Joint Swelling Research Articles

Silajathu Rasayana in management of Ankylosing Spondylitis - A Case Report

Ankylosing Spondylitis is a chronic seronegative inflammatory condition that primarily impacts the sacroiliac joint and spine, potentially leading to the fusion of spinal bones. The exact cause of this condition remains unknown. A 50-year-ojoints andatient was admitted to the Kayachikitsa inpatient department of Vaidyaratnam Ayurveda College, Ollur, presenting with both knee pain and swelling, pain in both elbow joints, and generalized back pain. She was treated by following the Amavatha management protocol, which included internal administration of Ayurvedic formulations such as Amrithotharam Kashaya, Indukantham Kashaya, Yogaraja Guggulu, Punarnavasam, and Rasnapanchakam Kashaya. External therapies such as Churna Pinda Sweda, Snehapana, Sarvanga Taila Dhara and Virechana. Silajathu Rasayana were administered in the final stage of the treatment. After six weeks of treatment, the patient experienced significant relief from upper and lower back pain, reduced elbow pain, and noticeable improvement in knee joint swelling and discomfort. This case study emphasizes the efficacy of Ayurvedic management especially Rasayana chikitsa in achieving substantial symptom improvement within a short duration.

Anti-inflammatory effect of Plantago asiatica crude extract in rat gout arthritis model

Plantago asiatica L., a perennial herb in the family Plantaginaceae, has been shown to impart several pharmacologic activities, including anti-oxidative, anti-inflammatory, and diuretic effects. In the study here, the anti-gout(y) arthritis (GA) effects of a crude extract from P. asiatica L. (PAE) were investigated in a rat GA model. For this, PAE was prepared by ethanol extraction and analyzed for phytochemicals by RP-HPLC and Q-TOF-MS. Thereafter, potential therapeutic effects of the PAE were investigated in rats; Wistar rats (male, 8 wk-of-age) were randomly allocated into four groups (n = 9/group) and intra-articularly injected with 3 mg monosodium urate (MSU) in saline solution to establish a GA model. For the study, rats received oral dosings of 0.3 mg colchicine/kg or 1 g PAE/kg (w/w) before and after gout was established. At fixed times after the treatments, assessment of joint swelling ratios and pathological changes in the joints, as well as of select cytokine expression in the blood, was done. RP-HPLC results showed the PAE contained at least 8 ‘active’ ingredients, with plantamajoside, verbascoside, and cymaroside being the most abundant. In comparison to in control rats, MSU induced joint space narrowing, ankle joint swelling, and increased levels of pro-inflammatory interleukin (IL)-1β, IL-17a, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ, and reductions in anti-inflammatory IL-10 in the blood. PAE treatment significantly reversed patho- genic joint space narrowing and swelling, reversed the MSU-induced changes in inflammatory factors, and in general imparted effects very similar to those seen with colchicine (COL; known non-steroidal anti-inflammatory drug for clinical treatment of GA). Collectively, these findings provide experimental evidence supporting the potential applicability of PAE to treat gouty arthritis.

Application of cell therapy in rheumatoid Arthritis: Focusing on the immunomodulatory strategies of Mesenchymal stem cells.

Rheumatoid arthritis (RA) is a common chronic autoimmune disease that primarily affects the joints, leading to synovial inflammation and hyperplasia, which subsequently causes joint pain, swelling, and damage. The microenvironment of RA is characterized by hypoxia, high reactive oxygen species (ROS), low pH, and levels of high inflammatory factors. Traditional treatments only partially alleviate symptoms and often cause various adverse reactions with long-term use. Therefore, there is an urgent need for safer and more effective treatments. In recent years, mesenchymal stem cells (MSCs) have shown significant potential in treating RA due to their diverse immunomodulatory mechanisms. MSCs paracrine a variety of soluble factors to improve the inflammatory microenvironment in RA patients by inhibiting T cell proliferation or inducing T cell differentiation to regulatory T cells (Tregs), inhibiting B cell proliferation and differentiation and immunoglobulin production, prompting macrophage polarization toward an anti-inflammatory phenotype, and inhibiting neutrophil recruitment and preventing the maturation of dendritic cells (DCs). This review summarizes the immunomodulatory effects of MSCs in RA and their application in animal models and clinical trials. Although the immunomodulatory mechanisms of MSCs are not yet fully elucidated, their significant potential in RA treatment has been widely recognized. Future research should further explore the immunomodulatory mechanisms of MSCs and optimize their functions in different pathological microenvironments to develop more effective and safer therapeutic strategies.

