Arthritis Of Sternoclavicular Joint Research Articles

Successful conservative management of advanced pyogenic sternoclavicular joint arthritis with osteomyelitis and pulmonary infiltration: a case report

BackgroundSternoclavicular joint arthritis is a rare condition that poses considerable diagnostic and therapeutic challenges, leading to severe complications and a high mortality rate. Although surgical interventions are often considered necessary for advanced cases, some reports have suggested that conservative management with antibiotic therapy can be effective in certain cases. However, to our knowledge, there are no reports of successful conservative treatment in cases exhibiting aggressive spread. This report highlights a case of advanced sternoclavicular joint arthritis with bone destruction and pulmonary infiltration, successfully treated conservatively with outpatient antibiotic therapy.Case presentationA 58-year-old Japanese male presented with a 1-month history of left-sided shoulder pain. Contrast-enhanced computed tomography showed abscess formation and clavicular bone destruction, with infiltrative shadows suggesting lung involvement. The diagnosis of sternoclavicular joint arthritis was made, and outpatient oral antibiotic therapy was initiated. The patient exhibited a marked reduction in inflammatory marker levels and symptoms, and antibiotic therapy was discontinued after 3 weeks, with no recurrence observed at a 4-month follow-up.ConclusionsThis case highlights that conservative management with antibiotics can be effective for treating advanced sternoclavicular joint arthritis, emphasizing the need for individualized management and further research into non-surgical treatment options.

Ultrasound imaging for sternoclavicular joint involvement in enthesitis-related arthritis: A closer look at capsular enthesitis

Introduction: Enthesitis-related arthritis is a specific subtype of juvenile idiopathic arthritis characterised by the co-presence of arthritis and enthesitis or the evidence of one of them coupled with at least two among sacroiliac joint tenderness, inflammatory back pain, presence of human leukocyte antigen-B27, acute symptomatic anterior uveitis, onset in a male child aged 6 years or older or history of spondyloarthropathy in a first-degree relative. Small joints like the sternoclavicular joint are rarely affected, and the prevalence of their involvement in enthesitis-related arthritis has been poorly assessed in the pertinent literature. Case report: The authors report an atypical case of left sternoclavicular joint arthritis/enthesitis in a 12-year-old male child with juvenile idiopathic arthritis. The B-mode sonographic findings of articular effusion, synovial hypertrophy and capsular bulging, coupled with the microvascular mapping with colour Doppler of the sternoclavicular joint, have been crucial to optimising the pharmacological approach in clinical practice. In this sense, the sonographic examination presented as a natural extension of the physical examination to accurately define the poor control of disease activity using first-line pharmacological agents. Discussion: The present case report can be considered the first to accurately report the B-mode and the colour Doppler findings of a pathological sternoclavicular joint in a patient enthesitis-related arthritis. Ultrasound imaging demonstrated intra-articular effusion, capsular bulging and synovial hypertrophy clearly defining sternoclavicular joint arthritis. Interestingly, the hypervascularisation involved both the synovial tissue and the capsule–bone interface – that is, the enthesis of the joint capsule – suggesting a potential co-existence of arthritis and enthesitis of the sternoclavicular joint in enthesitis-related arthritis patients. Conclusion: The high-resolution point-of-care ultrasound seems to be a potential ‘game changer’ in paediatrics to promptly optimise the pharmacological management in enthesitis-related arthritis patients. Indeed, unlike other imaging modalities such as magnetic resonance imaging, modern high-frequency ultrasound transducers guarantee a superior spatial resolution of superficial joints and allow an accurate mapping of small-size and low-flow vascular elements of synovial and capsular tissues optimising the grading of disease activity and avoiding the use of contrast agent.

Sternoclavicular joint tuberculosis

Abstract We studied five patients who presented with complaints of swelling of the sternoclavicular joint (SCJ), with pain and restriction of shoulder movements in some. There was no clinical or imaging evidence of pulmonary involvement in any of these patients. The diagnosis of SCJ tuberculosis (TB) was ascertained by histopathological evidence (n = 2), by Xpert MTB/RIF (n = 1) and based on clinical presentation and response to anti-TB treatment (n = 2). On follow-up, all patients had responded well to anti-TB treatment. TB should be considered in the differential diagnosis in patients presenting with subacute/chronic SCJ arthritis, with or without pulmonary involvement, especially in high TB burden countries.

