the type of physical activity and past trauma, as well as to examine both by inspection and palpation the periarticular tissues (tendons and entheses), for the timely use of X-ray examination, consultation of a rheumatologist aimed at diagnosis of psoriatic arthritis.

Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort.

Chikungunya-fever (CHIKF) remains a public health major issue. It is clinically divided into three phases: acute, post-acute and chronic. Chronic cases correspond to 25-40% individuals and, though most of them are characterized by long-lasting arthralgia alone, many of them exhibit persistent or recurrent inflammatory signs that define post-Chikungunya chronic inflammatory joint disease (pCHIKV-CIJD). We aimed to identify early clinical markers of evolution to pCHIKV-CIJD during acute and post-acute phases. We studied a prospective cohort of CHIKF-confirmed volunteers with longitudinal clinical data collection from symptoms onset up to 90 days, including a 21-day visit (D21). Of 169 patients with CHIKF, 86 (50.9%) completed the follow-up, from whom 39 met clinical criteria for pCHIKV-CIJD (45.3%). The relative risk of chronification was higher in women compared to men (RR = 1.52; 95% CI = 1.15-1.99; FDR = 0.03). None of the symptoms or signs presented at D0 behaved as an early predictor of pCHIKV-CIJD, while being symptomatic at D21 was a risk factor for chronification (RR = 1.31; 95% CI = 1.09-1.55; FDR = 0.03). Significance was also observed for joint pain (RR = 1.35; 95% CI = 1.12-1.61; FDR = 0.02), reported edema (RR = 3.61; 95% CI = 1.44-9.06; FDR = 0.03), reported hand and/or feet small joints edema (RR = 4.22; 95% CI = 1.51-11.78; FDR = 0.02), and peri-articular edema observed during physical examination (RR = 2.89; 95% CI = 1.58-5.28; FDR = 0.002). Furthermore, patients with no findings in physical examination at D21 were at lower risk of chronic evolution (RR = 0.41, 95% CI = 0.24-0.70, FDR = 0.01). Twenty-nine pCHIKV-CIJD patients had abnormal articular ultrasonography (90.6% of the examined). The most common findings were synovitis (65.5%) and joint effusion (58.6%). This cohort has provided important insights into the prognostic evaluation of CHIKF. Symptomatic sub-acute disease is a relevant predictor of evolution to chronic arthritis with synovitis, drawing attention to joint pain, edema, multiple articular involvement including small hand and feet joints as risk factors for chronification beyond three months, especially in women. Future studies are needed to accomplish the identification of accurate and early biomarkers of poor clinical prognosis, which would allow better understanding of the disease's evolution and improve patients' management, modifying CHIKF burden on global public health.

Radiological Spectrum of Active Sacroiliitis by Conventional Radiography and MRI

Introduction: The aim of the present study was to compare the role of Conventional Radiography and Magnetic Resonance Imaging (MRI), in diagnosis of active sacroiliitis and differentiation between inflammatory and infective sacroiliitis.Methods: Fifty two cases of active sacroiliitis diagnosed on MRI from August 2017 to August 2019 were included in study. All the patients were subjected to conventional radiology, MRI and findings were co-related with clinical and laboratory findings. Conventional radiography was used to evaluate structural changes. MR images were evaluated for bone lesions (extent and distribution of bone marrow edema and presence of bone erosions), soft-tissue lesions (capsulitis, extra capsular fluid collections, and peri-articular muscle edema) and joint space reduction for differentiation between infective and inflammatory etiology.Results: Conventional radiography showed sclerosis, erosion, partial and complete ankylosis. Thick capsulitis, extra capsular fluid collection, and peri-articular muscle edema were all more frequently observed in infective sacroiliitis (p<0.001). Iliac-dominant bone marrow edema more common in spondyloarthritis (p<0.001). When periarticular muscle edema was the sole predictor, unilateral sacroiliitis in spondyloarthritis was correctly identified in 79.16% of cases, and infectious sacroiliitis was correctly identified in 82.14% of cases.Conclusions: MRI is the optimum imaging modality to diagnose active sacroiliitis. MRI plays an essential role in better demonstrating early alterations and inflammatory activity and aid in differentiation of infective and inflammatory sacroiliitis. Conventional radiography with low sensitivity can be used as a screening tool and follow-up of patients with sacroiliitis.

