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Sample records for arthritis wrist joints

  1. Combined Treatment of Wrist and Trapeziometacarpal Joint Arthritis

    Science.gov (United States)

    Waitzenegger, Thomas; Leclercq, Caroline; Masmejean, Emmanuel; Lenoir, Hubert; Harir, Amir; Coulet, Bertrand; Chammas, Michel

    2015-01-01

    Background Combined thumb basal and wrist joint arthritis (excluding scaphotrapeziotrapezoid arthritis) is rare considering the frequency of arthritis of either joint alone. Combined surgical treatment has never been described in the literature. Furthermore, the scaphoidectomy common to all interventions for Watson stage 2 or 3 wrist arthritis theoretically makes it impossible to perform a trapeziectomy for thumb basal joint arthritis. Question/Purpose The aim of this study was to present and analyze the results of two types of surgical treatment when both wrist and thumb arthritis was present. Materials and Methods Our retrospective series included 11 patients suffering from Eaton Stage III thumb basal joint arthritis and scapholunate advanced collapse (SLAC) II and III-type wrist arthritis. Five patients (group A) underwent trapeziectomy and palliative surgery for their wrist with conservation of the distal pole of the scaphoid (one proximal row carpectomy [PRC] and four four-corner fusions), and six (group B) patients had a trapeziometacarpal arthroplasty either with PRC (two cases) or four-corner arthrodesis (four cases) including total scaphoidectomy. Results The mean follow-up was 57 months. The overall visual analog scale (VAS) score for pain was 1.5 at rest, with no difference between the trapeziectomy and arthroplasty groups. The average Kapandji score was 9.3 (9 in group A and 9.5 in group B). The flexion/extension range of motion for the wrist was 64° following four-corner arthrodesis and 75° following PRC. Only one case of algodystrophy was observed. The radiological analysis revealed no complications. Discussion This study shows that thumb basal joint arthritis and SLAC type wrist arthritis may be treated by combined treatment during the same intervention without any complications. The results of palliative surgery for the wrist, either with trapeziectomy or with a trapeziometacarpal arthroplasty, are comparable. With a trapeziectomy, the

  2. Combined Treatment of Wrist and Trapeziometacarpal Joint Arthritis.

    Science.gov (United States)

    Waitzenegger, Thomas; Leclercq, Caroline; Masmejean, Emmanuel; Lenoir, Hubert; Harir, Amir; Coulet, Bertrand; Chammas, Michel

    2015-11-01

    Background Combined thumb basal and wrist joint arthritis (excluding scaphotrapeziotrapezoid arthritis) is rare considering the frequency of arthritis of either joint alone. Combined surgical treatment has never been described in the literature. Furthermore, the scaphoidectomy common to all interventions for Watson stage 2 or 3 wrist arthritis theoretically makes it impossible to perform a trapeziectomy for thumb basal joint arthritis. Question/Purpose The aim of this study was to present and analyze the results of two types of surgical treatment when both wrist and thumb arthritis was present. Materials and Methods Our retrospective series included 11 patients suffering from Eaton Stage III thumb basal joint arthritis and scapholunate advanced collapse (SLAC) II and III-type wrist arthritis. Five patients (group A) underwent trapeziectomy and palliative surgery for their wrist with conservation of the distal pole of the scaphoid (one proximal row carpectomy [PRC] and four four-corner fusions), and six (group B) patients had a trapeziometacarpal arthroplasty either with PRC (two cases) or four-corner arthrodesis (four cases) including total scaphoidectomy. Results The mean follow-up was 57 months. The overall visual analog scale (VAS) score for pain was 1.5 at rest, with no difference between the trapeziectomy and arthroplasty groups. The average Kapandji score was 9.3 (9 in group A and 9.5 in group B). The flexion/extension range of motion for the wrist was 64° following four-corner arthrodesis and 75° following PRC. Only one case of algodystrophy was observed. The radiological analysis revealed no complications. Discussion This study shows that thumb basal joint arthritis and SLAC type wrist arthritis may be treated by combined treatment during the same intervention without any complications. The results of palliative surgery for the wrist, either with trapeziectomy or with a trapeziometacarpal arthroplasty, are comparable. With a trapeziectomy, the

  3. Combined pre-injection wrist and ankle MRI protocol and steroid joint injections in juvenile idiopathic arthritis

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    Kan, J.H. [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Graham, T.B. [Monroe Carell Jr. Children' s Hospital at Vanderbilt, Department of Pediatric Rheumatology, Nashville, TN (United States)

    2011-10-15

    Precise localization of affected compartments of the wrist and ankle in children with an established diagnosis of juvenile idiopathic arthritis (JIA) is clinically challenging. The purpose of this paper is to describe our experience utilizing a pre-injection MRI protocol of the wrist and ankle for localizing disease activity followed by fluoroscopically guided joint injections in children with JIA. (orig.)

  4. Wrist and finger joint MR imaging in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Klarlund, Mette; Østergaard, Mikkel; Gideon, P;

    1999-01-01

    PURPOSE: To elaborate the best MR imaging protocol for studies in rheumatoid arthritis (RA) and to evaluate the sensitivity and interobserver agreement with respect to detection of bone erosions (MR and radiography) and grading of synovial membrane hypertrophy (MR imaging only). MATERIAL...

  5. The comparisons between thermography and ultrasonography with physical examination for wrist joint assessment in juvenile idiopathic arthritis.

    Science.gov (United States)

    Lerkvaleekul, Butsabong; Jaovisidha, Suphaneewan; Sungkarat, Witaya; Chitrapazt, Niyata; Fuangfa, Praman; Ruangchaijatuporn, Thumanoon; Vilaiyuk, Soamarat

    2017-03-01

    This study aimed to assess infrared thermography (IRT) and ultrasonography (US) for detecting wrist arthritis in juvenile idiopathic arthritis (JIA) patients. Although IRT could help us detecting joint inflammation, IRT studies in JIA patients with wrist arthritis are still limited. Currently, no validated US criteria exist for detecting arthritis, and the most useful parameters between Gray-scale ultrasound (GSUS) or Power Doppler ultrasound (PDUS) remain unclear. Therefore, this study focused on detecting wrist arthritis in varying degrees using IRT and US compared with physical examination. Of 46 JIA patients, 16 had previous wrist arthritis but currently inactive, 30 still had wrist arthritis, and the median ages (IQR) were 7.7 (4.3) and 10.2 (4.8) years respectively. Fifteen healthy participants were included, with a median age (IQR) of 9.2 (2.0) years. Using IRT, mean temperature (Tmean) and maximum temperature (Tmax) at skin surface in the region of interest (ROI) in the arthritis group were higher than in the inactive group and the healthy controls with p examination, the moderate to severe arthritis had Tmean and Tmax higher than the mild arthritis group with statistical significance. The Heat Distribution Index (HDI), two standard deviations of all pixel temperature values in the ROI, in the moderate to severe arthritis group was higher than in the healthy controls (p = 0.027). The receiver operating characteristic analysis in arthritis detection revealed diagnostic sensitivity of 85.7% and 71.4% and specificity of 80.0% and 93.3% at a cut-off points of Tmean ≥ 31.0 C and Tmax ≥ 32.3 C respectively. For US, GSUS and PDUS are useful in detecting arthritis, providing high sensitivity (83.3%) and specificity (81.3%). Our study demonstrated that both IRT and US were applicable tools for detecting wrist arthritis.

  6. Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Boesen, Mikael; Jensen, Karl Erik; Torp-Pedersen, Søren

    2007-01-01

    OBJECTIVE: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). METHODS: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg...... with the MRI OMERACT synovitis score (r=0.60, p=0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. CONCLUSION: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased...

  7. A radiographic evaluation of temporomandibular and hand (Metacarpophalangeal / wrist joints of patients with adult rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Seema Kurup

    2012-01-01

    Conclusions: Although the TMJ showed osseous changes of a higher grade than the hand (MCP and wrist joints radiographically, it was observed that patients were more aware of the peripheral joint discomfort. There were no significant differences between TMJ and peripheral joints on both right and left sides.

  8. Computational Biomechanics of the Wrist Joint

    CERN Document Server

    Nazri Bajuri, Mohd

    2013-01-01

    This book presents an analysis of the stress distribution and contact stresses in severe rheumatoid wrist after total wrist arthroplasty. It assesses and compares the load transfer throughout the joint and contact pressure at the articulations. The data obtained from this study is of importance as this provide greater evidence to the benefits of total wrist arthroplasty in rheumatoid arthritis patients.

  9. Colour Doppler ultrasonography evaluation of vascularization in the wrist and finger joints in rheumatoid arthritis patients and healthy subjects

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    Carotti, M. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Salaffi, F., E-mail: fsalaff@tin.it [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy); Morbiducci, J. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Ciapetti, A., E-mail: ciapetti.a@libero.it [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy); Bartolucci, L. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Gasparini, S. [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy); Ferraccioli, G. [Division of Rheumatology, Catholic University of the Sacred Heart, Rome (Italy); Giuseppetti, G.M. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Grassi, W. [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy)

    2012-08-15

    Objectives: To evaluate the presence of blood flow by colour Doppler ultrasonography (CDUS) in the wrist and finger joints of rheumatoid arthritis (RA) patients and healthy subjects and to define a cut-off value of CDUS resistive index (RI). Methods: Forty-three patients with RA and 43 healthy controls were examined by CDUS. The wrists, second and third metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were evaluated in each patient and healthy subject. Spectral Doppler analysis was performed in order to characterize the type of flow and a mean RI was measured to define a cut-off level. The area under receiver operating characteristic curve was used to evaluate the screening method's performance. Results: Flow was detected in 219 of the 430 total joints (50.9%) of RA patients (111 in the wrists, 49 in the MCP and 30 in the PIP joints). Healthy subjects had a quantifiable flow in 45 of the 430 joints (10.5%) and, in particular, 39 (86.4%) in the wrist, 5 (11.14%) in the MCP and 1 (2.2%) in the PIP joints. The intra- and inter-reader agreements for the detection of Doppler signal were very good (kappa 0.82 and 0.89, respectively). Mean RI values were 0.72 {+-} 0.06 in RA patients and 0.86 {+-} 0.06 in healthy subjects (p < 0.01). At cut-off point of RI < 0.79 the sensitivity was 89.6% and the specificity was 78.8% (positive likelihood ratio 4.22). Conclusion: DUS is a useful tool for the detection of abnormal blood flow in inflammatory joints of RA patients.

