Synovitis Of Hip Research Articles

Transient synovitis of hip joint following COVID-19 infection in a child with Hodgkins lymphoma

Transient synovitis of hip joint following COVID-19 infection in a child with Hodgkins lymphoma

Реконструктивная локальная инъекционная терапия

The article discusses the treatment of osteoarthritis (OA) as the most common joint disease. The recommendations from professional associations for the patient management in OA using hyaluronic acid (HA) preparations differ somewhat depending on the affected joint, although they generally indicate positive effects of their use. Studies have shown the HA participation in the phagocytosis reduction, as well as in lowering the levels of prostaglandins, fibronectin, cAMP and a number of other anti-inflammatory effects. There is also a hypothesis that HA can prevent the release of arachidonic acid, block nociceptors and reduce the bradykinin formation, as well as it has chondroprotective properties. At the same time, total joint replacement is considered optimal (which has proven itself to be an effective and safe type of surgery) during the OA progression, the preservation of severe pain and loss of joint function, and the inefficacy of conservative treatment. The authors draw attention to the most common complication that occurs during total joint replacement — contralateral limb pain, and explain the mechanisms of its progression. They also present their case follow-ups of patients after total joint replacement with the development of synovitis in the contralateral hip joint and synovitis in combination with ligamentitis in the contralateral knee joint. Besides, the article highlights the clinical picture patterns and the methods of reconstructive local injection therapy with HA. KEYWORDS: osteoarthritis, knee joint, hip joint, hyaluronic acid, total joint replacement, contralateral limb pain, intra-articular injection, periarticular injection. FOR CITATION: Filatova Yu.S., Solovyov I.N., Solovyov E.I. Reconstructive local injection therapy. Russian Medical Inquiry. 2024;8(4):208– 214 (in Russ.). DOI: 10.32364/2587-6821-2024-8-4-4.

Clinical characteristics and correlation analysis of IVIG resistance in children with kawasaki disease complicated with hip synovitis: case-control study.

To investigate the clinical characteristics and risk factors of Kawasaki disease (KD) complicated with hip synovitis. Children with KD admitted from January 1, 2011, to December 31, 2020, in the KD database of Yuying Children's Hospital Affiliated with Wenzhou Medical University were retrospectively included. We selected KD children with hip synovitis as the case group and KD children without hip synovitis as the control group to analyze the possible risk factors of hip synovitis in KD children. Among 2,871 KD children admitted to our center in recent years, 28 had hip synovitis. In this study 140 KD children were enrolled, including 28 KD children with hip synovitis and 112 children with general KD (within one month of admission). The onset age of KD patients with hip synovitis was 30.92 (23.23-49.99) months, and there were 17 cases of bilateral hip involvement. The course of synovitis (limited movement, joint pain, lameness, unwillingness to stand, etc.) ranged from 1 to 19 days, with an average of (8.8 ± 4.6) days. We treated all KD children with IVIG (Intravenous immunoglobulin) plus aspirin, among which five patients in the case group developed coronary artery damage, six acquired IVIG resistance, and synovial inflammation disappeared within two weeks. Age, weight, length of stay, and incidence of IVIG resistance significantly differed between the two groups (P = 0.001, 0.005, <0.001, and 0.035, respectively). Logistic regression analysis showed that KD combined with hip synovitis was an independent risk factor for developing propyl pellet resistance, with an OR value of 4.625 (95% CI: 1.095, 19.526). KD combined with hip synovitis mainly involves bilateral hip joints, and joint pain and limited movement are the main clinical features. The symptoms are mild and self-limiting. KD combined with hip synovitis is a risk factor for IVIG resistance. Hip synovitis is a good predictor of IVIG resistance.

Prospective Comparison of the Imaging Value of 99m Tc-MDP Bone Scan and 68 Ga-FAPI-04 PET/CT in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome.