MRI Findings of Infectious Sacroiliitis in Children: Are There Age-Dependent Differences?

OBJECTIVE. The purpose of this study was to investigate the prevalence of various MRI findings of infectious sacroiliitis in children and with respect to age. MATERIALS AND METHODS. This institutional review board-approved, HIPAA-compliant retrospective study included children with infectious sacroiliitis who underwent MRI examination between December 1, 2002, and September 30, 2018. Two radiologists blinded to the clinical outcome reviewed each MRI examination to determine the presence or absence of periarticular marrow edema, erosions, capsular bulge, extracapsular edema, and soft-tissue abscess. If available, pelvic radiographs were retrospectively reviewed by a third radiologist. Mann-Whitney U, chi-square, and Fisher exact tests were used to compare MRI findings between younger and older children. RESULTS. The study included 40 children (19 boys and 21 girls; mean age, 8.6 ± 6.2 [SD] years). Sixteen children presented at or below 5 years of age (mean age, 1.7 ± 1.4 years) and 24 children presented at or above 8 years of age (mean age, 13.3 + 2.6 years). Periarticular marrow edema and anterior extracapsular edema were present in all children. Posterior extracapsular edema (p = 0.01) was statistically significantly more common in younger children when compared with older children. There was no significant difference in the presence of erosions (p = 0.60), capsule bulge (p = 0.63), or abscess (p = 0.34) between younger and older children. Pelvic radiographs (n = 28; obtained 1.6 days ± 1.7 from MRI) allowed the correct identification of the abnormal joint in only 50% of the studies. CONCLUSION. MRI findings of infectious sacroiliitis are common in children of all ages with posterior extracapsular edema statistically significantly more prevalent in younger children.

Anti-inflammatory Effects of Persimmon (Diospyros kaki L.) in Experimental Rodent Rheumatoid Arthritis

Persimmon (Diospyros kaki L.) fruits are used in traditional medicine largely due to their claimed beneficial effects on human health. The aim of this work was to evaluate the anti-inflammatory activity of a persimmon extract in rats with collagen-induced arthritis (CIA). CIA was induced in Wistar rats through an intradermal injection of an emulsion of bovine type II collagen (CII) in complete Freund’s adjuvant (FCA). Macroscopic evidence of CIA first appeared as periarticular erythema and edema in the hind paws. The incidence of CIA was 100% by day 27 in the CII-challenged rats, and the severity of CIA progressed for 35 days. Radiographs revealed focal resorption of bone, with osteophyte formation in the tibiotarsal joint and soft tissue swelling. The histopathologic features included erosion of the cartilage at the joint margins. The persimmon extract showed an anti-inflammatory effect given the significant reduction in both the edema volume and radiological alterations attributed to CIA in the bone. We demonstrate that the administration of persimmon extract attenuates the degree of chronic inflammation and tissue damage characteristic of CIA in rats, most probably by the potent antioxidant characteristics of the extract.

Evaluation of the Action of MOBIDERM® on Periarticular Edema After Total Knee Prosthesis - Randomized Controlled Pilot Study

Evaluation of the Action of MOBIDERM® on Periarticular Edema After Total Knee Prosthesis - Randomized Controlled Pilot Study

MRI findings for unilateral sternoclavicular arthritis: differentiation between infectious arthritis and spondyloarthritis.

To analyze and identify magnetic resonance imaging (MRI) and clinical findings for the differentiation between infectious arthritis and spondyloarthritis in patients with unilateral sternoclavicular arthritis. We retrospectively collected and evaluated the magnetic resonance (MR) images of 21 patients diagnosed with unilateral sternoclavicular arthritis, including 12 with infection and nine with spondyloarthritis, between 2004 and 2017. Capsular distension, extracapsular fluid collection, periarticular muscle edema, the prevalence and distribution of bone marrow edema, and the prevalence and size of bone erosions were assessed on the MR images. Clinical data were also reviewed. Capsular distension was more prominent in patients with infectious arthritis than those with spondyloarthritis (p= 0.002); extracapsular fluid collection and periarticular muscle edema were also more common in infectious arthritis than spondyloarthritis (p< 0.001, respectively); moreover, bone erosions were larger in infectious arthritis than spondyloarthritis (p= 0.023). Other findings significantly associated with infectious arthritis included advanced age (p= 0.007), an elevated C-reactive protein (CRP) level (p= 0.001), and erythrocyte sedimentation rate (ESR) (p< 0.001). The prevalence and distribution of bone marrow edema and the prevalence of bone erosions on MRI, the white blood cell count, and sex showed no significant differences between the two groups. Capsular distension, extracapsular fluid collection, periarticular muscle edema, and the size of bone erosions on MRI, as well as the age, CRP level, and ESR of patients, could be helpful for differentiating infectious arthritis from spondyloarthritis involving the sternoclavicular joint.