Differences in the response to TNF inhibitors at distinct joint locations in patients with psoriatic arthritis: results from nine European registries

BackgroundEfficacy of tumour necrosis factor inhibitors (TNFi) for peripheral arthritis in patients with psoriatic arthritis (PsA) has been established in randomized clinical trials that have used improvement in summated joint counts as an outcome. Whether joints at different anatomical locations might respond differentially to TNFi remains unknown. The aim of the study was to investigate potential variations in the responsiveness to a first tumour necrosis factor inhibitor (TNFi) among joints at distinct locations in patients with psoriatic arthritis (PsA) treated in routine clinical care.MethodsBionaive PsA patients from nine European countries were included in this observational cohort study if ≥ 1 joint was swollen at the initiation of a first TNFi as monotherapy or added to methotrexate. Only the 28-joint count was available without imaging data confirming the presence of synovitis. The primary outcome was time to first resolution of joint swelling at each joint level. Hazard ratios (HR) for resolution comparing different joint locations were estimated using interval-censored mixed-effects Cox proportional hazards models, including a random effect for country and patient, adjusted for age and sex.ResultsA total of 1729 patients with 8397 swollen joints at the start of TNFi were included. Considering the upper extremity, a higher rate of resolution of joint swelling (HR, 95% CI) was observed for the shoulder (1.65, 1.16–2.35) and elbow (1.90, 1.38–2.61), while a lower rate was found for the wrist (0.72, 0.62–0.83) compared to the joints of digit 3. Within fingers, and using the same reference, joint swelling resolved fastest in digit 4 (1.77, 1.49–2.11) and digit 5 (1.88, 1.53–2.31). A lower rate of resolution of joint swelling was found for the knee in comparison to the elbow, the corresponding joint on the upper limb (0.56, 0.40–0.78).ConclusionThe time to resolution of joint swelling upon treatment with TNFi in patients with PsA seems to depend on the localisation of the affected joints.

Management of Habitual Patellar Dislocation in Pediatrics

Habitual patellar dislocation occurs when the knee is bent and returns to its usual position when straightened. Habitual patella dislocation is 13.5 per 100,000 in children under 13 and 147.7 per 100,000 in children 14–18. This review aims to present a comprehensive and complete literature on the management of habitual dislocation of the patella so that appropriate therapy can be obtained. A complete literature review was used in this investigation. Source search databases are PubMed, Science Direct, and Google Scholar. The literature study shows that habitual patellar dislocation in children is infrequent. Stability requires bone and connective tissue that match the patellofemoral joint. Patella alta, torsional, angular, trochlear dysplasia, muscular anomalies, ligamentous laxity, or ligament damage can produce lateral patellar habitual instability. The quadriceps muscle drags laterally to the limb's mechanical axis. Clinical children with recurrent patellar dislocation may experience a sudden dislocation that "disappeared somewhere." If this condition returns, patients frequently develop unusual knee edema and inflammation. MRI, CT, and plain radiography can diagnose this condition. A CT scan can detect trochlear dysplasia. Joint effusion, osteochondral lesions, medial retinaculum tears, and medial patella and lateral femoral condyle cartilaginous discolorations can be seen by MRI. Conservative or surgical treatment of habitual patellar dislocation depends on the deformity and its effects.

P-1088. Safety Study of Rifaquizinone in Dogs Following Intra-articular Administration