This study aimed to explore the imaging value of 68 Ga-FAPI-04 PET/CT in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and compare it with that of 99m Tc-MDP bone scan. Nineteen participants with SAPHO syndrome underwent 68 Ga-FAPI-04 PET/CT and 99m Tc-MDP bone scan. Demographic data and clinical features were recorded, SAPHO imaging features were analyzed, and the osteoarticular lesion detection rate in both methods was calculated. This prospective study recruited 4 men and 15 women aged 52.4 ± 8.6 years. The anterior chest wall was involved in all participants (100%). Palmoplantar pustulosis was the most common (36.8%) skin symptom. 99m Tc-MDP bone scan and 68 Ga-FAPI-04 PET/CT together detected 84 osteoarticular lesions, of which 91.7% (77/84) were detected by the former and 96.4% (81/84) by the latter. Furthermore, 68 Ga-FAPI-04 PET/CT detected 5 cases of knee and hip joint synovitis. 68 Ga-FAPI-04 PET/CT was more sensitive than 99m Tc-MDP bone scan when evaluating osteoarticular lesions in SAPHO syndrome and could also evaluate synovial lesions. 68 Ga-FAPI-04 PET/CT could be a good imaging method for SAPHO syndrome but requires further verification in a more extensive research cohort.

Femoral Anteversion Is Associated With a Thinner Anterior Capsule in Patients With Femoroacetabular Impingement Syndrome

To measure femoral torsion on computed tomography images in patients with femoroacetabular impingement syndrome and explore whether femoral torsion was significantly correlated with anterior capsular thickness. Prospectively collected data of surgical patients were retrospectively reviewed. Only patients aged 16 to 55 years who underwent primary hip surgery were included in this study. Patients with a history of revision hip surgery, previous knee surgery, hip dysplasia, hip synovitis, and/or incomplete radiographs and medical records were excluded from the study. Femoral torsion was measured via computed tomography imaging using transcondylar slices of the knee. Anterior capsular thickness was measured using oblique-sagittal sequences on a 3.0-T magnetic resonance imaging system. The association between anterior capsular thickness and related variables, including femoral torsion, was assessed via multiple linear regression. The patients were then divided into 2 groups to further confirm the effect of femoral torsion on capsular thickness: Patients in the study group had hips with moderate (20°-25°) or severe (>25°) antetorsion, whereas patients in the control group had hips with normal torsion (5°-20°) or retrotorsion (<5°). Anterior capsular thickness was also compared between the 2 groups. A total of 156 patients (89 female patients [57.1%] and 67 male patients [42.9%]) were finally included in the study. The mean age and body mass index of the included patients were 35.8 ± 11.2 years and 22.7 ± 3.5, respectively. The mean femoral torsion for the entire study population was 15.9° ± 8.9°. Multivariable regression analysis showed that femoral torsion (P < .001) and sex (P= .002) were significantly correlated with anterior capsular thickness. Propensity-score matching yielded 50 hips in the study group and 50 hips in the control group on femoral torsion subanalysis. The results showed that anterior capsular thickness was significantly smaller in the study group than in the control group (3.8 ± 0.5 mm vs 4.7 ± 0.7 mm, P < .001). Femoral torsion is significantly inversely correlated with anterior capsular thickness. Level III, retrospective comparative study.

Subclinical hip involvement in rheumatoid arthritis. An ultrasound assessment

IntroductionHip joint involvement in rheumatoid arthritis has been related to disability and lower quality of life. Currently, not enough studies provide information for subclinical hip involvement. ObjectivesTo determine the prevalence of subclinical hip joint involvement in rheumatoid arthritis, characterizing it by ultrasound. Materials and methodsA descriptive cross-sectional study in rheumatoid arthritis patients with an established diagnosis of rheumatoid arthritis according to EULAR/ACR 2010 classification criteria, without hip pain or abnormalities during a clinical examination (subclinical group), this group was compared with a group of symptomatic patients with rheumatoid arthritis of the hip (pathological control group), and with healthy control individuals matched by age and body mass index. The presence of joint capsule distension, osteophytes, joint remodelling process, erosions, iliopsoas bursitis, and power Doppler signal was assessed. The images were interpreted by an experienced rheumatologist blinded to clinical and laboratory variables. Results234 hips were studied; 37 (31.6%) symptomatic hip patients, 40 (34.1%) asymptomatic hip patients and 40 (34.1%) healthy individuals. The prevalence of joint capsule distension was 20%, while symptomatic hip patients and healthy individuals had a prevalence of 48.6% and 15%, respectively. The asymptomatic group presented higher values for osteophytes and joint remodelling. ConclusionsUltrasound is a sensitive tool to identify subclinical hip joint synovitis in rheumatoid arthritis patients, reaffirming the value of ultrasound in preclinical diagnosis. The presence of erosions and iliopsoas bursitis was low; we observed no power Doppler signals nor significant associations between ultrasound findings with disease activity and laboratory test results.