Stellate ganglion block in the treatment of SAPHO syndrome: A case report.

Synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare and refractory autoinflammatory disease, and there is no consensus on its treatment. Stellate ganglion block (SGB) blocks sympathetic nerves, ameliorates immune dysfunction, and alleviates stress response, which has been used to treat various chronic pain syndromes, arrhythmias, and post-traumatic stress disorder (PTSD). Also, the SGB has been reported to be successfully used to treat certain skin diseases, autoinflammatory diseases, and menopausal symptoms. In this study, over 3 years of follow-up, we found that SGB successfully intervened the symptoms of SAPHO syndrome, including sternoclavicular joint arthritis and palmoplantar pustulosis.

Sternoclavicular Joint Arthritis in a Patient with Psoriatic Arthritis.

Sternoclavicular Joint Arthritis in a Patient with Psoriatic Arthritis.

Surgical treatment for sternoclavicular joint arthritis: A series of 3 cases

Surgical treatment for sternoclavicular joint arthritis: A series of 3 cases

A case of chronic pyogenic arthritis of sternoclavicular joint

A case of chronic pyogenic arthritis of sternoclavicular joint

Sternoclavicular joint septic arthritis manifesting as deep neck infection in patients with recent acupuncture history and intra-articular injection

Abstract Introduction: Septic arthritis in sternoclavicular joint (SCJ) with neck abscesses is very rare. Acupuncture and intra-articular injections have been reported as a cause of septic arthritis. Patient concerns: Two patients, one with a history of acupuncture and the other with a history of intra-articular injection complained of fever and neck abscess arising as a complication of SCJ septic arthritis. Diagnosis: Computed tomography revealed abscesses in the upper chest wall, retrosternum, anterior mediastinum, lower portion of the neck, and SCJ area. Interventions: Surgical drainage was performed successfully for both patients. The tissues from the SCJ, proximal clavicle, and deep cervical fascia showed chronic active inflammation without granulomas, accompanied with joint arthritis and osteomyelitis. In the abscesses, methicillin-resistant & sensitive Staphylococcus aureus was isolated. Empirical antibiotic treatment covering these organisms was administered to these patients. Outcomes: Following the surgical drainage, the hospital stay was free of complications and there was no recurrence of SCJ arthritis at 6 months follow-up. Conclusion: Neck abscesses in patients with a recent acupuncture or intra-articular injection may develop due to SCJ septic arthritis. If SCJ septic arthritis is not detected early, fatal complications can occur. Therefore, awareness of such an atypical presentation is essential for prompt diagnosis and appropriate management.

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.

Two cases of septic arthritis of sternoclavicular joint with pleural empyema

Two cases of septic arthritis of sternoclavicular joint with pleural empyema

Serum interleukin-23 protects, whereas methotrexate treatment stimulates selected components of the metabolic syndrome in patients with SAPHO syndrome.

IntroductionThe aim of the study was to evaluate the impact of disease activity, selected serum cytokines, and therapy on metabolic syndrome (MetS) components in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome.Material and methodsWe studied 46 SAPHO patients (40 women, 6 men). We recorded age, sex, disease duration, arthritis localization, type of skin changes, bone scintigraphy results, comorbidities, BASDAI, VAS, and treatment. We measured erythrocyte sedimentation rate, C-reactive protein, lipid profile, serum IL-6, IL-18, IL-23, endothelin-1, vascular endothelial growth factor, and epidermal growth factor (EGF).Results97.8% of patients had sternoclavicular joint arthritis, 91.3% of patients palmoplantar pustulosis. In 65.2% of SAPHO patients skin changes and arthritis started simultaneously. Apart from non-steroidal anti-inflammatory drugs, patients were treated with methotrexate (41.3%), sulfasalazine (41.3%), and antibiotics (39.1%). 19.5% of patients met MetS criteria. Serum IL-23 correlated positively with total cholesterol (TC; p = 0.02) and high-density lipoprotein cholesterol (HDL-C) (p = 0.01) in the SAPHO group. There was a negative correlation between HDL-C and BASDAI (p = 0.02). Patients treated with methotrexate had higher triglyceride (p = 0.01) and low-density lipoprotein cholesterol (LDL-C) (p = 0.01) levels. There was a negative correlation between TC and EGF (p = 0.03). Increased prevalence of autoimmune diseases and depression was observed in SAPHO patients.ConclusionsSerum IL-23 protects, whereas methotrexate treatment stimulates selected components of the MetS in patients with SAPHO syndrome.