Abstract Background Rifaquizinone (RFQ, TNP-2092) is a novel multitargeting drug conjugate in development for the treatment of prosthetic joint infections (PJIs). RFQ exerts its antibacterial activity by inhibiting RNA polymerase, DNA gyrase, and topoisomerase IV. This study sought to investigate the safety/tolerability of RFQ following intra-articular (IA) administration in Beagle dogs. Methods Forty Beagle dogs (20/sex) were randomly assigned to 4 groups (5/sex/group) to receive 0, 1, 2.5, and 5 mg/kg/day RFQ in 5% (w/v) glucose once daily for 14 days by IA administration into the right knee joint. All the dogs had a 14-day recovery period to assess the reversibility, persistence, or delayed occurrence of adverse effects. Blood and synovial fluid samples were collected and concentrations of RFQ in each matrix were determined by liquid chromatography tandem mass spectrometry. Results No test article-related adverse effects in body weight, food consumption, temperature, clinical pathology, or organ weight were observed in any of the study groups. In 2.5 and 5 mg/kg/day groups, lameness, swelling and ulceration of right knee joint during treatment were observed. The 5 mg/kg group dosing was terminated prematurely due to marked arthritis on right knee joint. The no observed adverse effect level (NOAEL) was 1 mg/kg/day. At this dose level the steady state of RFQ concentrations in synovial fluid was achieved in 4 days and maintained until Day 14 (Figure 1). The mean RFQ concentrations on Day 14 in synovial fluids for male and female dogs were 35,900 and 19,200 ng/mL, respectively, as compared to the plasma Cmax 411 and 303 ng/mL for male and female dogs, respectively. Plasma toxicokinetics (TK) analysis indicated no apparent sex differences in systemic exposure at any dose level. Conclusion The NOAEL of RFQ in dogs was 1 mg/kg/day via IA administration. The synovial fluid concentration at this dose level exceeded minimum biofilm bactericidal concentration inhibit 90% bacterial growth (MBBC90) levels for both S. aures and S. epidermidis. IA administration of RFQ is a promising option for the treatment of PJIs. Disclosures Huan Wang, PhD, TenNor Therapeutics (Suzhou) Ltd: Employee Qin Cheng, Master, TenNor Therapeutics (Suzhou) Ltd: Employee Weijian Ke, Master, TenNor Therapeutics (Suzhou) Ltd: Investigator Zhenkun Ma, PhD, TenNor Therapeutics (Suzhou) Ltd: Employee

Effectiveness and safety of radionuclide synovectomy with Yttrium-90 hydroxyapatite in patients with inflammatory arthritis: a longitudinal study.

Yttrium-90 plays a significant role in managing drug-resistant inflammatory arthritis through radionuclide synovectomy, where the radioisotope is injected into the affected joint to alleviate pain and inflammation by targeting the synovial tissue. This study aims to evaluate the effectiveness and safety of Yttrium-90 hydroxyapatite radionuclide synovectomy in improving joint functionality, as judged by physicians, in patients with inflammatory arthritis who had not responded to conventional treatments. Patients with inflammatory arthritis were recruited from the orthopedics department and referred to the nuclear medicine department for evaluation. A three-phase bone scan was conducted to identify eligible patients, who then received intra-articular injections of Yttrium-90 hydroxyapatite along with triamcinolone. After 48 h, patients underwent PET-CT imaging, followed by two follow-ups at 2 and 6 months to assess improvements in joint functionality and monitor for adverse reactions. Fifteen patients underwent radionuclide synovectomy. Significant improvements were observed between baseline and 2 months in joint restriction (P = 0.001), pain severity (P = 0.037), visual analog scale (VAS) (P = 0.004), and swelling (P = 0.002). At 6 months, further improvements were noted in joint restriction (P = 0.002), pain severity (P = 0.019), VAS (P = 0.013), and swelling (P = 0.023). However, no significant changes occurred between the 2- and 6-month follow-ups. One patient experienced radiation-induced skin necrosis, which resolved with conservative treatment, and another had self-limited skin rashes. Yttrium-90 hydroxyapatite radionuclide synovectomy proved to be an effective and safe treatment for improving joint functionality in patients with drug-resistant inflammatory arthritis of the knee for up to 6 months.

Gut Microbiota and Osteoarthritis: From Pathogenesis to Novel Therapeutic Opportunities.