HHV-7 Encephalitis: The Rare Infection and Its Outcome on a Child (P11-10.006)

<h3>Objective:</h3> The primary aims of this study were to relate HHV-7 infection with clinical manifestations of encephalitis, transient hip synovitis and hepatic changes in childhood and to evidence the effectiveness of early diagnosis and treatment in patients with encephalitis. <h3>Background:</h3> A 2-year-old male patient reported persistent high fever, coughing and rhinorrhea starting 1 week ago. They sought outpatient pediatric care and was prescribed ceftriaxone and prednisolone, with no satisfactory response. The symptoms evolved to vomiting and dehydration. During the physical exam, he showed irritation, with constant cervical stiffness and hyperextension, photophobia, and convergent strabismus. On arrival, he had been taking ceftriaxone, acyclovir and desloratadine. Laboratory tests were very altered in leukocytes, platelets, PCR, AST, ALT and GGT. During the ophthalmologic examination, a paresis of cranial nerve VI on the right was identified as secondary to a probable meningitis. After 21 days of treatment with acyclovir, the patient had a good prognosis, however, he had claudication upon movement of the left hip. <h3>Design/Methods:</h3> NA <h3>Results:</h3> The CSF results were colorless, cloudy, pH 8, Glucose 58, Leukocytes 40, Proteins 81. To confirm this observation, the molecular panel detected the presence of HHV-7. The imaging tests helped and added to the results of the blood count and CSF. Cranial MRI showed a hyperintensity in the FLAIR sequence of the perimesencephalic subarachnoid space and small accumulation of liquid. In addition, the abdomen CT found a bit of fluid in the hip region. <h3>Conclusions:</h3> Encephalitis is an inflammation of the brain parenchyma that leads to neurological dysfunction caused by infection or autoimmunity. In this occasion, the patient had a rare case of HHV-7 encephalitis. Basically, the treatment was carried out with acyclovir and ketoprofen, obtaining a progressive improvement of the clinical picture. Consequently, further research on the complications of HHV-7 is essential to develop a good characterization of this disease. <b>Disclosure:</b> Mr. Andrade has nothing to disclose. Miss MARQUES has nothing to disclose. Dr. Mota has nothing to disclose.

Deep-learning based quantification model for hip bone marrow edema and synovitis in patients with spondyloarthritis based on magnetic resonance images.

Objectives: Hip inflammation is one of the most common complications in patients with spondyloarthritis (SpA). Herein, we employed use of a deep learning-based magnetic resonance imaging (MRI) evaluation model to identify irregular and multiple inflammatory lesions of the hip. Methods: All of the SpA patients were enrolled at the Xijing Hospital. The erythrocyte sediment rate (ESR), C-reactive protein (CRP), hip function Harris score, and disease activity were evaluated by clinicians. Manual MRI annotations including bone marrow edema (BME) and effusion/synovitis, and a hip MRI scoring system (HIMRISS) assessment was performed by experienced musculoskeletal radiologists. The segmentation accuracies of four deep learning models, including U-Net, UNet++, Attention-Unet, and HRNet, were compared using five-fold cross-validation. The clinical agreement of U-Net was evaluated with clinical symptoms and HIMRISS results. Results: A total of 1945 MRI slices of STIR/T2WI sequences were obtained from 195 SpA patients with hip involvement. After the five-fold cross-validation, U-Net achieved an average segmentation accuracy of 88.48% for the femoral head and 69.36% for inflammatory lesions, which are higher than those obtained by the other three models. The UNet-score, which was calculated based on the same MRI slices as HIMRISS, was significantly correlated with the HIMRISS scores and disease activity indexes (p values <0.05). Conclusion: This deep-learning based automatic MRI evaluation model could achieve similar quantification performance as an expert radiologist, and it has the potential to improve the accuracy and efficiency of clinical diagnosis for SpA patients with hip involvement.