Analysis of chikungunya outbreak of 2016 in Rajasthan: a clinico-epidemiological study

Background: To describe the diversity of clinical manifestations, laboratory findings and outcome of chikungunya fever in patients attending SMS Hospital, Jaipur during the epidemic of 2016 (September to November).Methods: All cases of febrile illness with polyarthralgia/polyarthritis diagnosed as chikungunya were analyzed. Diagnosis was made by ELISA based IgM serology and RT PCR assay.Results: A total of 200 cases were studied. All of them presented with fever, severe crippling joint pain &amp; tenderness, headache, anorexia and body rash. On examination, there was periarticular edema, erythema, and tenderness in joints with post auricular and cervical lymphadenopathy. Unusual manifestations were hyper pigmentation of face and forehead and scrotal ulcers. On investigations patient had leucopenia with elevated level of SGOT, SGPT with normal bilirubin levels. Other complications observed were encephalopathy, encephalitis, myocarditis and hepatitis. There was no mortality in this group.Conclusions: Chikungunya though prevalent is under-reported. The diagnostic certainty is mandated by presence of febrile transiently crippling polyarthragias / arthritis. On analyzing a large series, unusual clinical features may emerge.

46-Year-Old Man With Lower Back Pain

46-Year-Old Man With Lower Back Pain

Zika virus and pregnancy: An overview.

In May 2015, the first episodes of Zika virus infection of the Latin America were confirmed in Brazil, where currently 196976 cases were reported. The main route of transmission occurs by Aedes mosquitoes, and the most common symptoms are maculopapular rash, fever, conjunctivitis, polyarthralgia, and periarticular edema. However, the infection is asymptomatic in 80% of the cases. The congenital infection is characterized when the transmission to the fetus occurs during pregnancy, but the mechanisms of how the virus infects the placenta remain unclear. Anatomopathological findings were described in first- and third-trimester human placentas; however, the major affected tissue of the baby is the neural. Several clinical situations were listed in these fetuses, such as neurological, ophthalmological, auditory, and articular alterations. The World Health Organization proposed a new congenital syndrome caused by Zika virus. The virus has an important neurotropism and the main manifestation observed in the syndrome is microcephaly, which is usually severe and associated with other neurological injuries. The appearance of sudden rash in pregnant women determines immediate investigation through RT-PCR and serological analysis. Moreover, the prevention consists in using repellents and avoiding endemic areas, considering that the vaccine is still under development.

Frequency of Arthritis-Like MRI Findings in the Forefeet of Healthy Volunteers Versus Patients With Symptomatic Rheumatoid Arthritis or Psoriatic Arthritis