  10. Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

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    Boesen, Mikael [Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen (Denmark)], E-mail: parker@frh.regioh.dk; Jensen, Karl Erik [State Hospital, Department of Radiology, MRI Division, Copenhagen (Denmark)], E-mail: karl.erik.Jensen@rh.regionh.dk; Torp-Pedersen, Soren [Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen (Denmark); Cimmino, Marco A. [Rheumatologic Clinic, Department of Internal Medicine, University of Genoa (Italy)], E-mail: cimmino@unige.it; Danneskiold-Samsoe, Bente; Bliddal, Henning [Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen (Denmark)

    2009-02-15

    Objective: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). Methods: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg/ml), 0.5 ml Lidocaine (5 mg/ml) and 0.15 ml gadolinium (Omniscan 0.5 mmol/ml). The drug solution was placed in the central proximal part of the wrist between the distal radius and the lunate bone. Coronal and axial MRI sequences were performed after the injection to visualize the distribution. Carpal distribution (radio-carpal, inter-carpal, and carpo-metacarpal) as well as radio-ulnar distribution was recorded. Full distribution in one compartment was given the value 1, partial distribution 0.5 and no distribution 0. A sum of the total distribution for all four compartments was calculated and correlated to the clinical parameters and the MRI OMERACT scores. Results: No uniform pattern was seen in the distribution of the contrast. Only two patients had full contrast distribution to all four compartments, and the mean distribution count for all patients was 2.4 (range 0.5-4). The distribution count correlated with the MRI OMERACT synovitis score (r = 0.60, p = 0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. Conclusion: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased with the MRI synovitis score, while no association was found with the erosion- and bonemarrow oedema score. These results indicate that a single injection into a standard injection site in the proximal part of the wrist cannot be assumed to distribute - and treat - the whole joint.

  11. Magnetic resonance imaging of soft tissue changes in rheumatoid arthritis wrist joints

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Szkudlarek, Marcin

    2001-01-01

    An increasingly aggressive therapeutic strategy, improved treatment options, and encouraging preliminary results have attracted growing attention to the potential of magnetic resonance imaging (MRI) in the diagnosis, prognostication, and monitoring of rheumatoid arthritis (RA). MRI offers...

  12. Fungal arthritis of the wrist caused by Candida parapsilosis during infliximab therapy for rheumatoid arthritis.

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    Miyamoto, Hideaki; Miura, Toshiki; Morita, Euan; Morizaki, Yutaka; Uehara, Kosuke; Ohe, Takashi; Tanaka, Sakae

    2012-11-01

    A 60-year-old woman with rheumatoid arthritis, who had been treated with infliximab, presented with uncontrollable wrist arthritis. Fungal arthritis caused by Candida parapsilosis was confirmed by examining her aspirated joint fluid. Her infliximab therapy was interrupted, and antifungal therapy with fluconazole was started. After the fungal infection had been ameliorated, surgical debridement and arthrodesis of the wrist joint were conducted, and her symptoms completely resolved. Although fungal arthritis is rare, it should be considered as a differential diagnosis of exacerbated monoarthritis in patients treated with biological agents.

  13. Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography

    DEFF Research Database (Denmark)

    Døhn, Uffe Møller; Ejbjerg, Bo J; Hasselquist, Maria

    2008-01-01

    BACKGROUND: The objectives of the present study were, with multidetector computed tomography (CT) as the reference method, to determine the performance of magnetic resonance imaging (MRI) and radiography for the detection of bone erosions in rheumatoid arthritis wrist bones, and to test whether...... on the same day. CT was performed on a Philips Mx8000IDT unit (voxel size 0.4 mm x 0.4 mm x 1 mm) and MRI was performed on a Philips Panorama 0.6T unit (voxel size 0.4 mm x 0.4 mm x 0.4 mm). Images were evaluated separately for erosions in all wrist bones and were scored according to the principles.......90 (both P persons' total erosion volume and total score (all P

  14. Interreader agreement in the assessment of magnetic resonance images of rheumatoid arthritis wrist and finger joints--an international multicenter study

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Klarlund, Mette; Lassere, M;

    2001-01-01

    Magnetic resonance imaging (MRI) allows direct visualization of inflammation and destruction in rheumatoid arthritis (RA) joints. However, MRI scoring methods have not yet been standardized or appropriately validated. Our aim was to examine interreader agreement for a simple system of scoring RA...... spin-echo, -/+ fat saturation (FS), -/+ iv gadolinium (Gd)] were scored for synovitis (score 0-3) and bone lesions (0-3). In substudy 2, we evaluated 19 sets of 2nd-5th MCP joints [10 sets from UK (Technique A) and 9 sets from the US (Technique B: 1.5 T; coronal T1 spin-echo and T2* gradient-echo + FS......, no Gd)] and 19 wrist joints [9 from the US (Technique B) and 10 from Denmark (Technique C: 1.0 T; coronal and axial T1 spin-echo, no FS, -/+ Gd)]. Synovitis (0-3), bone lesions (0-3), and joint space narrowing (JSN, 0-3) were scored in each MCP joint and in 3 different regions of the wrist. Bone...

  15. [Septic arthritis of thoracic facet joint].

    Science.gov (United States)

    Ben Abdelghani, K; Gérard-Dran, D; Combe, B

    2009-08-01

    Septic arthritis of the facet joint is a rare condition. We report a case of septic arthritis of both a thoracic facet joint and a wrist. Clinical manifestations were consistent with a spondylodiscitis. Magnetic resonance imaging of the spine demonstrated infection of facet joints of T1 and T2. A surgical biopsy of the wrist isolated a type B streptococcus. The same organism was found in urine culture. The patient had an uneventful recovery on antibiotics.

  16. Chronic Lyme disease arthritis: review of the literature and report of a case of wrist arthritis.

    Science.gov (United States)

    Scerpella, T A; Engber, W D

    1992-05-01

    A case of Lyme arthritis with advanced degenerative changes localized to the midcarpal joint was treated with a limited wrist arthrodesis with relief of pain and improved function. Chronic Lyme arthritis occurs as the third stage of Lyme disease. Serologic testing and a history of a characteristic rash may be helpful in the diagnosis. Radiographic and histopathologic findings are nonspecific, with both degenerative and inflammatory characteristics. Intravenous antibiotics provide an effective treatment of chronic Lyme arthritis.

  17. [Four corner fusion in patients with wrist arthritis].

    Science.gov (United States)

    Vázquez-Alonso, María Francisca; Viñas-Silva, Alberto

    2016-01-01

    Scapholunate advance collapse (SLAC) and Scaphoid nonunion advance collapse (SNAC), are the two most common patterns of postraumatic wrist arthritis. SLAC wrist develops after attenuation, either traumatically or atraumatically, of the scapholunate ligament. Atraumatic causes of SLAC wrist include calcium pyrophosphate dehydrate deposition disease, reumathoid arthritis, neuropathic diseases, and b2-microglobulin asociated amyloid deposition diseases. On the other hand, SNAC wrist develops following a scahpoid fracture that has progressed to a nonunion. Both of these processes lead to abnormal joint kinematics, since the lunate is unrestrained by the distal scaphoid and, therefore, assumes an extended posture. Over time, this may result in Dorsal intercalated segment instability (DISI) deformity, which invariably progresses to degenerative arthritis of the radioescaphoid articulation, followed by carpal collapse and midcarpal arthritis. The purpose of this retrospective study is to evaluate the functional outcome and pain relief in SLAC/SNAC wrist, after four corner fusion. This study was made in 52 patients of the Hospital de Traumatología y Ortopedia Lomas Verdes, these patients undergone four corner fusion surgery, in a period january 2007 to december 2014. We used Quick Dash Questionary to evaluate functional outcome and pain relief in these patients.

  18. Wrist ultrasound analysis of patients with early rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    J.A. Mendonça

    2011-01-01

    Full Text Available In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS and gray scale ultrasound (GSUS with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data. Twenty-one patients (17 women and 4 men with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP. The average disease duration was 14 months. The patients were 66.6% Caucasians and 33.3% non-Caucasians, with a mean age of 42 and 41 years, respectively. A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz transducer. All patients were X-rayed, and the Larsen score was determined for the joints, with grades ranging from 0 to V. This study showed significant correlations between clinical, sonographic and laboratory data: GSUS and swollen right wrist (r = 0.546, GSUS of right wrist and swelling of left wrist (r = 0.511, PDUS of right wrist and pain in left wrist (r = 0.436, PDUS of right wrist and C-reactive protein (r = 0.466. Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.

  19. 21 CFR 888.3810 - Wrist joint ulnar (hemi-wrist) polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint ulnar (hemi-wrist) polymer prosthesis. 888.3810 Section 888.3810 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... (hemi-wrist) polymer prosthesis. (a) Identification. A wrist joint ulnar (hemi-wrist) polymer...

  20. Osteoarthritis of the Wrist STT Joint and Radiocarpal Joint

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    Ronit Wollstein

    2012-01-01

    Full Text Available Our understanding of wrist osteoarthritis (OA lags behind that of other joints, possibly due to the complexity of wrist biomechanics and the importance of ligamentous forces in the function of the wrist. Scaphotrapeziotrapezoidal (STT OA is common, but its role in wrist clinical pathology and biomechanics is unclear. We identified the prevalence of radiographic STT joint OA in our hand clinic population and defined the relationship between STT and radiocarpal OA in wrist radiographs. One hundred consecutive wrist clinical and radiographic exams were retrospectively reviewed. Radiographs were evaluated for the presence and stage of OA. The mean age was 61.3 (±14.5 years. The radiographic occurrence of STT joint OA was 59% and of radiocarpal (RC OA was 29%. Radiographic STT and RC joint OA were inversely related. Tenderness over the STT joint in physical exam was not associated with OA in the STT or other joints. STT OA in our series was not related to wrist pain. These findings support the discrepancy between radiographic and cadaver findings and clinically significant OA in this joint. The inverse relationship between STT and RC OA, as seen in scapholunate advanced collapse (SLAC wrist, requires further biomechanical study.

  1. Osteoarthritis of the Wrist STT Joint and Radiocarpal Joint.

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    Wollstein, Ronit; Clavijo, Julio; Gilula, Louis A

    2012-01-01

    Our understanding of wrist osteoarthritis (OA) lags behind that of other joints, possibly due to the complexity of wrist biomechanics and the importance of ligamentous forces in the function of the wrist. Scaphotrapeziotrapezoidal (STT) OA is common, but its role in wrist clinical pathology and biomechanics is unclear. We identified the prevalence of radiographic STT joint OA in our hand clinic population and defined the relationship between STT and radiocarpal OA in wrist radiographs. One hundred consecutive wrist clinical and radiographic exams were retrospectively reviewed. Radiographs were evaluated for the presence and stage of OA. The mean age was 61.3 (±14.5) years. The radiographic occurrence of STT joint OA was 59% and of radiocarpal (RC) OA was 29%. Radiographic STT and RC joint OA were inversely related. Tenderness over the STT joint in physical exam was not associated with OA in the STT or other joints. STT OA in our series was not related to wrist pain. These findings support the discrepancy between radiographic and cadaver findings and clinically significant OA in this joint. The inverse relationship between STT and RC OA, as seen in scapholunate advanced collapse (SLAC) wrist, requires further biomechanical study.