Osteoarthritis (OA) is the most common chronic degenerative joint disease, characterized by cartilage damage, synovial inflammation, subchondral bone sclerosis, marginal bone loss, and osteophyte development. Clinical manifestations include inflammatory joint pain, swelling, osteophytes, and limitation of motion. The pathogenesis of osteoarthritis has not yet been fully uncovered. With ongoing research, however, it has been gradually determined that OA is not caused solely by mechanical injury or aging, but rather involves chronic low-grade inflammation, metabolic imbalances, dysfunctional adaptive immunity, and alterations in central pain processing centers. The main risk factors for OA include obesity, age, gender, genetics, and sports injuries. In recent years, extensive research on gut microbiota has revealed that gut dysbiosis is associated with some common risk factors for OA, and that it may intervene in its pathogenesis through both direct and indirect mechanisms. Therefore, gut flora imbalance as a pathogenic factor in OA has become a hotspot topic of research, with potential therapeutic connotations. In this paper, we review the role of the gut microbiota in the pathogenesis of OA, describe its relationship with common OA risk factors, and address candidate gut microbiota markers for OA diagnosis. In addition, with focus on OA therapies, we discuss the effects of direct and indirect interventions targeting the gut microbiota, as well as the impact of gut bacteria on the efficacy of OA drugs.

Additive effects of curcumin and glucosamine on knee function, cartilage protection, and subchondral bone preservation in a post-traumatic osteoarthritis rat model

Background: Osteoarthritis (OA) increasingly become a global public health concern. Curcumin and glucosamine, both widely used as dietary supplements for OA, have shown distinct therapeutic effects. However, curcumin’s low bioavailability and the debated efficacy of glucosamine limit their broader clinical use. Objective: Investigate the combined effects of curcumin and glucosamine on knee function, subchondral bone preservation, and cartilage protection in post-traumatic OA rat. Methods: Post-traumatic OA was induced in Lewis rats through medial meniscus transection (MMT) surgery. Rats were treated for 8 weeks with curcumin phospholipid liposome (C, 120 mg/kg/day), glucosamine (G, 190 mg/kg/day), or a combination of both (CG, C: G=1:3, 63/190 mg/kg/day). Knee width was measured weekly, and weight-bearing was assessed twice weekly. Subchondral bone and cartilage changes were analyzed using micro-CT, toluidine blue staining, and the OARSI (Osteoarthritis Research Society International) score. Collagen II expression in cartilage was evaluated by immunohistochemistry. Results: Curcumin phospholipid liposomes significantly reduced joint swelling by up to 4.1% (P<0.001) and improved weight-bearing force by 24.2% at week 2 (P<0.01) and 14.9% at week 8 (P<0.05) in comparison with the MMT group. Analysis of Micro-CT indicated an increase in bone volume (11.6%) and bone mineral content (13.0%) (P<0.05). Histological analysis showed a 28.8% reduction in OARSI scores (P<0.01) and a 53.1% increase in collagen II expression (P<0.005). Glucosamine treatment reduced joint swelling by up to 5.7% (P<0.0001), improved weight-bearing by 31.6% (P<0.001) at week 2, and significantly increased bone volume (30.4%) and bone mineral content (29.9%) (P<0.05). The combined treatment further reduced swelling by up to 6.6% (P<0.0001) and improved the R/L weight-bearing ratio by 24.7% (P<0.0001) at week 8. It also enhanced bone volume (28.6%), bone mineral content (29.7%, and anisotropy degree (59.3%) (P< 0.05). Additionally, the combination therapy decreased OARSI scores by 27.1% (P<0.01) and enhanced the expression of collagen II by 54.2% (P<0.005), indicating enhanced cartilage and subchondral bone protection. Conclusion: Curcumin showed superior protection for cartilage, while glucosamine mainly benefited subchondral bone. Combined treatment demonstrated additive effects, improving both knee structure and physical function in OA, offering enhanced pain relief, anti-inflammatory action, and joint preservation.

A Lack of Joint Line Tenderness Is Consistent With a Healed Meniscus, But Positive Clinical Examination Findings and MRI Scans Are Inconsistent in Identifying Failure After Meniscal Repair: A Systematic Review and Subgroup Meta-analysis.