Left Pubic Tuberculosis Was Misdiagnosed as Synovitis of the Left Hip

A 51-year-old male patient was admitted to hospital with “1 week of restricted movement in left hip pain.” The patient denied trauma and had no other specific discomfort. Slightly reduced weight and physical strength, normal diet. No previous history of tuberculosis or exposure. Admission examination: no obvious abnormalities in the appearance of the spine, no tenderness and percussion pain. Left groin tenderness (+), left hip and buttock percussion pain (+), left 4-word experiment (+). Admission to complete relevant investigations: consider infectious lesions of the left pubic bone. After admission to the hospital and standardized treatment of tuberculosis, the patient's left pubic pain was significantly improved.

Transient hip synovitis in an early adolescent: A rare case report

Transient hip synovitis in an early adolescent: A rare case report

Femoral neck-shaft angle can predict the anterior capsular thickness in patients with femoracetabular impingement syndrome.

To measure the femoral neck-shaft angle (NSA) on computed tomography (CT) images in femoracetabular impingement syndrome (FAIS) patients and explore its relationship with the anterior capsular thickness (ACT). A retrospective review of prospectively collected data from 2022 was performed. Inclusion criteria included: primary hip surgery, 18 to 55years of age, and CT imaging of the hips. Exclusion criteria included: revision hip surgery, mild or borderline hip dysplasia, hip synovitis, and incomplete radiographs and medical records. NSA was measured on CT imaging. ACT was measured using magnetic resonance imaging (MRI). Multiple linear regression was performed to assess the association between ACT and related variables, including age, sex, body mass index (BMI), lateral center-edge angle (LCEA), alpha angle, Beighton test score (BTS), and NSA. A total of 150 patients were included. The mean age, BMI, and NSA were 35.8 ± 11.2years, 22.8 ± 3.5, and 129.4° ± 7.7°, respectively. Eighty-five (56.7%) patients were females. Multivariable regression analysis revealed that NSA (P = 0.002) and sex (P = 0.001) were significantly negatively correlated with ACT. Age, BMI, LCEA angle, alpha angle, and BTS were not correlated with ACT. This study confirmed that NSA significantly predicts ACT. A decrease in the NSA by 1° increases the ACT by 0.24mm. Level III.

Hip synovitis in osteonecrosis of the femoral head as a predictor of ineffectivenessof decompression of a necrosis nidus and necessity of total hip replacement

В статье оценивается значимость наличия синовита при остеонекрозе головки бедренной кости как прогностического признака неэффективности декомпрессии очага некроза и необходимости тотального эндопротезирования тазобедренного сустава.

89 Association of brucellosis and ankylosing spondylitis: a pediatric case report

IntroductionAnkylosing spondylitis is a common chronic rheumatic disease in male young adults. Brucellosis is a worldwide zoonosis and remains endemic in several Mediterranean countries, which may have features similar to other diseases, leading to serious problems of differential diagnosis. This case report described a case of a 14-year-old male diagnosed with ankylosing spondylitis whose exploration reveals associated subacute brucellosis.Methods and resultsA 14- years- old boy from Batna, born of a first degree consanguineous marriage, and the 2nd of a sibling of 05 children. He had no relevant past medical history. He complained of chronic polyarthritis of three years, affecting the large joints: hip, knees, ankles, elbows and wrists as well as the cervico-dorsolumbar spine. Pain on palpation of the tendon insertion zones without fever. Delayed growth in weight and height was found. He was misdiagnosed at disease onset as Rheumatic fever treated by Extencillin with vitamin D3 supplementation but no improvement was noticed.The Ultrasound examination of the joints revealed moderate effusion with synovial thickening of the hip (hip synovitis). CT scan of the cervical-dorsal-lumbosacral spine revealed a bilateral erosive sacroiliitis with cervical ankylosis of the posterior apophyseal joints at C2-C3, C3-C4, and C4-C5 levels. A biological inflammatory syndrome was found. Brucellosis serology (Rose Bengal and Wright) was positive twice (IgM and IgG). Quantiferon test was negative.The treatment of the Brucellosis was started (Doxicyclines, Gentamycin, and Rifampicin). Non-steroidal anti-inflammatory drugs were also prescribed.ConclusionBrucellosis is a differential diagnosis of spondyloarthritis. However, an association of both diseases might exist and should be adequately managed.Disclosure of InterestNone declared