  2. Ultrasound Doppler Score Correlates with OMERACT RAMRIS Bone Marrow Oedema and Synovitis Score in the Wrist Joint of Patients with Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Boesen, M; Ellegaard, K; Boesen, L;

    2012-01-01

    PURPOSE: MRI is considered the standard of reference for advanced imaging in rheumatoid arthritis (RA). However, in daily clinical practice ultrasound (US) imaging with Doppler information is more versatile and often used for fast and dynamic assessment of joint inflammation. The aim was to compa...

  3. Prosthesis of the wrist-joint

    Energy Technology Data Exchange (ETDEWEB)

    Feldmeier, C.

    1983-02-25

    Function of the hand-joint and the well-being of patients can be severely affected by arthrosis of the wrist-joint. Therapeutically, arthrodesis usually results in a painfree status of stiffness. A painless and well functioning joint can be achieved by alloplastic joint replacement or resurfacing. The possibilities and clinical results in cases of arthrosis of the carpo-metacarpal joint of the thumb, pseudarthrosis of the scaphoid, aseptic necrosis of the Lunate and severe arthrosis of the radio-carpal joint are demonstrated.

  4. Interreader agreement in the assessment of magnetic resonance images of rheumatoid arthritis wrist and finger joints--an international multicenter study

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Klarlund, Mette; Lassere, M

    2001-01-01

    changes on MRI among 5 centers that had not undertaken intergroup calibration. MRI of RA wrist and metacarpophalangeal (MCP) joints were scored by experienced readers in 5 centers in different countries. In substudy 1, 5 sets of 2nd-5th MCP joints from UK [Technique A: 1.5 T, coronal and axial T1 and T2...... spin-echo, -/+ fat saturation (FS), -/+ iv gadolinium (Gd)] were scored for synovitis (score 0-3) and bone lesions (0-3). In substudy 2, we evaluated 19 sets of 2nd-5th MCP joints [10 sets from UK (Technique A) and 9 sets from the US (Technique B: 1.5 T; coronal T1 spin-echo and T2* gradient-echo + FS...

  5. Midcarpal Hemiarthroplasty for Wrist Arthritis: Rationale and Early Results

    OpenAIRE

    Vance, Michael C.; Packer, Greg; Tan, David; Crisco, J.J. Trey; Wolfe, Scott W.

    2012-01-01

    Midcarpal hemiarthroplasty is a novel motion-preserving treatment for radiocarpal arthritis and is an alternative to current procedures that provide pain relief at the expense of wrist biomechanics and natural motion. It is indicated primarily in active patients with a well-preserved distal row and debilitating arthritic symptoms. By resurfacing the proximal carpal row, midcarpal arthroplasty relieves pain while preserving the midcarpal articulation and the anatomic center of wrist rotation. ...

  6. Contribution of arthroscopy in case of septic appearance arthritis of the wrist: a nine cases series.

    Science.gov (United States)

    Hariri, A; Lebailly, F; Zemirline, A; Hendriks, S; Facca, S; Liverneaux, P

    2013-09-01

    Septic arthritis of the wrist is a diagnostic and therapeutic emergency. Synovectomy and lavage by arthrotomy is often followed by stiffness. The purpose of this study was to evaluate the diagnostic and therapeutic contribution of emergency arthroscopic synovectomy with intraarticular lavage. Nine patients were operated on for wrist pathology with septic appearance. All had signs of local inflammation, three showed locoregional inflammation, three were febrile. In one patient several joints were involved. Seven patients presented with inflammatory or degenerative arthritis. All patients underwent emergency surgery using radiocarpal joint puncture, arthroscopic exploration, intraarticular lavage and synovectomy at both the radiocarpal and midcarpal joints. The results were evaluated by pain, Quick DASH, grip strength, and wrist range of motion. In three cases, joint fluid appeared clear, in three it was turbid, and in three purulent. Gram stain and culture revealed bacteria in four cases. Synovitis was radiocarpal four times, radiocarpal and midcarpal once. In one case, there was radiocarpal and midcarpal chondritis. Average pain was 5.3/10 preoperatively and 2/10 at the last clinical follow-up visit. Mean grip strength was 23.3 kg on the involved side vs. 33.5 kg on the opposite one. Mean flexion was 55° for the involved wrist vs. 68°; mean extension was 52° for the affected wrist vs. 59°. No patient was reoperated on. In all cases, there was no sign of local inflammation, regional lymphadenopathy or systemic infection at the last follow-up. One patient died of colon metastatic cancer. Another patient developed a severe Complex Regional Pain Syndrome type I (CRPS1). Our results suggest three principles of management of wrist arthritis with septic appearance: extended surgical indication, emergency operation and arthroscopic procedure.

  7. Midcarpal hemiarthroplasty for wrist arthritis: rationale and early results.

    Science.gov (United States)

    Vance, Michael C; Packer, Greg; Tan, David; Crisco, J J Trey; Wolfe, Scott W

    2012-08-01

    Midcarpal hemiarthroplasty is a novel motion-preserving treatment for radiocarpal arthritis and is an alternative to current procedures that provide pain relief at the expense of wrist biomechanics and natural motion. It is indicated primarily in active patients with a well-preserved distal row and debilitating arthritic symptoms. By resurfacing the proximal carpal row, midcarpal arthroplasty relieves pain while preserving the midcarpal articulation and the anatomic center of wrist rotation. This technique has theoretical advantages when compared with current treatment options (i.e., arthrodesis and total wrist arthroplasty) since it provides coupled wrist motion, preserves radial length, is technically simple, and avoids the inherent risks of nonunion and distal component failure. The KinematX midcarpal hemiarthroplasty has an anatomic design and does not disrupt the integrity of the wrist ligaments. We have implanted this prosthesis in nine patients with promising early results. The indications for surgery were as follows: scapholunate advanced collapse wrist (three), posttraumatic osteoarthritis (three), inflammatory arthritis (two), and Keinböck disease (one). Prospective data has been collected and the results are preliminary given the infancy of the procedure. The mean follow-up was 30.9 weeks (range: 16 to 56 weeks). The mean Mayo wrist score increased from 31.9 preoperatively to 58.8 (p manipulation for wrist stiffness. There was no evidence of prosthetic loosening or capitolunate narrowing. The procedure is simple (average surgical time was 49 minutes) and maintains coupled wrist motion through preservation of the midcarpal articulation. The preliminary data show that it appears safe but considerably longer follow-up is required before conclusions can be drawn as to its durability, reliability, and overall success. The level of evidence for this study is therapeutic level IV (case series).

  8. The instability of wrist joint and total wrist replacement

    Institute of Scientific and Technical Information of China (English)

    Jin-xing Ma; Yong-Qing Xu

    2016-01-01

    Total wrist arthroplasty are not used as widely as total knee and hip replacement.The functional hands are requiring surgeons to design a durable and functional satisfying prosthesis.This article will list the main reasons that cause the failure of the prosthesis.Some remarkable and representative prostheses are listed to show the devolvement of total wrist prosthesis and their individual special innovations to fix the problems,And the second part we will discuss the part that biomechanical elements act in the total wrist replacement (TWA).Summarize and find out what the real problem is and how we can find a way to fix it.

  9. 21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint polymer constrained prosthesis. 888.3780 Section 888.3780 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made...

  10. Inflammatory arthritis-like and other MR findings in wrists of asymptomatic subjects

    Energy Technology Data Exchange (ETDEWEB)

    Robertson, P.L.; Page, P.J.; McColl, G.J. [University of Melbourne, Royal Melbourne Hospital, Radiology Department, Parkville (Australia)

    2006-10-15

    To describe magnetic resonance (MR) imaging findings in the wrists of asymptomatic subjects that might be confused with pathologic findings. MR examination of the dominant wrist was performed in 30 asymptomatic volunteers aged 22-49 years using pre-contrast and post-contrast sequences in the coronal and axial planes. The bases of the metacarpals, the carpus and the distal radius and ulna were evaluated by two musculoskeletal radiologists for lesions, notches, blood vessels and synovial enhancement. There were 24 bright osseous lesions (erosions, intraosseous ganglia, oedema or cysts) in 14 subjects. Intraosseous blood vessels were seen in all but one wrist examined, most commonly in the capitate and lunate bones. Enhancement was present in 26 of 27 notches identified at the base of the second metacarpal and less commonly in the capitate, hamate and triquetral notches. A small joint effusion was present in 14 subjects. Joint or soft-tissue enhancement was identified in 16 wrists. Many MR abnormalities and variants may be detected in the wrists of asymptomatic subjects. Many of these could be confused with pathologic findings usually associated with inflammatory arthritis. (orig.)

  11. Arthritis of the Hand

    Science.gov (United States)

    .org Arthritis of the Hand Page ( 1 ) The hand and wrist have multiple small joints that work together to ... a shoelace. When the joints are affected by arthritis, activities of daily living can be difficult. Arthritis ...

  12. Optimised, low cost, low field dedicated extremity MRI is highly specific and sensitive for synovitis and bone erosions in rheumatoid arthritis wrist and finger joints: comparison with conventional high field MRI and radiography

    DEFF Research Database (Denmark)

    Ejbjerg, B.J; Narvestad, E; Jacobsen, S;

    2005-01-01

    of the wrist and 2nd-5th MCP joints was performed on a low field MRI unit (0.2 T Esaote Artoscan) and a high field MRI unit (1.0 T Siemens Impact) on 2 subsequent days. MRI was performed and evaluated according to OMERACT recommendations. Additionally, conventional x ray, clinical, and biochemical examinations......OBJECTIVE: To evaluate a low field dedicated extremity MRI unit for detection of bone erosions, synovitis, and bone marrow oedema in wrist and metacarpophalangeal (MCP) joints, with a high field MRI unit as the standard reference. METHODS: In 37 patients with RA and 28 healthy controls MRI...... were performed. In an initial low field MRI 'sequence selection phase', based on a subset of 10 patients and 10 controls, sequences for comparison with high field MRI were selected. RESULTS: With high field, spin echo MRI considered as the reference method, the sensitivity, specificity, and accuracy...