The objective of the present study is to evaluate arthritis-like findings on MRI studies of the forefeet of healthy volunteers versus patients with symptomatic rheumatoid arthritis (RA) or psoriatic arthritis (PsA). Two observers analyzed MR images of the forefeet of 31 healthy volunteers, 30 patients with symptomatic RA, and 30 patients with symptomatic PsA, to identify MRI patterns of RA or PsA (e.g., bone marrow edema [BME], erosions, tenosynovitis, joint effusion, periarticular soft-tissue edema, or bony proliferations) on the basis of the Outcome Measures in Rheumatoid Arthritis Clinical Trial RA MRI scoring system and the PsA MRI scoring system. The Mann-Whitney test with Bonferroni correction was used for statistical analysis. Reader 1 found BME in 14 healthy volunteers (45%), whereas reader 2 found BME in 10 volunteers (32%). Tenosynovitis was observed by reader 1 in three healthy volunteers (10%). Joint effusion was found by reader 1 in seven healthy volunteers (23%) and by reader 2 in three volunteers (10%); the mean intensity grades for these findings were low (range, 1-1.33). Erosions, soft-tissue edema, and bony proliferations were not found in the forefeet of healthy volunteers. Reader 1 and reader 2 observed all arthritis-like features on the MR images of patients with RA. The percentages of patients with RA who had such MRI features, as identified by reader 1 and reader 2, respectively, were as follows: BME, 83% and 80%; erosions, 40% and 40%; tenosynovitis, 33% and 17%; effusion, 87% and 53%; soft-tissue edema, 20% and 27%; and bony proliferations, 3% and 3%. The percentages of patients with PsA who were found to have arthritis-like findings on MR images, as determined by reader 1 and reader 2, respectively, were as follows: BME, 70% and 67%; erosions, 20% and 20%; tenosynovitis, 57% and 50%; effusion, 70% and 37%; and soft-tissue edema, 60% and 53%. Bony proliferations were observed by reader 2 only in 7% of patients with PsA. The mean minimum intensity grade was 1 (for tenosynovitis in patients with RA, as observed by reader 2), whereas the maximum intensity grade was 2.53 (for erosions in patients with RA, as observed by reader 1). Tenosynovitis and soft-tissue edema were observed more frequently in patients with PsA than in patients with RA (p = 0.001-0.059). On the forefoot of healthy volunteers, mild BME is a common finding, and tenosynovitis and joint effusion are occasional findings. The frequency and intensity of arthritis-like findings on MRI are similar in patients with RA and PsA, with the exception of tenosynovitis and soft-tissue edema, which are more frequently observed in patients with PsA than in patients with RA.

Contrast Enhanced Magnetic Resonance Imaging in Sacroiliitis

Background: Spondyloarthritis (SpA) traditionally encompasses ankylosing spondylitis, psoriatic arthritis and reactive arthritis associated with inflammatory bowel diseases. Sacroiliac joint (SIJ) inflammation is an important and usually the first finding of SpA. Objectives: The aim of this retrospective study was to assess the value of different magnetic resonance imaging (MRI) sequences in evaluation of bone marrow and subchondral bone changes in active sacroiliitis and inter- and intra-observer reliability of these sequences. Patients and Methods: Ninety patients (65 males, 25 females; mean age 33.44 ± 11 years; range 15 to 62) with MRI findings suggestive of active sacroiliitis were selected from picture archive and communication system (PACS) by the consensus of two radiologists. The SIJs were retrospectively analyzed by two radiologists separately blinded to each other’s evaluations. Each sequence was evaluated at different times (one week apart from each other) in the same monitor of PACS system by each observer. Periarticular bone edema and contrast enhancement were recorded separately by each observer. Results: Highest agreement between measurements of observer 1 and 2 was found on contrast enhanced fat suppressed T1 weighted imaging (CE FS T1 WI) (97.78%) among all sequences and on FS T2 WI of axial planes within sequences taken before contrast injections (97.78%). Conclusion: FS T2 W and CE FS T1 W sequences of axial planes were the most useful sequences in determination of active sacroiliitis. Therefore, in patients with renal failure or allergy to contrast media, FS T2 WI can be obtained to detect active sacroiliitis.

Adelmidrol, a Palmitoylethanolamide Analogue, as a New Pharmacological Treatment for the Management of Inflammatory Pain

Palmitoylethanolamide (PEA), an endogenous fatty acid amide belonging to the family of the N‐acylethanolamines (NAEs) and some of its analogues, have shown great efficacy in the treatment of pain and inflammation. Adelmidrol is one of these analogues. The aim of this study was to investigate the effect of Adelmidrol on the modulation of the inflammatory response in a mouse model of collagen‐induced arthritis (CIA). CIA was induced by an intradermally injection of 100 μl of the emulsion (containing 100 μg of bovine type II collagen (CII) and complete Freund adjuvant (CFA) at the base of the tail. On day 21, a second injection of CII in CFA was administered. Mice subjected to CIA were administered intraperitoneally with Adelmidrol (10 mg/kg). Mice developed erosive hind‐paw arthritis when immunized with CII in CFA. Macroscopic clinical evidence of CIA first appeared as periarticular erythema and edema in the hindpaws. The incidence of CIA was 100% by day 28 in the CII‐challenged mice, and the severity of CIA progressed over a 35‐day period with a resorption of bone. The histopathology of CIA included erosion of the cartilage at the joint. Treatment with Adelmidrol ameliorated the clinical signs at days 26 to 35 and improved histologic status in the joint and paw. The degree of oxidative and nitrosative damage was significantly reduced in Adelmidrol ‐treated mice, as indicated by nitrotyrosine and malondialdehyde (MDA) levels. Plasma levels of the proinflammatory cytokines and chemokines were significantly reduced by Adelmidrol treatment. We demonstrated that Adelmidrol exerts an antiinflammatory effect during chronic inflammation such as CIA.

