Small Joints Of Feet Research Articles

Magnetic resonance imaging (MRI) of feet demonstrates subclinical inflammatory joint disease in cutaneous psoriasis patients without clinical arthritis.

We evaluated inflammation at the small joints of feet in psoriasis patients without clinical arthritis (PsO) as against clinically overt psoriatic arthritis (PsA) patients, using a low field magnet extremity MRI (eMRI). Patients with psoriasis recruited from dermatology and rheumatology clinics of a tertiary care institution in southern India were divided into PsO and PsA groups. Demographic and physical examination details were recorded. Consenting patients underwent non-contrast eMRI of the right foot. Two trained readers scored the MRI parameters of inflammation (synovitis, tenosynovitis, osteitis) using a modification of the PsA magnetic resonance imaging score (PsAMRIS). Proportion of patients with any sign of MRI inflammation was noted. Clinical variables were compared with inflammation scores for any association. A total of 83 patients (30 PsA and 53 PsO), with 75% males and mean age of 42.2±11.6years were included. There was no statistical difference between the median eMRI inflammatory scores in PsA and PsO patients (p=0.493). Evidence of inflammation was present in 33.9% and 50% patients in the PsO and PsA groups, respectively. Early arthritis for psoriatic patients screening questionnaire (EARP) score of ≥3 was significantly associated with imaging features of inflammation in PsO group (p=0.044). This study corroborates a high proportion of subclinical inflammation in small joints of foot in PsO patients, which needs to be reproduced in larger, longitudinal cohorts to predict risk factors for progression tofuture PsA development.

Charcot’s neuroarthropathy of the hand in a patient with diabetes mellitus

Charcot’s neuroarthropathy (CNA) is a destructive disease associated with a reduced proprioceptive sensation. Diabetes mellitus (DM) is one of the most common etiological factor for CNA which typically affects ankles and small joints of feet. Neuroarthropathy seen in upper extremity in patients with DM is a rare clinical condition.In this report, we presented a case of CNA with hand involvement who had type-II DM. Neuroarthropathy was rapidly progressed and destructive changes were observed in right hand joints after a minor trauma in current case.Charcot’s neuroarthropathy may rarely occur in the joints of hand in patients with DM. Early diagnosis of CNA is important in order to protect joints and avoid further disability.

The spectrum of Rheumatoid Arthritis. A single unit experience

Background Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovium, leading to joint damage and bone destruction causing severe disability and increased mortality. Studies on the spectrum and expression of RA in Asian population are limited in the literature. Objective of the study was to describe the demographic, clinical and laboratory characteristics of RA patients followed up at Rheumatology Department, Teaching Hospital, Kurunegala. Method Descriptive study of both first visit and follow up patients diagnosed with RA was conducted during 3 week period starting from 20th July 2014. The relevant data were recorded and analyzed after excluding incomplete data. Results Of the 89 patients recruited, 14 (16%) were males and 75 (84%) were females. The mean age of patients was 53.05 (+/-16.8) years and the mean disease duration at presentation was 11.6 months. The upper limb joints were affected more than the lower limbs and the most commonly involved joint was the proximal interphalangeal (PIP) joint (85.4%) followed by the wrist joint (80.9%), the knee (78.7%), metacarpophalangeal (MCP) joints (76.4%), ankle joint (65.2%), elbow joint (49.4%), shoulder joint (49.4%) and small joints of foot (37.1%). The least affected joints were the hip (9%) and the temperomandibular (TM) joint (4.5%). Only 40.4% were seropositive. The mean ESR at presentation was 73.4 (+/-31.33) while mean Heamoglobin was 10.8 mg/dl (+/-1.38) and platelet count was 336000 (+/-96.68). Conclusions Demographic and clinical characteristics were similar to world statistics except lower rate of seropositivity and higher female predominance.

Evaluation of Guduchi Yoga In the Management of Vatarakta (Gouty Arthritis)- A Clinical Study

The joint diseases are becoming the main health problem in the present era. Vatarakta is one of the main articular diseases which is characterized by severe pain tenderness inflammation and burning sensation in the affected joints. It is a tridoshaja vyadhi with vata pradhanyata and rakta as main dushya. Small joints of feet and hands are mainly affected in Vatarakta. Sedentary lifestyle is one of the etiological factors of Vatarakta. The etiology and Symptomatology of Gout is very much simiar to that of Vatarakta. Gout can be defined as the pathological reaction of joint or periarticular tissues which results from deposition of Monosodium urate monohydrate crystals in joints and tissues. Hyperurecemia can occur due to overproduction or under excretion of uric acid. In Ayurvedic dassics although we find plenty of dravyas for joint disorders the area ofnbsp joint diseases management still remains to be elusive. Therefore there is a definite need to explore more efficacious and radical cure to this chronic progressive illness. Guduchi Ttnospora cordifolia Willd is one such drug which is the drug of choice in the treatment of Vatarakta and according to the recent research claims cucumber juice extract Cucumis sativus Linn is proven to be effective in the management of Gout. Hence the present clinical study aims to evaluate the efficacy of combined effect of Guduchi extract and cucumber juice extract in the management of Vatarakta Gouty arthritis.ObjectivesToevaluate the therapeutic effect of Guduchi Yoga in bringing about remission of the symptomsillness in the patients suffering from Vatarakta Gouty arthritisTo evaluate the efficacy of Guduchi Yoga in hyperurecemia.Materials and Methods lt is a randomized single blind study with pre-test and post-test design. In this study 20 patients diagnosed as Vatarakta and met the American College of Rheumatology ACR criteria for acute Gouty arthritis were subjected to the clinical study. Detailed profile which incorporated relevant data like symptomatology physical signs and investigation reports were considered for assessment criteria. The Guduchi Yoga Aqueous extract of Guduchi and Trapusha was administered to patients of either sex in the dosage of 1gm BID with luke warm water after food for 12 weeks3 months.Observation and Results ln the present dinical study it was observed that Guduchi Yoga proved to possess statistically significant results in bringing out remission of the symptoms of patients suffering from Vatarakta Gouty arthritis followed by feeling of general wellbeing. It was also observed that the test drug helped in attaining normal serum uric acid levels after the treatment for 12 weeks.Conclusion From the present study it can be concluded that the combined effect of Guduchi and Trapusha extracts showed promising results with the above said criteria ofassessment without any untoward effects.

Rare and Unusual Bleeding Manifestations in Congenital Bleeding Disorders

Epistaxis, superficial and deep hematomas, hemarthrosis, gastrointestinal bleeding, hematuria represent the most frequent hemorrhagic events in congenital coagulation disorders. Occasionally, bleeding manifestations occur in unusual sites or are peculiar. A clotting defect may alter the clinical aspect of skin conditions or infections (hemorrhagic scabies or varicella). Hemobilia may occur as a complication of transjugular liver biopsy in hemophilia or Bernard-Soulier syndrome. Hemarthrosis of small joints of feet and hands occur in patients with hemophilia treated with protease inhibitors. Intramedullary hematomas of long bones have been described in α2-plasmin inhibitor or fibrinogen deficiencies. Spleen fracture with consequent hemoperitoneum has been reported in patients with fibrinogen deficiency. Rectus muscle sheath hematoma may occur in patients with factor VII (FVII)or FX deficiency. Acute or subacute intestinal obstruction may be caused by intramural wall hematomas in hemophilia and von Willebrand (vW)-disease. Physicians should always keep in mind that a congenital hemorrhagic disorder may cause bleeding in any tissue of the body and therefore alter the normal clinical features of a given disease.