  13. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Hansen, M; Stoltenberg, M;

    1999-01-01

    OBJECTIVE: To evaluate the synovial membrane volume, determined by magnetic resonance imaging (MRI), as a marker of joint disease activity and a predictor of progressive joint destruction in rheumatoid arthritis (RA). METHODS: Twenty-six patients with RA, randomized to receive disease-modifying a......OBJECTIVE: To evaluate the synovial membrane volume, determined by magnetic resonance imaging (MRI), as a marker of joint disease activity and a predictor of progressive joint destruction in rheumatoid arthritis (RA). METHODS: Twenty-six patients with RA, randomized to receive disease......-Pratt analysis). The rate of erosive progression on MRI was highly correlated with baseline scores and, particularly, with area under the curve (AUC) values of synovial membrane volume (Spearman's sigma = 0.69, P

  14. MRI of the wrist in juvenile idiopathic arthritis: erosions or normal variants? A prospective case-control study

    Energy Technology Data Exchange (ETDEWEB)

    Ording Muller, Lil-Sofie [University Hospital North Norway, Department of Radiology, Tromsoe (Norway); Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Boavida, Peter [Homerton University Hospital, Department of Radiology, London (United Kingdom); Avenarius, Derk; Eldevik, Odd Petter [University Hospital North Norway, Department of Radiology, Tromsoe (Norway); Damasio, Beatrice [Ospedale Pediatrico Gaslini, Department of Radiology, Genoa (Italy); Malattia, Clara [Ospedale Pediatrico Gaslini, Department of Rhematology, Genoa (Italy); Lambot-Juhan, Karen [Hopital Necker Enfants Malades, Department of Radiology, Paris (France); Tanturri, Laura [Ospedale Pediatrico Bambino Gesu, Department of Radiology, Rome (Italy); Owens, Catherine M. [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); UCL, Institute of Child Health, London (United Kingdom); Rosendahl, Karen [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); UCL, Institute of Child Health, London (United Kingdom); Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Department of Surgical Sciences, Bergen (Norway)

    2013-07-15

    Bony depressions at the wrist resembling erosions are frequently seen on MRI in healthy children. The accuracy of MRI in detecting early bony destruction is therefore questionable. We compared findings on MRI of the wrist in healthy children and those with juvenile idiopathic arthritis (JIA) to investigate markers for true disease. We compared the number and localisation of bony depressions at the wrist in 85 healthy children and 68 children with JIA, ages 5-15 years. The size of the wrist was assessed from a radiograph of the wrist performed on the same day as the MRI. No significant difference in the number of bony depressions in the carpal bones was seen between healthy children and children with JIA at any age. Depressions are found in similar locations in the two groups, except for a few sites, where bony depressions were seen exclusively in the JIA group, particularly at the CMC joints. The wrist was significantly smaller in children with JIA (P < 0.001). Using adult scoring systems and standard MR sequences in the assessment of bone destruction in children may lead to overstaging or understaging of disease. At present, standard MRI sequences cannot easily be used for assessment of early signs of erosions in children. (orig.)

  15. The prevalence of monosodium urate and calcium pyrophosphate crystals in synovial fluid from wrist and finger joints.

    Science.gov (United States)

    Galozzi, Paola; Oliviero, Francesca; Frallonardo, Paola; Favero, Marta; Hoxha, Ariela; Scanu, Anna; Lorenzin, Mariagrazia; Ortolan, Augusta; Punzi, Leonardo; Ramonda, Roberta

    2016-03-01

    The aim of this study was to assess the frequency of monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals in synovial fluids (SFs) aspirated from wrist and finger joints of patients with previously diagnosed joint diseases. We reviewed the results of SF analysis of 1593 samples and identified 126 patients with effusions in the small joints of the hands and wrists. We reported from patients' medical files data about sex, age, diagnosis, disease duration and the microscopic SF results. The prevalence of CPP crystals in SF was 85.71% in CPP-crystals arthritis (CPP-CA), 19.35% in rheumatoid arthritis (RA), 13.89% in osteoarthritis (OA) and 0% in psoriatic arthritis (PsA), spondyloarthritis (SpA), gout and miscellanea. The prevalence of MSU crystals in SF was 83.3% in gout, 10% in PsA, 2.8% in OA and 0% in RA, SpA, miscellanea and CPP-CA. Consistent with previously reported data concerning the big joints, microcrystals can be frequently found also in the small joints of patients with previous diagnosis. The finding underlines the importance of analyzing SF from the hand and wrist joints in the attempt to identify comorbidities associated with the presence of crystals and to develop targeted treatment strategies.

  16. Validation of automatic joint space width measurements in hand radiographs in rheumatoid arthritis

    NARCIS (Netherlands)

    Schenk, Olga; Huo, Yinghe; Vincken, Koen L; van de Laar, Mart A; Kuper, Ina H H; Slump, Kees C H; Lafeber, Floris P J G; Bernelot Moens, Hein J

    2016-01-01

    Computerized methods promise quick, objective, and sensitive tools to quantify progression of radiological damage in rheumatoid arthritis (RA). Measurement of joint space width (JSW) in finger and wrist joints with these systems performed comparable to the Sharp-van der Heijde score (SHS). A next st

  17. Signs of muscle thixotropy during human ballistic wrist joint movements.

    Science.gov (United States)

    Axelson, H W

    2005-11-01

    A study was conducted on healthy subjects to determine whether voluntary ballistic wrist flexion movements are influenced by immediately preceding conditioning of the forearm muscles. Single rapid wrist flexion movements were made in response to an auditory "Go" signal. Rectified surface EMG was recorded from wrist flexors and extensors, and joint position was measured by a goniometer. The movements were preceded (2-3 s) by four different conditioning routines: 40-s rest (Rest), 10-s voluntary alternating wrist joint flexion and extension movements (Osc), and 10 s of 25 degrees weak isometric wrist extensor (Ext) or flexor contractions (Flex). When subjects made ballistic movements after Osc compared with Rest, peak velocity was higher (P = 0.02) and movement time shorter (P = 0.06), but there was no difference (P = 0.83) in motor reaction time (time between the onset of the first agonist burst and movement onset). If the movements were preceded by Ext compared with Flex, motor reaction time was longer (P = 0.01), indicating a longer electromechanical delay. There were no indications that postconditioning differences in agonist or antagonist muscle activity could explain the results. It was also demonstrated that, after Rest, peak velocity was lower (P < 0.01) for the first than for the second of a series of repetitive ballistic movements. The observations corresponded to results from passive experiments in which the median nerve was electrically stimulated. In conclusion, history-dependent (thixotropic) changes in skeletal muscle resistance seem to have implications for voluntary ballistic wrist movements. The study also provided evidence that muscle conditioning influences the central nervous reaction time preceding ballistic contractions.

  18. Damping of the wrist joint during voluntary movement.

    Science.gov (United States)

    Milner, T E; Cloutier, C

    1998-10-01

    Damping characteristics of the musculoskeletal system were investigated during rapid voluntary wrist flexion movements. Oscillations about the final position were induced by introducing a load with the characteristics of negative damping, which artificially reduced the damping of the wrist. Subjects responded to increases in the negatively damped load by stronger cocontraction of wrist flexor and extensor muscles during the stabilization phase of the movement. However, their ability to counteract the effects of the negatively damped load diminished as the negative damping increased. Consequently, the number and frequency of oscillations increased. The oscillations were accompanied by phase-locked muscle activity superimposed on underlying tonic muscle activation. The wrist stiffness and damping coefficient increased with the increased cocontraction that accompanied more negatively damped loads, although changes in the damping coefficient were less systematic than the stiffness. Analysis of successive half-cycles of the oscillation revealed that the wrist stiffness and damping coefficient increased, despite decreasing muscle activation, as oscillation amplitude and velocity declined. This indicates that the inverse dependence of the damping coefficient on oscillation velocity contributes significantly to damping of joint motion. It is suggested that this property helps to offset a negative contribution to damping from the stretch reflex.

  19. Synovitis of the wrist joint caused by an intraarticular perforation of an osteoid osteoma of the scaphoid

    Directory of Open Access Journals (Sweden)

    Praveen Bhardwaj

    2012-01-01

    Full Text Available Uncommon location and atypical presentation of the osteoid osteomas of the scaphoid can pose a diagnostic challenge. Because of its intraarticular location, scaphoid osteoid osteoma can present with synovitis which is the more commonly reported presentation for other intraarticular locations like in hip and elbow and only rarely reported at the wrist. We report a case of perforation of the osteoid osteoma into the wrist joint, resulting in exuberant synovitis. The clinical significance of this report is to reinforce that synovitis can be a presentation of osteoid osteoma and it should be considered in the differential diagnosis of monoarticular arthritis. Prolonged synovitis may cause damage to the other joint surfaces of the wrist and hence carpal osteoid osteoma should be considered for early surgical excision.

  20. 21 CFR 888.3800 - Wrist joint metal/polymer semi-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... cemented prosthesis. 888.3800 Section 888.3800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Wrist joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A wrist joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace a wrist...

  1. Dynamic contrast-enhanced magnetic resonance imaging of the wrist in early arthritis

    Directory of Open Access Journals (Sweden)

    M.A. Cimmino

    2011-09-01

    Full Text Available Objectives: MRI has been proposed as the imaging method of choice to evaluate the long-term outcome in patients with early arthritis. The role of dynamic MRI, performed at presentation, in predicting the outcome of patients with early arthritis has been addressed in the present study. Methods: 39 patients with early arthritis, involving at least one wrist, were studied with clinical visits and laboratory investigations, every 3 months. Dynamic MRI was performed with a low-field (0.2T, extremity-dedicated machine (Artoscan, Esaote, Genova, Italy equipped with a permanent magnet and with a dedicated hand and wrist coil. During the intravenous injection of Gd-DTPA, twenty consecutive fast images of 3 slices of the wrist were acquired. The synovial contrast enhancement ratio was calculated both as rate of early enhancement (REE per second during the first 55” and as relative enhancement (RE at t seconds. Results: In our cohort of patients, REE and RE were significantly lower than those observed in a historical cohort of 36 patients with active rheumatoid arthritis. In univariate analysis, low RE predicted complete remission of arthritis. In multivariate analysis, fulfillment of RA criteria during follow-up was predicted by high RE. The need for immunosuppressive treatment at the end of follow-up was predicted by both low RE and high REE. Conclusions: Dynamic MRI may be used to predict several outcomes of early arthritis involving the wrist

  2. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis.

    Science.gov (United States)

    Shah, Chirag M; Stern, Peter J

    2013-03-01

    Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the two most common patterns of posttraumatic wrist arthritis. This review discusses the etiology and clinical evaluation, as well as up-to-date treatment options, for both of these conditions. Classic as well as newer innovative techniques are discussed with clinical outcomes in order to provide an evidence-based review of the world's literature on SLAC/SNAC wrist.

  3. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis

    OpenAIRE

    Shah, Chirag M.; Stern, Peter J.

    2013-01-01

    Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the two most common patterns of posttraumatic wrist arthritis. This review discusses the etiology and clinical evaluation, as well as up-to-date treatment options, for both of these conditions. Classic as well as newer innovative techniques are discussed with clinical outcomes in order to provide an evidence-based review of the world’s literature on SLAC/SNAC wrist.