Unilateral Sacroiliitis: Differential Diagnosis Between Infectious Sacroiliitis and Spondyloarthritis Based on MRI Findings.

The purpose of this study was to identify the MRI features that aid in the differentiation between infectious sacroiliitis and unilateral sacroiliitis associated with spondyloarthritis. The MR images of 54 patients who received a diagnosis unilateral sacroiliitis between August 2001 and August 2013 were reviewed. MR images were evaluated for bone lesions (extent and distribution of bone marrow edema and presence and size of bone erosions), soft-tissue lesions (capsulitis, extracapsular fluid collections, and periarticular muscle edema), and joint space enhancement. The Fisher exact test was used for comparison of categoric data, and multivariate stepwise logistic regression analysis was performed. Thick capsulitis, extracapsular fluid collection, and periarticular muscle edema were all more frequently observed in infectious sacroiliitis (p < 0.001). Iliac-dominant bone marrow edema and joint space enhancement were statistically significantly more common in spondyloarthritis (p < 0.001 and p = 0.014, respectively). The presence of periarticular muscle edema was the only independently differentiating variable on multivariate stepwise logistic regression analysis. When periarticular muscle edema was the sole predictor, unilateral sacroiliitis in spondyloarthritis was correctly identified in 77.3% of cases, and infectious sacroiliitis was correctly identified in 90.6% of cases. The overall accuracy was 85.2%. MRI features of the bone lesions, soft-tissue lesions, and joint space enhancement in unilateral sacroiliitis aid in the differential diagnosis between infection and spondyloarthritis. Among various findings, periarticular muscle edema was the single most important predictor of infectious sacroiliitis.

Patterns of compensation of functional deficits of the knee joint in patients with juvenile idiopathic arthritis.

ObjectivesJuvenile idiopathic arthritis (JIA) is a group of pathological syndromes of unknown aetiology, observed at the developmental age. Their common feature is sustained chronic arthritis with flares and remissions. Clinical signs and symptoms include joint pain, periarticular tissue oedema or articular exudate, frequently associated with hypertrophy of the synovial membrane. The intra- and extra-articular structural damage impairs the motion range and smoothness. The disease process may involve any joint. The knee joint is the most frequently affected in oligo- and polyarthritis. The aim of the study was to determine a direct correlation between disorders of knee joint function and the change in the range of motion of the ankle and hip joints of both lower extremities, and the so-called indirect impact of these changes on patients’ posture.Material and methodsThe study included 36 JIA patients and 56 healthy controls aged 8–16 years. The evaluation was based on physical examination.ResultsThe results showed differences in the values of quality and range of motion between patients and controls. In the patient group pes planovalgus was more frequently associated with knee joint dysfunction along with the inherent restriction of dorsal flexion of the foot. Shortening of the iliotibial band, increased outward rotation of the right lower extremity with enlarged joint contour and augmented inward rotation of the contralateral healthy extremity all proved significant. Changes in motion range in the joints below and over the knee were associated with alterations of antero-posterior spine curvatures and vertebral rotation along the long spinal axis. Based on the results, the mechanism of the compensation is outlined.ConclusionsThe observed differences in the range and quality of motion in the ankle, hip and spinal joints between patients and healthy children provide evidence that dysfunction of the knee joint affects the function of the other above-mentioned levels of the motor system.