The number of meniscal repairs being completed each year is increasing; however, the optimal, cost-effective postoperative assessment to determine the success or failure of a meniscal repair is not well known. The purpose of this systematic review was to identify the clinical examination testing that correlates with objective magnetic resonance imaging (MRI) or second-look arthroscopy (SLA) findings to determine an optimal clinical workup for assessing postoperative meniscal repair healing. It was hypothesized that specific clinical tests would correlate with meniscal repairs that did not heal. Systematic review and meta-analysis; Level of evidence, 4. This systematic review included all clinical studies investigating meniscal repairs, meniscal repair outcomes, and meniscal healing with clinical findings, MRI, and/or SLA, published in a peer-reviewed journal and with full English text available. All included studies were evaluated for bias using the Methodological Index for Non-Randomized Studies (MINORS). The clinical tests included those using "Barrett's criteria," with the assessment of effusion, joint line tenderness, locking, McMurray testing, and radiographs. This parameter has also been abbreviated to "modified Barrett's criteria" to include only joint line tenderness, effusion, and McMurray testing. No significant correlations were found between clinical tests and MRI or SLA. A subgroup meta-analysis between Barrett's and non-Barrett's studies reported no significant subgroup differences (χ12 = 0.24; P = .62). A meta-analysis of diagnostic accuracy using a group of 7 studies that reported on true-positive, true-negative, false-positive, and false-negative data for SLA demonstrated that only a lack of joint line tenderness had a high specificity for a healed meniscal repair, with a log diagnostic odds ratio of 2.62 (95% CI, 0.47-4.76). This study found no significant correlation with any specific clinical test for meniscal repair healing status using postoperative MRI and/or SLA findings. However, it was found that no healing (when compared with complete or incomplete healing) on MRI and joint line tenderness should be considered when assessing the status of postoperative meniscal repair healing. In addition, a subgroup meta-analysis found that a lack of joint line tenderness was highly correlated with a healed meniscal repair.

Hidden in plain sight: A case of misdiagnosed leprosy mimicking rheumatoid arthritis

<i>Mycobacterium leprae</i> is a causative agent of leprosy, a chronic granulomatous infection that primarily affects the skin and the peripheral nerves.<b> </b>Musculoskeletal involvement, including inflammatory arthritis, is quite common despite being under recognized. Leprosy presents protean manifestations, making it a great mimicker. Herein, we report a case of a 41-year-old Indonesian who resided in Malaysia for the past 20 years and presented with chronic joint pain and swelling of hands for a year, along with gradual facial swelling and numbness in the toes. Retrospectively, the patient noticed an erythematous skin lesion over the trunk and lower limbs 6 months before these symptoms, which did not improve with standard treatment for allergic reactions. These spectral manifestations and the subtle signs of leprosy led to a diagnostic delay of more than a year. In this study, we aim to enhance clinical awareness among primary care providers about recognizing, classifying, and appropriately treating the disease to prevent life-long deformity and disability.

Innovative rheumatoid arthritis management using injection replacement approach via dual therapeutic effects of hyalurosomes-encapsulated luteolin and dexamethasone.

Rheumatoid arthritis is a highly prevalent debilitating condition linked to inflammation. The effectiveness of the present therapeutic techniques is constrained; so, there is an urgent requirement for a novel nanoplatform entailing drugs with proven efficacy. The current work highlighted the development of dexamethasone and luteolin co-encapsulated hyalurosomes (LUT-DEX hyalurosomes). High entrapment efficiency of 92.79 % and 81.21 % for DEX and LUT, respectively in addition to sustained release of both drugs were attained, where only 45 % DEX and 75.87 % LUT were released after 24 h indicating the possibility of a persistent therapeutic impact. A spherical nano-system with smooth edges and a characteristic layer of hyaluronic acid surrounding the core of the particles was evidenced by a transmission electron microscope. The efficacy of LUT-DEX hyalurosomes was evaluated in-vision vivo using a rat model of rheumatoid arthritis initiated by Complete Freund's Adjuvant (CFA). Histological examination and serum concentrations of malondialdehyde (MDA), interleukin 1ß (IL1ß), tumour necrosis factor-alpha (TNF-α), interleukin 3 (MMP-3), and nuclear factor (erythroid-derived) Like 2 NRF2) were also evaluated. The dual drug-loaded hyalurosomes demonstrated 2.9-, 3.2-, 2.5- and 2.7-fold decreases in MMP3, TNF-α, MDA and IL1, respectively, compared with the positive control group. Conversely, the negative control group demonstrated the highest NRF2 level followed by LUT-DEX hyalurosomes, comparison compared to the positive control group which demonstrated the lowest NRF2 level. The histological examination of the joints confirmed the superior effect of the dual drug encapsulated nano delivery system in reducing joint swelling and inflammation achieving similar results as the negative control group. Ultimately, the developed hyalurosomes co-encapsulating dexamethasone and luteolin, possess the potential to serve as a highly auspicious innovative strategy for managing rheumatoid arthritis.