  4. Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Tehranzadeh, J.; Ashilyan, O.; Anavim, A.; Tramma, S. [Univ. of California, Orange (United States). Dept. of Radiological Sciences

    2006-11-15

    The purpose of this study is to describe the appearance of tenosynovitis in various tendon groups in the wrist and hand and to compare MR enhanced and non-enhanced imaging evaluation of tenosynovitis of hand and wrist in inflammatory arthritis. We reviewed 72 MRI studies of hands and wrists, including coronal, axial and sagittal images in 30 consecutive patients with inflammatory arthritis and tenosynovitis. We compared the degree of synovitis on T2-weighted vs contrast-enhanced T1-weighted images, using a predetermined scale. We also measured the extent of tenosynovitis in three dimensions. The tendons were assigned to volar, dorsal, ulnar and radial groups in the wrist and to extensor, flexor and thumb groups in the hand. Degree of tenosynovitis (graded 0-3), cross-sectional area and volume of the inflamed synovium in various tendon groups were then compared by statistical analysis. Review of the medical records revealed the following diagnoses in our patient population: rheumatoid arthritis (n=16), unspecified inflammatory polyarthritis (n=9), psoriatic arthritis (n=2), CREST syndrome (n=1), systemic lupus erythematosus (n=1), paraneoplastic syndrome with arthritis (n=1). The average T2 brightness scores and post-gadolinium enhancement scores were 1.0 and 1.7 respectively (P<0.001) in the wrist studies. The average T2 brightness scores and post-gadolinium enhancement scores were 0.7 and 1.4, respectively (P<0.001) in the hand studies. The average sensitivity of T2-weighted imaging for detection of tenosynovitis was 40% in the hand and 67% in the wrist tendons, when contrast-enhanced images were used as a reference. Carpal tunnel flexor tendons were the most frequently affected tendons of the wrist. The most frequently affected tendons of the hand were second and third flexor tendons. The hand flexors demonstrated higher degrees of enhancement and larger volumes of the inflamed tenosynovium than did the hand extensors and tendons of the thumb.

  5. Rheumatoid arthritis affecting temporomandibular joint.

    Science.gov (United States)

    Sodhi, Amandeep; Naik, Shobha; Pai, Anuradha; Anuradha, Ardra

    2015-01-01

    Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune inflammatory disorder that is characterized by joint inflammation, erosive properties and symmetric multiple joint involvement. Temporomandibular joint (TMJ) is very rare to be affected in the early phase of the disease, thus posing diagnostic challenges for the dentist. Conventional radiographs fail to show the early lesions due to its limitations. More recently cone-beam computed tomography (CBCT) has been found to diagnose the early degenerative changes of TMJ and hence aid in the diagnosis of the lesions more accurately. Our case highlights the involvement of TMJ in RA and the role of advanced imaging (CBCT) in diagnosing the bony changes in the early phase of the disease.

  6. Rheumatoid arthritis affecting temporomandibular joint

    Directory of Open Access Journals (Sweden)

    Amandeep Sodhi

    2015-01-01

    Full Text Available Rheumatoid arthritis (RA is a chronic, systemic, autoimmune inflammatory disorder that is characterized by joint inflammation, erosive properties and symmetric multiple joint involvement. Temporomandibular joint (TMJ is very rare to be affected in the early phase of the disease, thus posing diagnostic challenges for the dentist. Conventional radiographs fail to show the early lesions due to its limitations. More recently cone-beam computed tomography (CBCT has been found to diagnose the early degenerative changes of TMJ and hence aid in the diagnosis of the lesions more accurately. Our case highlights the involvement of TMJ in RA and the role of advanced imaging (CBCT in diagnosing the bony changes in the early phase of the disease.

  7. Symptomatic manubriosternal joint involvement in rheumatoid arthritis.

    OpenAIRE

    1989-01-01

    The manubriosternal joint is commonly involved in rheumatoid arthritis but rarely gives rise to symptoms. A patient is reported with seropositive, erosive rheumatoid arthritis, who developed symptoms resembling pleuritic pain, arising from synovitis of the manubriosternal joint. Treatment with intra-articular steroid injection resolved these symptoms rapidly.

  8. Symptomatic manubriosternal joint involvement in rheumatoid arthritis.

    Science.gov (United States)

    Doube, A; Clarke, A K

    1989-06-01

    The manubriosternal joint is commonly involved in rheumatoid arthritis but rarely gives rise to symptoms. A patient is reported with seropositive, erosive rheumatoid arthritis, who developed symptoms resembling pleuritic pain, arising from synovitis of the manubriosternal joint. Treatment with intra-articular steroid injection resolved these symptoms rapidly.

  9. 21 CFR 888.3790 - Wrist joint metal constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint metal constrained cemented prosthesis... constrained cemented prosthesis. (a) Identification. A wrist joint metal constrained cemented prosthesis is a... as cobalt-chromium-molybdenum, and is limited to those prostheses intended for use with bone...

  10. 21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a...

  11. 21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a...

  12. 21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a...

  13. Gouty wrist arthritis causing carpal tunnel syndrome--a case report.

    Science.gov (United States)

    Sikkandar, M F; Sapuan, J; Singh, R; Abdullah, S

    2012-06-01

    A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome. He gave history of bilateral wrist pain associated with numbness over the median nerve distribution of the hand. Tinels sign and Phalens test were positive with no obvious thenar muscle wasting on examination. Tophaceous deposits in the flexor tendons and within the synovium of the wrist joint was seen during surgery and this established gout as the cause of median nerve entrapment in this patient.

  14. The influence of elbow joint kinematics on wrist speed in cricket fast bowling.

    Science.gov (United States)

    Middleton, Kane Jytte; Alderson, Jacqueline Anne; Elliott, Bruce Clifford; Mills, Peter Michael

    2015-01-01

    This modelling study sought to describe the relationships between elbow joint kinematics and wrist joint linear velocity in cricket fast bowlers, and to assess the sensitivity of wrist velocity to systematic manipulations of empirical joint kinematic profiles. A 12-camera Vicon motion analysis system operating at 250 Hz recorded the bowling actions of 12 high performance fast bowlers. Empirical elbow joint kinematic data were entered into a cricket bowling specific "Forward Kinematic Model" and then subsequently underwent fixed angle, angular offset and angle amplification manipulations. A combination of 20° flexion and 20° abduction at the elbow was shown to maximise wrist velocity within the experimental limits. An increased elbow flexion offset manipulation elicited an increase in wrist velocity. Amplification of elbow joint flexion-extension angular displacement indicated that, contrary to previous research, elbow extension range of motion and angular velocity at the time of ball release were negatively related to wrist velocity. Some relationships between manipulated joint angular waveforms and wrist velocity were non-linear, supporting the use of a model that accounts for the non-linear relationships between execution and outcome variables in assessing the relationships between elbow joint kinematics and wrist joint velocity in cricket fast bowlers.

  15. Pre- and post-operative comorbidities in idiopathic carpal tunnel syndrome: cervical arthritis, basal joint arthritis of the thumb, and trigger digit.

    Science.gov (United States)

    Kim, J H; Gong, H S; Lee, H J; Lee, Y H; Rhee, S H; Baek, G H

    2013-01-01

    We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.

  16. Detailed Joint Region Analysis of the 7-Joint Ultrasound Score: Evaluation of an Arthritis Patient Cohort over One Year

    Directory of Open Access Journals (Sweden)

    S. Ohrndorf

    2013-01-01

    Full Text Available Objective. The main objective of this study was to evaluate the 7-joint ultrasound (US7 score by detailed joint region analysis of an arthritis patient cohort. Methods. The US7 score examines the clinically most affected wrist, MCP and PIP II, III, MTP II, and V joints for synovitis, tenosynovitis/paratenonitis, and erosions. Forty-five patients with rheumatoid arthritis (RA (84.4% and spondyloarthritis with polyarticular peripheral arthritis (PsA 13.3%; AS 2.2% with a median disease duration of 6.5 yrs (range 7.5 mths–47.6 yrs were included and examined at baseline and 3, 6, and 12 months after starting or changing therapy (DMARD/biologic. In this study, detailed US7 score joint region analysis was firstly performed. Results. The joint region analysis performed at baseline disclosed synovitis in 95.6% of affected wrists in the dorsal aspect by greyscale (GS US where Grade 2 (moderate was most often (48.9% detected. Palmar wrist regions presented Grade 1 (minor capsule elevation in 40% and Grade 2 (moderate synovitis in 37.8%. Tenosynovitis of the extensor carpi ulnaris (ECU tendon was found in 40%, with PD activity in 6.6%. Most of the erosions in MCP II were detected in the radial (68.9%, followed by the dorsal (48.9% and palmar (44.4% aspects. In MTP V, erosions were seen in 75.6% from lateral. Conclusions. Synovitis in GSUS was more often detected in the wrist in the dorsal than in the palmar aspect. ECU tendon involvement was frequent. Most erosions were found in the lateral scan of MTP V and the medial (radial scan of MCP II.

  17. The effect of strapping on the motor performance of the ankle and wrist joints.

    Science.gov (United States)

    Kauranen, K; Siira, P; Vanharanta, H

    1997-08-01

    The purpose of this study was to examine the effect of strapping on different components of motor performance of wrist and ankle joints. The subjects were 14 healthy volunteers (12 females, two males), aged 21-33 years, with no known previous injuries of the ankle and wrist joints. The measurements were made with the HPM/BEP system and Isokinetic Lido Active Multi-joint system. First, the subjects performed the test without strapping and then, on the following day, with strapped right wrist and ankle joints. The strapping of the wrist increased the simple reaction time by 9%, choice reaction time by 9% and decreased the wrist tapping speed by 21%. Wrist strength decreased in flexion (180 degrees/s) by 14% and ulnar deviation (180 degrees/s) by 8%. The strapping of the ankle increased the simple reaction time by 12%, choice reaction time by 9% and decreased foot tapping speed by 14%. Ankle strength in plantar flexion decreased in 60 degrees/s by 22% and 180 degrees/s by 14% and in inversion in 60 degrees/s by 28% and 180 degrees/s by 15%. These results suggest the strapping of ankle and wrist joints reduces motor performance in the above-mentioned directions as measured by the following parameters: simple reaction time, choice reaction time, tapping speed, and muscle strength.