P20 Treatment resistant psoriatic arthritis: a case report

Introduction/BackgroundAlthough the era of targeted drugs has transformed the treatment of psoriatic arthritis (PsA), treatment resistant PsA still occurs. We present a rare case of a patient (renamed Ms Smith) with severe treatment resistant PsA.Ms Smith, a previously healthy 25-year-old, was diagnosed with arthritis in July 2018. She presented at that time with severe monoarthritis of right ankle starting in September 2017. It was initially thought to be possible sarcoma, but biopsy confirmed inflammation. She had no psoriasis and was HLA-B27 positive. She was diagnosed seronegative peripheral spondyloarthritis (psoriatic type).Description/MethodShe was treated with sulfasalazine and methotrexate in September 2018 but had side effects and no response. Her arthritis spread to multiple joints (tender joint count (TJC) 8, swollen joint count (SJC) 5, patient/physician global 4) and treatment was escalated to adalimumab biosimilar, but with minimal improvement (6 TJC, 5 SJC, patient/physican global 4). Despite additional prednisolone and subcutaneous methotrexate, she did not make a significant response.Given her poor response, she was switched to secukinumab in March 2019 along with short course prednisolone. At 12 weeks she had partial response from physician assessment, but she did not feel much better. To maximise response, she was also given leflunomide but experienced side effects and no benefit. She also developed bloody diarrhoea, raising concern about inflammatory bowel disease (a recognised complication of IL-17), but investigations were negative. Given the side-effects and non-response, secukinumab and leflunomide were stopped after 6 months.In January 2020, she presented with TJC 24, SJC 6 and patient/physician global of 5. She was switched to tofacitinib and restarted on leflunomide with subcutaneous methotrexate. Again, she stopped leflunomide but continued tofacitinib plus methotrexate until August 2020. At that time, she had presented with left hip pain; MRI confirmed sacroiliitis and left hip synovitis. She also had multiple swollen joints. Given worsening disease and spinal involvement, she was switched to etanercept as fourth biologic but did not respond to this either.Discussion/ResultsShe saw a second rheumatologist who agreed with diagnosis/treatments. Bloods tests, illustrated in Table 1, showed increase in her CRP. X-rays reviewed by radiology specialist interestingly showed significant erosive disease as well as unexpectedly some subluxation that appeared more like RA than PsA. Following an IFR, she was started on tocilizumab (subcutaneously initially and then one intravenously) but developed a non-allergic reaction to it (so only given half the infusion) and unusually her CRP increased to 325.P20 Table 1:Blood test resultsBlood testsResultsC-reactive protein127 (previously consistently around 80-90)Rheumatoid factorNegativeAnti-cyclic citrullinated peptides (anti-CCP) NegativeAnti-nuclear antibodiesNegativeProteinase 3 (PR3)Normal (2.5)Myeloperoxidase (MPO)Borderline positive (4.3)IgG4Very raised (no antibodies identified)TriglyceridesNormalFerritin300A PET-CT scan showed FDG avid nodes in the axillae, abdominal retroperitoneum, pelvis, and inguinal regions. A lymph node biopsy found IgG4 cells and reactive changes to a tattoo. Discussion in regional IgG4 meeting felt IgG4 disease was unlikely. Echocardiogram and blood cultures were negative.She was recently started on rituximab, alongside methotrexate. If no response to this - what next? Cyclophosphamide? She has recently been diagnosed with Human Papillomavirus and had Cervical Intraepithelial Neoplasia 1 on colposcopy.Key learning points/ConclusionMs Smith has one of the most resistant forms of arthritis that did not respond to any treatment to date.