Magnetic resonance imaging findings in the sternoclavicular joint in juvenile idiopathic arthritis and comparison with clinical examination.

The sternoclavicular joint (SCJ), an important link between the appendicular and axial skeleton, though involved in 41% of rheumatoid arthritis patients, has not been studied in juvenile idiopathic arthritis (JIA). Hence, this cross-sectional study was done to delineate the magnetic resonance imaging (MRI) findings in SCJ in JIA and compare with the clinical examination to diagnose SCJ arthritis. Of the 116 JIA patients attending the pediatric rheumatology clinic, twenty-one patients (42 SC joints) were evaluated by 1.5 T MRI using the four components of early and late inflammatory changes-synovial hypertrophy, bone marrow edema (BME), cartilage lesions, and bone erosions. Results were compared with clinical assessment of SCJ arthritis. Of the 42 SCJ evaluated (21/116 patients), MRI changes were seen in 27 SCJs (15 patients, 12.9% of 116 JIA patients). Early MRI changes were seen in 60% of joints found normal on clinical examination, with as much as 1/4th of them revealing late destructive changes. Synovial hypertrophy, BME, cartilage lesions, and bone erosions were seen in 5, 15, 4, and 10 patients, respectively. Sensitivity and specificity of clinical examinations to evaluate SC joint involvement were 55.5% and 53.3%, respectively. MRI evaluation of the SCJ in JIA revealed findings in 15/21 enrolled patients. BME, bone erosions, synovial hypertrophy, and cartilage lesions were seen in 15, 10, 5, and 4 enrolled patients, respectively. Clinical examination was found to be neither sensitive nor specific. Key Points • MRI could delineate both early and late inflammatory changes in SCJ in JIA. BME, bone erosions, synovial hypertrophy, and cartilage lesions were seen in 15, 10, 5, and 4 enrolled patients, respectively. • The frequency of SC joint involvement in JIA was at least 12.9% of patients in our study. • Clinical examination for evaluating SC joint arthritis has low sensitivity (55.5%) and specificity (53.3%).

ИНФЕКЦИОННЫЙ АРТРИТ ГРУДИНО-КЛЮЧИЧНОГО СОЧЛЕНЕНИЯ: ДИАГНОСТИКА И ПЕРСОНИФИЦИРОВАННОЕ ЛЕЧЕНИЕ

We analyzed short-term results of personalized treatment of 31 patients with sternoclavicular septic arthritis. Sternoclavicular joint infection was spread hematogenously in 74,2 % of patients and staphylococcus was the most causative pathogen (87,1 %). Diagnostic work-up included computer tomography, ultrasound-guided aspiration and microbiological analyses of aspirate and blood culture. 16 patients with sternoclavicular joint infection underwent incision, debridement and drainage at the first stage of treatment. Three of them died. Negative pressure wound therapy was used in 11 patients. Antibiotic therapy was effective in 50 % of patients with serous arthritis of sternoclavicular joint. Antibiotic with drainage and/or negative pressure wound therapy was efficient in 33,3 % of cases. The final respective-reconstructive stage of treatment was performed in 48,1 % of patients with good results. Wide resection was performed including medial end of clavicular, part of manubrium sterni and medial end of first and second ribs followed by pectoralis muscle flap.

Septic Arthritis of Sternoclavicular Joint with Multiple Abscesses : A Case Report

Septic Arthritis of Sternoclavicular Joint with Multiple Abscesses : A Case Report

A Case of Acute Lymphoblastic Leukemia Presenting as Unilateral Sternoclavicular Joint Arthritis and Mass

A Case of Acute Lymphoblastic Leukemia Presenting as Unilateral Sternoclavicular Joint Arthritis and Mass