  18. Chondrocalcinosis of the wrist.

    Science.gov (United States)

    Saffar, P

    2004-10-01

    Calcium Pyrophosphate Dihydrate Deposition (CPDD) disease has characteristic radiographic features including soft tissue calcification, joint space narrowing, bone sclerosis, subchondral cyst formation without osteophyte formation, and large intraosseous geodes. Triangular fibrocartilage calcification is frequently found and isolated scapho-trapezio-trapezoid (STT) arthritis is specific for CPDD. Distal radio-ulnar (DRUJ), isolated midcarpal joint and piso-triquetral joint involvement also occur. 127 patients were reviewed. Seventy-eight had symptomatic STT joint arthritis, for which 36 underwent surgery. Twenty-two patients had a SLAC wrist deformity for which ten underwent surgery. Eight patients had isolated midcarpal arthritis for which three midcarpal arthrodeses, two four-bone arthrodeses and two carpal tunnel releases were performed. Nineteen patients had a generalized arthritis and seven of the patients underwent surgery: four-corner arthrodesis+scaphoidectomy (one case), carpal tunnel release (two cases) extensor synovectomy (two cases) and trigger finger release (two cases).

  19. Evaluation of effects of different treatments for the wrist joints of subdominant hands using joint proprioception and writing time.

    Science.gov (United States)

    Hu, Chunying; Huang, Qiuchen; Yu, Lili; Hu, Yue; Rongming, Xia; Li, Zhou; Xiaojiao, Fu; Gu, Rui; Cui, Yao; Ge, Meng; Xu, Yanfeng; Liu, Jianfeng

    2016-05-01

    [Purpose] The purpose of this study was to examine immediate effects of strength training and NJF distal resistance training in wrist joints by using writing time and evaluation of proprioception using the JPE test. [Subjects and Methods] The subjects were 12 young healthy people (24.2 ± 3.1 y, 169.7 ± 6.5 cm, 65.3 ± 12.6 kg). Two isotonic contraction techniques were applied on the wrist joint: wrist joint extension muscle strength training (MST) and the wrist joint extension pattern of NJF. The uppercase English alphabet writing time and joint position errors of the left upper limb were measured before and after one intervention session of MST and NJF. [Results] The decrease in errors in wrist extension angle repetition and the writing time represented the improvement resulting from NJF. [Conclusion] This result suggests that the subdominant hands wrist joint proprioception and writing function can be improved by NJF together with proximal resistance training.

  20. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Hansen, M; Stoltenberg, M;

    1999-01-01

    -modifying antirheumatic drug (DMARD) therapy alone (11 patients) or DMARDs in combination with oral prednisolone (15 patients), were followed up for 1 year with contrast-enhanced MRI of the dominant wrist (months 0, 3, 6, and 12), conventional radiography (months 0 and 12), and clinical and biochemical examinations. Bone...... erosion (by MRI and radiography) and synovial membrane volumes (by MRI) were assessed. RESULTS: Significant synovial membrane volume reductions were observed after 3 and 6 months in the DMARD + prednisolone group, and after 6 and 12 months in the DMARD-alone group (P ...-Pratt analysis). The rate of erosive progression on MRI was highly correlated with baseline scores and, particularly, with area under the curve (AUC) values of synovial membrane volume (Spearman's sigma = 0.69, P

  1. Wrist joint moments of walker-assisted gait:a study of biomechanics and instrumentation

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    While walkers are commonly prescribed to improve patient stability and ambulatory ability,quantitativestudy of the biomechanical and functional requirements for effective walker use is limited.To investigate the changesin wrist joint moments that occur with the use of a standard walker,a strain gauge-based walker instrumentation system was developed for the measurement of wrist joint moments.This walker dynamometer was integrated with an upper extremity biomechanical model.Preliminary system data were collected for twelve healthy,right-handed young adultsfollowing informed consent.Bilateral upper extremity kinematic data were acquired with a six-camera motion analysis system.Internal joint moments at the wrist were determined in the three clinical planes using the inverse dynamics method.Results showed that during a walker-assisted gait there were several typical demands of wrist abductor,adductor,flexor and external rotator.An interesting " bare phase " of wrist joint moments was also found in phaseangle[-30°,30°] of gait cycle.Complete description of wrist joint moments during walker-assisted gait may provide insight into walker use parameters and rehabilitative strategies.

  2. Wrist and digital joint motion produce unique flexor tendon force and excursion in the canine forelimb.

    Science.gov (United States)

    Lieber, R L; Silva, M J; Amiel, D; Gelberman, R H

    1999-02-01

    The force and excursion within the canine digital flexor tendons were measured during passive joint manipulations that simulate those used during rehabilitation after flexor tendon repair and during active muscle contraction, simulating the active rehabilitation protocol. Tendon force was measured using a small buckle placed upon the tendon while excursion was measured using a suture marker and video analysis method. Passive finger motion imposed with the wrist flexed resulted in dramatically lower tendon force (approximately 5 N) compared to passive motion imposed with the wrist extended (approximately 17 N). Lower excursions were seen at the level of the proximal interphalangeal joint with the wrist flexed (approximately 1.5 mm) while high excursion was observed when the wrist was extended or when synergistic finger and wrist motion were imposed (approximately 3.5 mm). Bivariate discriminant analysis of both force and excursion data revealed a natural clustering of the data into three general mechanical paradigms. With the wrist extended and with either one finger or four fingers manipulated, tendons experienced high loads of approximately 1500 g and high excursions of approximately 3.5 mm. In contrast, the same manipulations performed with the wrist flexed resulted in low tendon forces (4-8 N) and low tendon excursions of approximately 1.5 mm. Synergistic wrist and finger manipulation provided the third paradigm where tendon force was relatively low (approximately 4 N) but excursion was as high as those seen in the groups which were manipulated with the wrist extended. Active muscle contraction produced a modest tendon excursion (approximately 1 mm) and high or low tendon force with the wrist extended or flexed, respectively. These data provide the basis for experimentally testable hypotheses with regard to the factors that most significantly affect functional recovery after digital flexor tendon injury and define the normal mechanical operating characteristics

  3. Septic arthritis in the temporomandibular joint

    Directory of Open Access Journals (Sweden)

    Hassan Mahdi Al-Khalisy

    2015-01-01

    Full Text Available Septic arthritis of the temporomandibular joint (TMJ is a rare event that has only been reported a few dozen times worldwide. This case is remarkable for septic arthritis of the TMJ joint in an otherwise healthy male. Case Report: A 24-year-old male presented to the emergency department with periauricular swelling, erythema, fever, myalgia′s and generalized joint pain. He had previously sought medical attention and was placed on ciprofloxacin. However, he developed facial swelling and a rash and had to discontinue the antibiotic. On physical exam the patient had a large swelling and tenderness in his left periauricular area, with erythema and deviation of the right mandible which limited his ability to open the mouth. A computed tomography showed mild asymmetric soft tissue swelling in the left pharyngeal region but did not show joint effusion. Subsequent magnetic resonance imaging did show effusion of the joint space. The effusion was drained, and the synovial fluid was submitted for gram stain, culture, and sensitivity. The cultures grew menthicillin sensitive Staphyloccocus Aureus. The patient was discharged to complete a two week course of intravenous (IV Ceftriaxone and IV Vancomycin via home infusion. Conclusion: Septic Arthritis of the TMJ is a rare event with very specific clinical symptoms. Due to the low sensitivity of the computed tomography scan, magnetic resonance imaging should be considered when computed tomography scan is negative for TMJ effusion.

  4. Role of Scaphoid in the Abduction and Adduction Movements of Wrist Joint

    Directory of Open Access Journals (Sweden)

    Sadik I Shaikh

    2013-06-01

    Full Text Available Background: Being a carpal bone scaphoid has an important role in wrist movements. Wrist joint is a synovial modified ellipsoid joint where movements like flexion, extension and adduction, abduction take place around two axes (transverse and antero-posterior. These movements at the wrist joint are associated with considerable range of movements at the mid carpal joint, as same group of muscles act on both of these joints. Methodology: A study has been done amongst 120 persons at the tertiary care hospital during the period from 2006-07 to detect the important movements of scaphoid bone specially during the abduction and adduction of wrist joint (which occur in association with the intercarpal joints and also to detect whether such movements have any speciality in the population. Results: In fully abducted position, it was 45o among 53.3% subjects and the average among all the subjects was 60o. So, the degree of abduction was 30o. The extent of movement was more in adduction (ie, 1.90 cm - 1.03 cm = 0.87 cm than in abduction (ie, 1.03 cm - 0.72 cm = 0.31cm. Conclusion: It was found in this study that the scaphoid acts as a link bone between the two rows of carpal bones and prevents the buckling of midcarpal joint especially of the capitato- lunate joint interface. [Natl J Med Res 2013; 3(3.000: 253-256

  5. Arthroscopically assisted Sauvé-Kapandji procedure: an advanced technique for distal radioulnar joint arthritis.

    Science.gov (United States)

    Luchetti, Riccardo; Khanchandani, Prakash; Da Rin, Ferdinando; Borelli, Pierpaolo P; Mathoulin, Christophe; Atzei, Andrea

    2008-12-01

    Osteoarthritis of distal radioulnar joint (DRUJ) leads to chronic wrist pain, weakness of grip strength, and limitation of motion, all of which affect the quality of life of the patient. Over the years, several procedures have been used for the treatment of this condition; however, this condition still remains a therapeutic challenge for the hand surgeons. Many procedures such as Darrach procedure, Bower procedure, Sauvé-Kapandji procedure, and ulnar head replacement have been used. Despite many advances in wrist arthroscopy, arthroscopy has not been used for the treatment of arthritis of the DRUJ. We describe a novel technique of arthroscopically assisted Sauvé-Kapandji procedure for the arthritis of the DRUJ. The advantages of this technique are its less invasive nature, preservation of the extensor retinaculum, more anatomical position of the DRUJ, faster rehabilitation, and a better cosmesis.

  6. Septic arthritis of the manubriosternal joint.

    Science.gov (United States)

    Peng, Edward W K; McKillop, Graham; Prasad, Sai; Walker, William S

    2007-03-01

    Pyarthrosis of the manubriosternal joint is exceedingly rare. Its rarity defies an early diagnosis, and other causes of chest pain would normally be ruled out first. We describe a patient with a short history of chest pain, pyrexia, and raised inflammatory markers. A destroyed manubriosternal joint with a large abscess was found during surgical exploration. This case illustrates an unusually rapid development of septic arthritis involving a fibrocartilaginous joint in an otherwise healthy young man. Nine other cases have been described in the literature and are reviewed. Early diagnosis followed by adequate surgical drainage and antibiotic therapy led to a good outcome.

  7. Development of an Underactuated 2-DOF Wrist Joint using McKibben PAMs

    Science.gov (United States)

    Rajagopal, S. P.; Jain, S.; Ramasubramanian, S. N.; Johnson, B. V.; Dwivedy, S. K.