Mechanistic and therapeutic insights into the function of N6-methyladenosine in arthritic diseases.

Arthritis is a class of diseases, characterized by joint and surrounding inflammation, accompanied by joint swelling, pain, dysfunction. According to different factors, arthritis can be divided into osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and so on. N6-methyladenosine (m6A) is the most common internal modification of eukaryotic mRNA and is involved in splicing, stabilization, output and degradation of RNA metabolism. This review systematically summarized current insights into the mechanism of m6A in arthritis. The studies related to the involvement of m6A in the pathogenesis of arthritis reported in PubMed, Google scholar, and other open source literatures were investigated to evaluate the important roles of m6A in arhtritis, and the clinical relevances. M6A methylation regulators play the roles of writers, erasers, and readers, are crucial for regulating gene expression, and play important roles in many biological processes such as virus replication and cell differentiation. In addition, more and more studies have shown that m6A is closely related to the development of arthritis. As a new therapeutic target for arthritis, m6A has a wide influence on the pathological mechanism of arthritis. However, further research is needed to determine how m6A affects arthritis pathology and its use in target therapy and diagnosis.

Renal transplantation in patients with cryopyrin-associated periodic syndrome: A case report and literature review.

The cryopyrin-associated periodic syndrome (CAPS) is a rare autosomal dominant hereditary inflammatory disease clinically characterized by three overlapping types and associated with interleukin (IL)-1β.We reported a rare case of CAPS in a patient with accompanying symptoms such as growth retardation and urticaria-like rash. These clinical manifestations were caused by mutations in the NALP3 gene. A 28-year-old male patient, with a height of 1.3m and a weight of 33.4kg. He began to experience fever, rash, joint swelling and pain, as well as recurrent cerebral infarction, delayed growth and development, and decreased hearing, among other neuroendocrine manifestations six months after birth. After being examined at Peking Union Medical College Hospital in September 2014, a mutation in the NALP3 gene related to the encoding of Cryopyrin protein was detected,leading to a diagnosis of CAPS with a high probability of CINCA. This is a rare case of CAPS, a disease inherited in an autosomal dominant manner and associated with mutations in the NALP3 gene. Based on its clinical manifestations and severity, it can be divided into three subtypes. The clinical presentation involves autoimmune inflammatory disease, with inflammation affecting multiple organs throughout the body, including the joints, skin, face, and kidneys. Involvement of the kidneys can lead to kidney failure, which is one of its most severe complications.

Febrile neutropenia in an immunocompetent patient with brucellosis: a case report and literature review

Introduction and importance: Brucellosis is a zoonotic disease that can affect various organs, with symptoms like fever, lymphadenopathy, and arthritis. Hematologic complications, including febrile neutropenia, are rare. This report highlights the diagnostic and therapeutic challenges of brucellosis with febrile neutropenia. Case presentation: A 36-year-old man presented with a 3-week history of fever, polyarthralgia, and night sweats. Examination showed febrile symptoms, joint swelling, and cervical lymphadenopathy. Laboratory tests revealed neutropenia and elevated inflammatory markers. Imaging was unremarkable, and blood cultures were negative, but brucellosis was confirmed by serology. Treatment with doxycycline and rifampicin led to clinical improvement. Clinical discussion: Brucellosis diagnosis can be challenging due to nonspecific symptoms and requires high suspicion, especially in non-endemic areas. In this case, early identification and targeted therapy led to symptom resolution. This case underlines the importance of considering zoonotic diseases in febrile neutropenia with inconclusive initial findings. Conclusion: Brucellosis with febrile neutropenia is rare but manageable with timely diagnosis and treatment, leading to favorable outcomes.