The modified Kocher criteria for septic hip: Does it apply to the knee?

Background:Pediatric septic arthritis is a surgical emergency and timely diagnosis prevents serious complications. To differentiate between septic hip and transient synovitis, the predictive value of four original Kocher criteria (fever, inability to bear weight, elevated serum white blood cell count, and elevated erythrocyte sedimentation rate) plus Caird’s addition of elevated C-reactive protein have been studied, termed the modified Kocher criteria. These criteria have not been tested extensively on septic knee. This study tested the utility of the modified Kocher criteria in predicting septic knee while validating it for septic hip.Methods:A retrospective chart review was conducted of pediatric patients evaluated at a single institution for irritable hip or knee between 2009 and 2018. Patients who underwent arthrocentesis were included and the modified Kocher criteria were applied to all.Results:One hundred fifty-five patients (96 hips and 59 knees) were identified. One hundred four (67.1%) patients had septic arthritis with 44/59 (74.6%) of knees and 60/96 (62.5%) of hips. The strongest predictors for septic hip and knee were elevated C-reactive protein (odds ratio = 26.9, p < 0.0001) and refusal to bear weight (odds ratio = 14.5, p < 0.0001), respectively. For hips, 5/5 criteria produced a 100% positive predictive value for septic arthritis. For knees, the combination of inability to bear weight and elevated C-reactive protein had a positive predictive value of 89.7%.Conclusion:While all five of the modified Kocher criteria are not predictive of pediatric septic knee, the combination of two specific factors (inability to bear weight and elevated C-reactive protein) is strongly predictive. This study validates previous work that the modified Kocher criteria are predictive of septic hip.Level of evidence:level III

Artrite Reativa após infecção por Giardia lamblia: um relato de caso

Giardia sp. is one of the most common intestinal parasites in humans; during the first two years of life it is the main cause of intestinal parasitic infections. In addition to enteric symptoms, this parasitosis can be a trigger to extra-intestinal manifestations such as ophthalmic, dermatological, urinary tract and musculoskeletal symptoms. It is possible to include arthritis, which, associated to a post-enteropatic or genitourinary symptoms may characterize a Reactive Arthritis (ReA). Nevertheless, it stands out that an association with post-infectious arthritis is relatively scarce, and it’s believed that the secondary arthropathy to giardiasis can be sub diagnosed. The main goal of the present article is to report a case of synovitis associated to Giardia sp. We describe an, eighteen month old, with an acute right hip synovitis, treated with non-hormonal anti-inflammatory medication for five days, with improvement of symptoms. However, after 29 days, the child had similar presentation in the contra lateral joint, being treated again with non-hormonal anti-inflammatory medication. The parasitological examination was positive for Giardia Lamblia. After treatment, the symptoms resolved with the child remaining asymptomatic. It is necessary to include Giardia sp. on the etiological reasoning towards Reactive Arthritis, especially in cases of recurrence since the presentation of this disease is non-specific and prevalence is high in young children from developing countries.

Usefulness of MRI findings in differentiating between septic arthritis and transient synovitis of hip joint in children: A systematic review and meta-analysis

PurposeSeptic arthritis (SA) of the hip joint is a serious infection which can lead to more irreversible complications. Differentiating Septic arthritis from Transient synovitis (which is the most common cause of painful hip in children) is difficult and very important to prevent serious complications which can occur with Septic arthritis. The aim of this study was to find out the MRI findings which can differentiate between these two conditions. MethodsSystematic literature search was conducted according to the PRISMA guidelines on MEDLINE(PubMed), Google Scholar, ScienceDirect, and world Health Organization Virtual Health Library, up to April 2022. Studies that compared MRI findings between Septic Arthritis and Transient Synovitis of hip joint in children were included. The pooled sensitivity and specificity estimates of these findings were calculated using MetaDTA version 2.0. ResultsSix studies were included in qualitative analysis and five were included in quantitative analysis. Pooled sensitivity and specificity of synovial enhancement were 94.2 % (95 % CI, 45.2–99.7 %) and 60.6 % (95% CI, 6–97.4 %) respectively. Soft tissue changes had pooled sensitivity and specificity of 75 % (95% CI, 57.5–86.9 %) and 69.9 % (95 % CI, 46.5–86.2 %) respectively. Pooled sensitivity and specificity of femoral head changes were 41.5 % (95 % CI, 15.9–72.7 %) and 87.3 % (95 % CI, 75.5–93.8 %) respectively. Bone marrow changes had pooled sensitivity and specificity of 70 % (95 % CI, 26.8–93.7 %) and 99.9 % (95 % CI, 28.7–100 %) respectively. ConclusionMRI findings especially bone marrow changes were found to be useful in differentiating septic arthritis from transient synovitis among children presented with painful hip after exclusion of other causes.