    2014-10-01

    In this work, model of an underactuated 2-DOF wrist joint with pneumatically actuated muscles is proposed. For the joint, McKibben-type artificial muscles are used in parallel configuration for the actuation. For each Degree of Freedom (DOF) one agonist-antagonist pair arrangement is usually used with a pulley mechanism. A mathematical model of wrist joint is derived using conventional forward kinematic analysis. The static model relating pressure in the muscle with the orientation of the wrist joint is obtained by combining the experimental data and mathematical model. Regulation of pressure can be achieved by pulse width modulation control of on/off solenoid valves. A set of free vibration experiments are done for the dynamic identification of the muscle characteristics.

  8. Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain.

    Science.gov (United States)

    Moraux, A; Lefebvre, G; Pansini, V; Aucourt, J; Vandenbussche, L; Demondion, X; Cotten, A

    2014-06-01

    Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment.

  9. Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain

    Energy Technology Data Exchange (ETDEWEB)

    Moraux, A. [Hopital Roger Salengro, Service d' Imagerie Musculo-Squelettique, Centre de Consultation de l' Appareil Locomoteur, CHRU Lille (France); Imagerie Medicale Jacquemars Gielee, Lille (France); Lefebvre, G.; Pansini, V.; Aucourt, J.; Vandenbussche, L.; Cotten, A. [Hopital Roger Salengro, Service d' Imagerie Musculo-Squelettique, Centre de Consultation de l' Appareil Locomoteur, CHRU Lille (France); Demondion, X. [Hopital Roger Salengro, Service d' Imagerie Musculo-Squelettique, Centre de Consultation de l' Appareil Locomoteur, CHRU Lille (France); Pole Recherche Faculte de Medecine de Lille, Laboratoire d' Anatomie, Lille (France)

    2014-06-15

    Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment. (orig.)

  10. Effects of Neoprene Wrist/Hand Splints on Handwriting for Students with Joint Hypermobility Syndrome: A Single System Design Study

    Science.gov (United States)

    Frohlich, Lauren; Wesley, Alison; Wallen, Margaret; Bundy, Anita

    2012-01-01

    Purpose: Pain associated with hypermobility of wrist and hand joints can contribute to decreased handwriting output. This study examined the effectiveness of a neoprene wrist/hand splint in reducing pain and increasing handwriting speed and endurance for students with joint hypermobility syndrome. Methods: Multiple baseline, single system design…

  11. ТREATMENT STRATEGY OF FLEXION CONTRACTURE OF THE WRIST JOINT IN CHILDREN WITH CEREBRAL PALSY

    Directory of Open Access Journals (Sweden)

    Владимир Александрович Новиков

    2014-09-01

    Full Text Available Objectives. The objective of study was to assess the effectiveness of transplantation of m. flexor carpi ulnaris tendon on the place of m. extensor carpi radialis brevis / longus (Green operation to eliminate the deficit of active wrist joint extension in children with cerebral palsy. Materials and methods. The present study is based on a survey of children with cerebral palsy with affected upper limb. The main criterion for selection of patients was the presence of active extension deficit in the wrist joint, both isolated and in combination with other contractures of the upper limb joints. Total 22 patients with spastic forms of cerebral palsy were examined. Results and conclusions. Green operation is a good method of surgical treatment of active extension deficit in the wrist joint in patients with cerebral palsy. In the presence of moderately severe contractures in the wrist joint, serial casting can eliminate them completely. Presence of a fixed pronation contracture of the forearm is a factor that reduces the effectiveness of FCU transplantation. Pronation contracture should be corrected before or during Green surgery. FCU transplantation is effective for children of any age, but its effectiveness is reduced from 12 years old.

  12. Brucellar Arthritis Involving Left Sternoclavicular Joint

    Directory of Open Access Journals (Sweden)

    Senem Şaş

    2016-09-01

    Full Text Available Brucellosis is a widely spread zoonosis and an important global public health problem, especially in the Mediterranean region. Brucellosis is a systemic infectious disease, and it is transmitted to humans by consumption of raw milk or its by-products as well as by contact with products of infected animals. Clinical findings differ depending on the Brucella species, the host, and the duration of illness. The diagnosis of brucellosis is made by positive culture. Since the organism is cultured on blood, the examination is made primarily on the basis of suspicion as well as the high levels of humoral antibody titer. The disease may cause various complications. The most common complications of brucellosis are osteoarticular complications, including arthritis, bursitis, and tendinitis. In this report, brucellar arthritis involving the sternoclavicular joint (STCJ is presented. In this report we present a rare example of an osteoarticular complication caused by brucellosis

  13. [Ankle joint arthritis--etiology, diagnosis and treatment].

    Science.gov (United States)

    Uri, Ofir; Haim, Amir

    2008-11-01

    Ankle joint arthritis causes functional limitation and affects the quality of life many patients. It follows traumatic injuries, inflammatory joint arthritis, primary osteoarthritis, hemochromatosis and infections. Understanding the unique anatomy and biomechanics of the ankle is important for diagnosis and treatment of ankle joint pathology. The treatment of ankle joint arthritis has advanced considerably in recent years and it is still a surgical challenge. Total ankle replacement seems to be a promising form of treatment, even though current data does not demonstrate advantages over ankle joint arthrodesis.

  14. New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Hansen, Michael; Stoltenberg, Michael;

    2003-01-01

    progression on CR associated with the presence of MRI erosions. METHODS: In 10 patients with rheumatoid arthritis, MRI and CR of the dominant wrist were performed annually for 5 years. In each image set, each wrist bone (metacarpal bases, carpal bones, radius, and ulna) was assessed for the absence...

  15. Prognostic laboratory markers of joint damage in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Lindqvist, E; Henriksen, Karen Eberhardt; Bendtzen, K;

    2005-01-01

    To investigate whether determination of a set of laboratory markers at baseline provides prognostic information on joint damage in hands and feet in rheumatoid arthritis.......To investigate whether determination of a set of laboratory markers at baseline provides prognostic information on joint damage in hands and feet in rheumatoid arthritis....

  16. Bone and Joint Infections in Children: Septic Arthritis.

    Science.gov (United States)

    Agarwal, Anil; Aggarwal, Aditya N

    2016-08-01

    The pathological invasion of a joint and subsequent inflammation is known as septic arthritis. The knee and hip are the most frequently involved joints. Staphylococcus aureus is the most common cause of septic arthritis in children. An acute onset of illness with an inflamed painful joint and restricted movements and inability to use joint (pseudoparalysis) clinically indicates septic arthritis. The diagnosis is difficult in a neonate or young child where refusal to feed, crying, discomfort during change of diaper (if hip is involved) or attempted joint movement may be the only findings. Fever and other systemic signs may also be absent in neonates. Septic arthritis is diagnosed clinically, supported by appropriate radiological and laboratory investigations. The peripheral blood white cell count is frequently raised with a predominance of polymorphonuclear cells. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often markedly raised. Ultrasonography and MRI are preferred investigations in pediatric septic arthritis. Determination of infecting organism in septic arthritis is the key to the correct antibiotic choice, treatment duration and overall management. Joint aspirate and/or blood culture should be obtained before starting antibiotic treatment. Several effective antibiotic regimes are available for managing septic arthritis in children. Presence of large collections, thick pus, joint loculations and pus evacuating into surrounding soft tissues are main indications for surgical drainage. Joint aspiration can be a practical alternative in case the lesion is diagnosed early, with uncomplicated presentations and superficial joints.

  17. MRI findings of the wrist in patients with multiple osteonecrosis in large joints of the extremities

    Energy Technology Data Exchange (ETDEWEB)

    Saitoh, Shinobu; Ebata, Tatsuki; Abe, Kazuhiro [Chiba Univ. (Japan). School of Medicine; Imai, Katsumi; Rokkaku, Tomoyuki

    1998-02-01

    We evaluated MRI findings of the wrist in patients who had multiple osteonecrosis in the large joints of their extremities (hips, knees, shoulders, and ankles) and compared these with the clinical symptoms and radiographical findings. Sixty wrists of 30 patients (3 males and 27 females) with multiple osteonecrosis were studied. Subjects ranged in age from 16 to 59 years. Their primary diseases were SLE in 24 patients, alcoholic osteonecrosis in two, Sjoegren`s syndrome in one, dermatomyositis in one, leukemia in one, and MCTD in one patient. Using MRI, we found osteonecrosis in seven wrists of four patients. Lesions were seen in six scaphoids of three patients, in two lunates of two patients, and in one capitate. We noted a reduced range of motion in three of the seven wrists with osteonecrosis. Two of the seven complained at wrist pain at motion, although three wrists were symptom free. Radiographically, an abnormality was recognized in two of the seven wrists. Generally, osteonecrosis of the lunate (Kienboeck`s disease) is more frequent than that of the scaphoid (Preiser`s disease). However in the present series, we found a higher osteonecrosis rate of the scaphoid than the lunate, using MRI. The discrepancy can be explained by the vascularity. In 1986, Gelberman reported that the scaphoid, the capitate, and 8% of the lunate had either vessels entering only one surface or large areas of bone that were dependent on a single vessel. The present study is consistent with these anatomical features. In other words, the present results demonstrated that Kienboeck`s disease can be induced not only by a deficient blood supply but also by some additional factors. (author)

  18. High-temporospatial-resolution dynamic contrast-enhanced (DCE) wrist MRI with variable-density pseudo-random circular Cartesian undersampling (CIRCUS) acquisition: evaluation of perfusion in rheumatoid arthritis patients.

    Science.gov (United States)

    Liu, Jing; Pedoia, Valentina; Heilmeier, Ursula; Ku, Eric; Su, Favian; Khanna, Sameer; Imboden, John; Graf, Jonathan; Link, Thomas; Li, Xiaojuan

    2016-01-01

    This study is to evaluate highly accelerated three-dimensional (3D) dynamic contrast-enhanced (DCE) wrist MRI for assessment of perfusion in rheumatoid arthritis (RA) patients. A pseudo-random variable-density undersampling strategy, circular Cartesian undersampling (CIRCUS), was combined with k-t SPARSE-SENSE reconstruction to achieve a highly accelerated 3D DCE wrist MRI. Two healthy volunteers and 10 RA patients were studied. Two patients were on methotrexate (MTX) only (Group I) and the other eight were treated with a combination therapy of MTX and anti-tumor necrosis factor (TNF) therapy (Group II). Patients were scanned at baseline and 3 month follow-up. DCE MR images were used to evaluate perfusion in synovitis and bone marrow edema pattern in the RA wrist joints. A series of perfusion parameters was derived and compared with clinical disease activity scores of 28 joints (DAS28). 3D DCE wrist MR images were obtained with a spatial resolution of 0.3 × 0.3 × 1.5 mm(3) and temporal resolution of 5 s (with an acceleration factor of 20). The derived perfusion parameters, most notably transition time (dT) of synovitis, showed significant negative correlations with DAS28-ESR (r = -0.80, p perfusion in RA joints, showing promise as a potential tool for evaluating treatment responses.