Ankle injury due to supination trauma: Potential factors worsening patient outcome

PurposeSupination trauma is a common sports injury, and often leads to chronic ankle instability. This study analyses whether indications of healing can be detected 2 weeks after supination trauma. MethodsThis prospective, monocentric study at a German Medical Center examined patients with acute supination trauma. Only patients with severity levels 2-3 were included in the study, and were advised to wear an orthosis for 5 weeks starting in the emergency room. The follow-up period was two weeks after trauma (follow-up examination 1/FE1: swelling of the ankle joint, tenderness over the lateral ligament complex and the syndesmosis, questionnaire). Nine months after injury (follow-up examination 2/FE2), these patients were interviewed by telephone using a questionnaire surveying current complaints in everyday life, sports, and work, as well as the general healing process. ResultsForty-one patients aged 35.1 years (±10.5) were included in the study. The presence of hematoma two weeks post-injury (n=6) correlated significantly with inability to work (p=0.02). Calcaneofibular ligament (CFL) tenderness was seen in 36 patients, posterior talofibular ligament (PTFL) tenderness in 29 patients, and syndesmosis tenderness in 9 patients. All patients who reported pressure pain at the anterior talofibular ligament (ATFL) at FE1 were significantly more likely to experience feelings of instability at FE2 (p=0.011). All patients who reported instability at FE1 had significantly greater problems climbing stairs at FE2 (p=0.003). All patients with hematoma and instability two weeks post-injury had a persistent feeling of instability at FE2. Patients with hematoma and pressure pain at the ATFL at FE1 had persistent pain through FE2. ConclusionsPersistent hematoma, pressure pain at the ATFL or feelings of instability two weeks after ankle sprain increase the likelihood of symptoms persisting for up to nine months post-injury. Physicians and patients should be well informed about the treatment guidelines and not underestimate this injury. In general, further studies are necessary to clarify why acute ankle sprains often lead to persistent complaints.

Usefulness of Ultrasound in the diagnosis of Septic Arthritis: about a case

Introduction. Septic arthritis in the pediatric age group is a medical emergency with serious consequences if not treated early. Early diagnosis is essential to initiate appropriate treatment and prevent permanent joint damage. Ultrasound has emerged as an essential tool for the early and accurate detection of septic arthritis, allowing for a rapid and detailed evaluation of the affected joint, especially in cases where clinical findings are subtle.Clinical Case. A 1-month-old male infant was brought by his mother to the emergency service of our hospital due to irritability and crying when changing his diaper, significant increase in the volume of the right thigh, and pain during movement. An initial ultrasound was performed, which reported signs of superficial cellulitis, and a second ultrasound was performed, which revealed thickening of the synovium, a fluid collection in the joint capsule with echoes inside it, which concluded with the diagnosis of septic arthritis of the right hip.Discussion. Ultrasound not only allowed the identification of joint effusion and synovial thickening, but was also crucial in differentiating between superficial infection (cellulitis) and deeper septic arthritis.Conclusions. The importance of our clinical case lies in the use of ultrasound as a diagnostic method to detect joint involvement early. In combination with the clinical method and microbiological studies, it becomes an important component of the diagnostic approach and timely management of septic arthritis, thus reducing associated complications

Role of ultrasound and magnetic resonance imaging in the assessment of painful ankle joint

Background Ankle pain may originate from several intra-articular as well as extra-articular pathologies and can be triggered by a traumatic or nontraumatic incident. Aim The purpose of this work was to evaluate the diagnostic accuracy of musculoskeletal ultrasound (US) about MRI in the evaluation of ankle joint pain. Patients and methods This prospective cross-sectional work was performed on 40 patients with clinical criteria of ankle pain (acute and chronic, traumatic and nontraumatic). All participants were subjected to US and MRI. Results Chronic left-sided nontraumatic ankle lesions were the most prevalent among our cases. The specificity, sensitivity, negative predictive value, positive predictive value, and accuracy of US (about MRI) to diagnose tendon disorders were (all) 100%, for Haglund deformity were (all) 50%, for tibiofibular ligament pathology, bone marrow edema, osteochondral defect of the talar dome and medullary aneurysmal bone cyst were (all) 0%, for anterior talofibular ligament pathology were 84.4, 100, 100, 93.1, and 95%, respectively, for joint effusion were 91, 100, 100, 70, and 93%, respectively, and for bone lesions were 18, 100, 100, 50, and 55%, respectively. Conclusions US and MRI are used for imaging evaluation of patients with ankle pain. US can be used as primary imaging investigation. MRI may be used to confirm the findings of US. However, it should be used as the first imaging modality in patients with marrow abnormality or deep-seated pathologies.