Evaluation of efficacy and safety of traditional Chinese medicine in the treatment of hip synovitis in children: A protocol for systematic review and meta-analysis.

Background:Hip synovitis is a common hip disorder in children and a frequent cause of hip or groin pain in children. Its onset is rapid and poses a threat to patient health. Conventional treatment methods have suboptimal efficacy and large side effects. Clinical study surface, the therapeutic effect of traditional Chinese medicine (TCM) on hip synovitis in children is obvious. Therefore, we aimed to systematically review the efficacy and safety of TCM on hip synovitis in children.Methods:We will search databases including PubMed, Web of Science, EMBASE database, Cochrane Library, MEDLINE, Wanfang Data, Chinese biomedical literature database, China National Knowledge Infrastructure, Chinese science and technology journals database, and World Health Organization International Clinical Trials Registry Platform (since the databases were established). We also searched secondary resources, including the reference lists of studies. Included articles were carefully screened and reviewed by 2 researchers. Statistical analysis was performed using Review Manager 5.3 software.Results:This study will comprehensively evaluate the efficacy and safety of TCM for the treatment of hip synovitis in children.Conclusion:This systematic review explores the efficacy and safety of TCM for the treatment of hip synovitis in children and provides an update on its clinical use.

RARE PRESENTATION OF LEGG-CALVÉ-PERTHES DISEASE OF HIP JOINTS

Collapse of femoral head due to reduced blood supply and subsequent remodeling of the femoral head is known as Perthes disease. Usual age of presentation is 4 to 10 years. Here we present a child who developed painful limp on the left lower limb on the early days of his third year of life. It was misdiagnosed as synovitis (transient) of the left hip. There was no resolution of the limp, so more investigations were done and he was later found to have Perthes disease.

Compromiso subclínico de cadera en artritis reumatoide. Un estudio ultrasonográfico

IntroductionHip joint involvement in rheumatoid arthritis has been related to disability and lower quality of life. Currently, not enough studies provide information for subclinical hip involvement. ObjectivesTo determine the prevalence of subclinical hip joint involvement in rheumatoid arthritis, characterizing it by ultrasound. Materials and methodsA descriptive cross-sectional study in rheumatoid arthritis patients with an established diagnosis of rheumatoid arthritis according to EULAR/ACR 2010 classification criteria, without hip pain or abnormalities during a clinical examination (subclinical group), this group was compared with a group of symptomatic patients with rheumatoid arthritis of the hip (pathological control group), and with healthy control individuals matched by age and body mass index. The presence of joint capsule distension, osteophytes, joint remodelling process, erosions, iliopsoas bursitis, and power Doppler signal was assessed. The images were interpreted by an experienced rheumatologist blinded to clinical and laboratory variables. Results234 hips were studied; 37 (31.6%) symptomatic hip patients, 40 (34.1%) asymptomatic hip patients and 40 (34.1%) healthy individuals. The prevalence of joint capsule distension was 20%, while symptomatic hip patients and healthy individuals had a prevalence of 48.6% and 15%, respectively. The asymptomatic group presented higher values for osteophytes and joint remodelling. ConclusionsUltrasound is a sensitive tool to identify subclinical hip joint synovitis in rheumatoid arthritis patients, reaffirming the value of ultrasound in preclinical diagnosis. The presence of erosions and iliopsoas bursitis was low; we observed no power Doppler signals nor significant associations between ultrasound findings with disease activity and laboratory test results.