MRI findings of the shoulder and hip joint in patients with polymyalgia rheumatica

Objectives. The purpose of this study is to evaluate magnetic resonance imaging (MRI) findings of the shoulder and hip joint in patients with polymyalgia rheumatica (PMR).Methods. MR images of a total of 25 PMR patients (23 shoulders and 6 hips), 43 rheumatoid arthritis (RA) patients (22 shoulders and 22 hips), and 50 control patients (25 shoulders and 25 hips) were examined. The following MRI findings were evaluated: In the shoulder, thickness and abnormalities of the supraspinatus tendon, effusion around the glenohumeral joint, subacromial-subdeltoid bursa, and the biceps tendon; In the hip, effusion around the acetabulofemoral joint, iliopsoas bursa, and trochanteric bursa. Periarticular soft-tissue edema and bone findings were also analyzed.Results. The supraspinatus tendon was significantly thicker in PMR patients than in RA patients and control patients (p < 0.05). Severe rotator cuff tendinopathy was frequently observed in PMR patients (p = 0.002). The scores for the amount of effusions (joint, bursa, and tendon sheath in the shoulder and bursa in the hip) were much higher in PMR patients (p < 0.05). Periarticular soft tissue edema was detected more frequently in PMR patients than in RA patients and control patients (p < 0.05).Conclusions. Thick supraspinatus tendon, severe rotator cuff tendinopathy, effusion around the joints, and periarticular soft tissue edema can be good indicators for the diagnosis of PMR.

Syringomyelia with Chiari I malformation presenting as hip charcot arthropathy: a case report and literature review.

Neuroarthropathy (neuropathic osteoarthropathy), also known as Charcot joint, is a condition characterized by a progressive articular surface destruction in the setting of impaired nociceptive and proprioceptive innervation of the involved joint. It is seen most commonly in the foot and ankle secondary to peripheral neuropathy associated with diabetes mellitus. Cases of hip (Charcot) neuroarthropathy are rare and almost exclusively reported in patients with neurosyphilis (tabes dorsalis). We report a case of a 36-year-old man who presented to the emergency department complaining of right hip pain. On physical examination, pain and thermal sensory deficits were noted in the upper torso with a cape-like distribution, as well as signs of an upper motor neuron lesion in the left upper and lower extremities. A magnetic resonance imaging study (MRI) of the right hip showed evidence of early articular surface destruction and periarticular edema consistent with hip Charcot arthropathy. An MRI of the spine revealed an Arnold-Chiari type I malformation with extensive syringohydromyelia of the cervical and thoracic spine.

Palmitoylethanolamide and luteolin ameliorate development of arthritis caused by injection of collagen type II in mice

IntroductionN-palmitoylethanolamine (PEA) is an endogenous fatty acid amide belonging to the family of the N-acylethanolamines (NAEs). Recently, several studies demonstrated that PEA is an important analgesic, antiinflammatory, and neuroprotective mediator. The aim of this study was to investigate the effect of co-ultramicronized PEA + luteolin formulation on the modulation of the inflammatory response in mice subjected to collagen-induced arthritis (CIA).MethodsCIA was induced by an intradermally injection of 100 μl of the emulsion (containing 100 μg of bovine type II collagen (CII)) and complete Freund adjuvant (CFA) at the base of the tail. On day 21, a second injection of CII in CFA was administered. Mice subjected to CIA were administered PEA (10 mg/kg 10% ethanol, intraperitoneally (i.p.)) or co-ultramicronized PEA + luteolin (1 mg/kg, i.p.) every 24 hours, starting from day 25 to 35.ResultsMice developed erosive hind-paw arthritis when immunized with CII in CFA. Macroscopic clinical evidence of CIA first appeared as periarticular erythema and edema in the hindpaws. The incidence of CIA was 100% by day 28 in the CII-challenged mice, and the severity of CIA progressed over a 35-day period with a resorption of bone. The histopathology of CIA included erosion of the cartilage at the joint. Treatment with PEA or PEA + luteolin ameliorated the clinical signs at days 26 to 35 and improved histologic status in the joint and paw. The degree of oxidative and nitrosative damage was significantly reduced in PEA + luteolin-treated mice, as indicated by nitrotyrosine and malondialdehyde (MDA) levels. Plasma levels of the proinflammatory cytokines and chemokines were significantly reduced by PEA + luteolin treatment.ConclusionsWe demonstrated that PEA co-ultramicronized with luteolin exerts an antiinflammatory effect during chronic inflammation and ameliorates CIA.