Adult hypophosphatasia presenting with recurrent acute joint pain.

Hypophosphatasia (HPP) is a genetic disorder due to pathological variants in ALPL, the gene encoding tissue-nonspecific alkaline phosphatase (ALP). HPP is typically associated with bone-related symptoms, such as bone deformity, fractures and bone pain in children, but can appear in adults with symptoms resembling arthritis. A 22-year-old male experienced repeated and severe sudden attacks of joint pain in the elbows and knees. Magnetic resonance imaging and joint ultrasonography showed joint effusions indicating chronic inflammation. Blood biochemical tests revealed a remarkably low serum ALP level, and repeated examination confirmed a sustained low ALP level; urine phosphoethanolamine, plasma inorganic pyrophosphate and plasma pyridoxal-5'-phosphate levels were elevated, raising concern for HPP. While the patient had no history of premature loss of primary teeth, fragility fractures, muscle weakness or abnormalities in growth, genetic testing revealed a likely pathogenic and a pathogenic heterozygous variant in the ALPL gene, i.e., c.979T>C (p.Phe327Leu) and c.1559del (p.Leu520Argfs), confirming HPP. Additional genetic testing of his parents showed a heterozygous c.1559del variant in his father and a heterozygous c.979T>C variant in his mother. A diagnosis of adult HPP due to compound heterozygous mutations was therefore confirmed. Enzyme replacement therapy with asfotase alfa was then introduced; no attacks of arthralgia occurred in the 1-year period since then. This case highlights the possibility of HPP in adults who present clinically with repeated joint symptoms and low serum ALP levels but without bone-related symptoms. A diagnosis of adult HPP without bone-related symptoms can be challenging. A reduction in tissue-nonspecific ALP activity leads to an accumulation of pyrophosphate in the joints, which can cause arthralgia. Some cases of adult HPP have arthralgia as the only presenting symptom. At one-year follow-up, enzyme replacement therapy with asfotase alfa might lead to a reduction in arthralgia attacks due to HPP.

Data Insights on the Risks of Local Heat and Massage in Gouty Arthritis Treatment.

Gouty arthritis is a common inflammatory condition caused by the deposition of uric acid crystals in the joints, leading to intense pain, swelling, and functional impairment. Thermal therapies, including hot and cold fomentation, are often used as adjunctive treatments for managing inflammation and pain in various musculoskeletal conditions. However, the efficacy of these therapies in acute gout remains underexplored. This study aims to compare the effects of hot fomentation versus cold fomentation in patients experiencing acute gout flares, assessing pain reduction, swelling, joint mobility, and overall patient satisfaction. A randomized controlled trial was conducted with 2,400 patients diagnosed with acute gouty arthritis, divided into two equal groups: Group A received hot fomentation (38°C-42°C) and Group B received cold fomentation (5°C-10°C). Both interventions were applied twice daily for 20 min over 5 days, alongside standard gout care. Pain intensity was measured using the visual analog scale (VAS), while joint circumference, range of motion, and patient satisfaction were recorded at baseline, day 3, and day 5. Statistical analyses compared outcomes between the two groups. Cold fomentation significantly reduced pain intensity (VAS score reduction of 68% by day 5) compared to hot fomentation (26% reduction, P < 0.001). Joint swelling decreased by 25% in the cold group versus 5% in the hot group, with cold therapy also leading to greater improvements in joint mobility (average increase of 15° vs. 5°, P < 0.01). Notably, 35% of patients in the hot fomentation group experienced flare-ups, compared to only 2% in the cold fomentation group (P < 0.001). Patient satisfaction was also higher in the cold group, with 85% of participants reporting satisfaction versus 30% in the hot group. This study demonstrates that cold fomentation is significantly more effective than hot fomentation in managing acute gouty arthritis. Cold therapy provided superior pain relief, reduced swelling, improved joint mobility, and minimized the risk of symptom exacerbation. In contrast, hot fomentation often worsened symptoms, making it unsuitable for acute gout management. These findings suggest that cold fomentation should be the preferred thermal therapy for gout flare-ups, while heat applications should be avoided.