A CASE OF MEDIASTINITS AND SEPTIC THROMBOPHLEBITIS SECONDARY TO SEPTIC STERNOCLAVICULAR JOINT ARTHRITIS

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Septic Sternoclavicular joint (SCJ) is a rare diagnosis. Certain risk factors such as diabetes mellitus have been associated with it. The most serious complication of this condition is mediastinits. CASE PRESENTATION: A 48-year-old male with history of type II diabetes mellitus presented with complaints of a progressively worsening left parasternal discomfort that started 3 days ago, which worsened with movement. He also described subjective fever, chills and diaphoresis at home. He denied upper respiratory symptoms. He has had no recent surgeries or instrumentation. He travelled recently to a but denied sick contacts. On presentation he was febrile, tachycardic, diaphoretic, hypertensive. His labs showed leukocytosis to 32000/mm3, a sodium level of 124 and elevated glucose of 484. On physical examination the patient had reproducible left shoulder and chest wall tenderness with palpation. Levaquin 750 mg intravenously was initiated along with supportive therapy. Computed Tomography (CT) of the chest showed anterior mediastinal fat infiltration consistent with mediastinitis and left sided pleural effusion. CT head and neck was ordered which showed inflammatory changes at the left thoracic inlet with involvement of adjacent mediastinal fat, with nonopacification of left subclavian vein and left innominate vein, suspicious for septic phlebitis and adjacent mediastinitis. Blood cultures grew methicillin-sensitive staphylococci. The patient was then started on cefazolin intravenously. Follow up blood cultures cleared and he was discharged on intravenous cefazolin for 4 weeks and outpatient follow up. DISCUSSION: SJC infection is rare occurring only about 0.5-1% of all infections [1]. Common causes include diabetes mellitus, intravenous drug use, trauma, immunosuppression, infected central lines among others. The clinical signs of SCJ septic arthritis are chest pain localizing to the SCJ (78 %), fever (65 %), and shoulder pain (24 %) and neck pain (2%) [1,2]. Joint swelling and overlying erythema is common. A CT scan of the chest or magnetic resonance imaging is recommended as the initial imaging study that helps identify bone destruction, however the final diagnosis is made from culture of the joint fluid obtained using needle aspiration or open biopsy. Common organisms that has been described are staphylococcus aureus coli, H influenza, Streptococcus pneumonia, streptococcus pyogenes [1,2]. The most potential and serious complication is mediastinitis, which occurs in less than 15% of cases [1,2] as in our case. Our case is unique because it also lead to septic thrombophelibitis of left subclavian vein. Antibiotics with or without drainage and surgical debridement is the treatment of choice. CONCLUSIONS: Sternoclavicular joint septic arthritis is a rare condition. Anterior mediastinitis and septic thrombophlebitis should be suspected as possible complications in uncontrolled diabetes. Reference #1: Ross JJ, Shamsuddin H. Sternoclavicular septic arthritis: review of 180 cases. Medicine (Baltimore). 2004;83(3):139-48. Reference #2: 2. Yood RA, Goldenberg DL. Sternoclavicular joint arthritis. Arthritis Rheum. 1980;23:232–9. DISCLOSURES: No relevant relationships by Janak Adhikari, source=Web Response No relevant relationships by Karim Anis, source=Web Response No relevant relationships by AHMET HAKKI KAPICI, source=Web Response No relevant relationships by Fnu Zafrullah, source=Web Response

Pyogenic arthritis of sternoclavicular joint with surgical resection: Report of two cases

Pyogenic arthritis of sternoclavicular joint with surgical resection: Report of two cases

Internal Jugular Vein Thrombosis Mimicking Sternoclavicular Joint Septic ArthritisA Rare Case Report

Internal jugular vein thrombosis is a vascular disease occurring spontaneously. Some of the predisposing factors include trauma, intravenous catheterization and deep neck infections. It is important to an orthopaedician, as it mimics sternoclavicular joint septic arthritis very closely. This can lead to wrong decision in opting for surgical drainage of the abscess which may turn out to be disastrous to the patient. Our case report describes a patient who presented to the emergency room with pain, swelling and redness over the sternoclavicular joint. Initial evaluation suggested septic arthritis of left sternoclavicular joint. On further evaluation this was ruled out and finally diagnosed as internal jugular vein thrombosis with adhesive capsulitis of left shoulder.

Sternoclavicular joint arthritis due to Aeromonas sp.

Sternoclavicular joint arthritis due to Aeromonas sp.

Sternoclavicular joint arthritis as the initial presentation of sarcoidosis.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. It can affect the musculoskeletal system in the form of acute and rarely, in the form of chronic peripheral arthritis involving bilateral small and large joints. Axial joint involvement with sarcoidosis is rare. Herein we report a case with sternoclavicular joint arthritis as the initial presentation of sarcoidosis. This report aims to demonstrate a rare initial presentation of sarcoidosis and highlight the importance of considering sarcoidosis as a differential diagnosis in patients presenting with sternoclavicular joint arthritis.