  19. Indicators for detection of septic arthritis in the acutely swollen joint cohort of those without joint prostheses.

    Science.gov (United States)

    Roberts, John; Schaefer, Eric; Gallo, Robert A

    2014-02-01

    Differentiating septic arthritis from culture-negative, acute atraumatic joint effusion is difficult. Studies have attempted to elucidate factors that herald infection, but, due to overlap, most conclude that the diagnosis ultimately relies on clinical judgment. Furthermore, studies are limited by broad inclusion criteria. The current retrospective case study sought to examine (1) which markers differentiate a culture-positive septic joint from culture-negative effusion in patients suspicious for infection despite no growth on Gram stain and without previous surgery in the affected joint and (2) whether threshold values of these markers exist that predict septic arthritis. The study was performed by reviewing records of those who underwent operative irrigation and debridement involving the shoulder, elbow, wrist, hip, knee, and ankle. Patients were included if they were older than 18 years and had an acutely swollen/painful joint and no organisms on initial Gram stain. Exclusion criteria were lack of serum markers or synovial fluid aspirate, antibiotics within 1 week, adjacent wound or skin infection, recent trauma to the joint, and previous joint infection or surgery to the joint. Several clinical, serological, and synovial parameters were collected and analyzed using paired t test with Bonferonni correction. Serum C-reactive protein was the only significantly different variable between groups. Serum C-reactive protein greater than 10.5 mg/dL was predictive of infection. In those suspicious for infection despite no growth on Gram stain and without previous surgery in the affected joint, C-reactive protein greater than 10.5 mg/dL is suspicious for joint sepsis and should warrant consideration for urgent irrigation and debridement.

  20. Septic arthritis of the acromioclavicular joint: an uncommon location.

    Science.gov (United States)

    Martínez-Morillo, Melania; Mateo Soria, Lourdes; Riveros Frutos, Anne; Tejera Segura, Beatriz; Holgado Pérez, Susana; Olivé Marqués, Alejandro

    2014-01-01

    Septic pyogenic arthritis of the acromioclavicular joint is a rare entity that occurs in immunosuppressed patients or those with discontinuity of defense barriers. There are only 15 cases described in the literature. The diagnosis is based on clinical features and the isolation of a microorganism in synovial fluid or blood cultures. The evidence of arthritis by imaging (MRI, ultrasound or scintigraphy) may be useful. Antibiotic treatment is the same as in septic arthritis in other locations. Staphylococcus aureus is the microorganism most frequently isolated. Our objective was to describe the clinical features, treatment and outcome of patients diagnosed with septic arthritis of the acromioclavicular joint at a Rheumatology Department. We developed a study with a retrospective design (1989-2012). The medical records of patients with septic arthritis were reviewed (101 patients). Those involving the acromioclavicular joint were selected (6 patients; 6%).

  1. Effect of Combination Therapy on Joint Destruction in Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Graudal, N.; Hubeck-Graudal, T.; Tarp, S.

    2014-01-01

    on progression of radiographic joint erosions in patients with rheumatoid arthritis (RA). Methods and Findings: The following combination drug therapies compared versus single DMARD were investigated: Double DMARD: 2 DMARDs (methotrexate, sulfasalazine, leflunomide, injectable gold, cyclosporine, chloroquine...

  2. The effect of tendon loading on in-vitro carpal kinematics of the wrist joint.

    Science.gov (United States)

    Foumani, M; Blankevoort, L; Stekelenburg, C; Strackee, S D; Carelsen, B; Jonges, R; Streekstra, G J

    2010-06-18

    Measurements of in-vitro carpal kinematics of the wrist provide valuable biomechanical data. Tendon loading is often applied during cadaver experiments to simulate natural stabilizing joint compression in the wrist joint. The purpose of this study was to investigate the effect of tendon loading on carpal kinematics in-vitro. A cyclic movement was imposed on 7 cadaveric forearms while the carpal kinematics were acquired by a 4-dimensional rotational X-ray imaging system. The extensor- and flexor tendons were loaded with constant force springs of 50 N, respectively. The measurements were repeated without a load on the tendons. The effect of loading on the kinematics was tested statistically by using a linear mixed model. During flexion and extension, the proximal carpal bones were more extended with tendon loading. The lunate was on the average 2.0 degrees (p=0.012) more extended. With tendon loading the distal carpal bones were more ulnary deviated at each angle of wrist motion. The capitate was on the average 2.4 degrees (p=0.004) more ulnary deviated. During radioulnar deviation, the proximal carpal bones were more radially deviated with the lunate 0.7 degrees more into radial deviation with tendon loading (pcarpal kinematics during flexion-extension and radioulnar deviation.

  3. Subtalar joint septic arthritis in a patient with hypogammaglobulinemia.

    Science.gov (United States)

    Wynes, Jacob; Harris, William; Hadfield, Robert A; Malay, D Scot

    2013-01-01

    The clinical presentation of a monoarticular, red, hot, and swollen joint has many possible diagnoses, including septic arthritis, which is 1 of the most devastating. The morbidity associated with this pathologic process involves permanent joint damage and the potential for progression to systemic illness and, even, mortality. The common risk factors for joint sepsis include a history of rheumatoid arthritis, previous joint surgery, joint prosthesis, intravenous drug abuse, alcoholism, diabetes, previous intra-articular steroid use, and cutaneous ulceration. The diagnosis is primarily determined from the culture results after arthrocentesis and correlation with direct visualization, imaging, and various serologies, including synovial analysis. In the present report, a case of an insidious presentation of subtalar joint septic arthritis and its association with a unique patient presentation concomitant with primary immunodeficiency and culture-proven Myocplasma hominis infection is discussed. Septic arthritis has a predilection for the lower extremities and typically is isolated to the hip or knee, with less common involvement of the ankle or metatarsophalangeal joints. Owing to the uncommon nature of primary immunodeficiency disorders and the paucity of studies discussing their association with septic arthridites, we aimed to raise awareness of subtalar joint septic arthritis and to provide a brief overview of the pathogenesis as it presented in a 33-year-old male with X-linked hypogammaglobulinemia/agammaglobulinema.

  4. [Septic arthritis of the temporomandibular joint: report of one case].

    Science.gov (United States)

    Pintor, Fernanda; Carrasco, Rolando; Verdugo-Avello, Francisco; Landaeta, Mirtha

    2015-06-01

    Septic arthritis of the temporomandibular joint (TMJ) is an uncommon condition, caused by hematic bacterial migration or direct migration of other head and neck infections. We report a 41 year old female who presented a right temporomandibular joint involvement, with bone destruction of the mandibular condyle and an infectious process spreading to the temporal space, following a necrotizing medial and external otitis with associated mastoiditis. A septic arthritis of the TMJ by continuity was diagnosed and treated with antimicrobials, TMJ arthrocentesis and occlusal stabilization, with a positive evolution. However, the patient remains in control due a secondary TMJ osteoarthritis caused by the septic arthritis.

  5. Semiautomated three-dimensional segmentation software to quantify carpal bone volume changes on wrist CT scans for arthritis assessment.

    Science.gov (United States)

    Duryea, J; Magalnick, M; Alli, S; Yao, L; Wilson, M; Goldbach-Mansky, R

    2008-06-01

    Rapid progression of joint destruction is an indication of poor prognosis in patients with rheumatoid arthritis. Computed tomography (CT) has the potential to serve as a gold standard for joint imaging since it provides high resolution three-dimensional (3D) images of bone structure. The authors have developed a method to quantify erosion volume changes on wrist CT scans. In this article they present a description and validation of the methodology using multiple scans of a hand phantom and five human subjects. An anthropomorphic hand phantom was imaged with a clinical CT scanner at three different orientations separated by a 30-deg angle. A reader used the semiautomated software tool to segment the individual carpal bones of each CT scan. Reproducibility was measured as the root-mean-square standard deviation (RMMSD) and coefficient of variation (CoV) between multiple measurements of the carpal volumes. Longitudinal erosion progression was studied by inserting simulated erosions in a paired second scan. The change in simulated erosion size was calculated by performing 3D image registration and measuring the volume difference between scans in a region adjacent to the simulated erosion. The RMSSD for the total carpal volumes was 21.0 mm3 (CoV = 1.3%) for the phantom, and 44.1 mm3 (CoV = 3.0%) for the in vivo subjects. Using 3D registration and local volume difference calculations, the RMMSD was 1.0-3.0 mm3 The reader time was approximately 5 min per carpal bone. There was excellent agreement between the measured and simulated erosion volumes. The effect of a poorly measured volume for a single erosion is mitigated by the large number of subjects that would comprise a clinical study and that there will be many erosions measured per patient. CT promises to be a quantifiable tool to measure erosion volumes and may serve as a gold standard that can be used in the validation of other modalities such as magnetic resonance imaging.

  6. Wrist osteoarthritis.

    Science.gov (United States)

    Laulan, J; Marteau, E; Bacle, G

    2015-02-01

    Painful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint disease, although wrist osteoarthritis occurs as an idiopathic condition in a small minority of cases. Surgery is indicated only when conservative treatment fails. The main objective is to ensure pain relief while restoring strength. Motion-preserving procedures are usually preferred, although residual wrist mobility is not crucial to good function. The vast array of available surgical techniques includes excisional arthroplasty, limited and total fusion, total wrist denervation, partial and total arthroplasty, and rib-cartilage graft implantation. Surgical decisions rest on the cause and extent of the degenerative wrist lesions, degree of residual mobility, and patient's wishes and functional demand. Proximal row carpectomy and four-corner fusion with scaphoid bone excision are the most widely used surgical procedures for stage II wrist osteoarthritis secondary to scapho-lunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist. Proximal row carpectomy is not indicated in patients with stage III disease. Total wrist denervation is a satisfactory treatment option in patients of any age who have good range of motion and low functional demands; furthermore, the low morbidity associated with this procedure makes it a good option for elderly patients regardless of their range of motion. Total wrist fusion can be used not only as a revision procedure, but also as the primary surgical treatment in heavy manual labourers with wrist stiffness or generalised wrist-joint involvement. The role for pyrocarbon implants, rib-cartilage graft implantation, and total wrist arthroplasty remains to be determined, given the short follow-ups in available studies.

  7. MRI of the wrist in juvenile idiopathic arthritis: proposal of a paediatric synovitis score by a consensus of an international working group. Results of a multicentre reliability study

    Energy Technology Data Exchange (ETDEWEB)

    Damasio, Maria Beatrice; Mattiuz, Chiara; Magnano, GianMichele [Ospedale Pediatrico Gaslini, Department of Radiology, Genova (Italy); Malattia, Clara; Martini, Alberto [University of Genova, Department of Paediatrics, Genova (Italy); Tanturri de Horatio, Laura; Barbuti, Domenico; Toma, Paolo [Ospedale Pediatrico Bambino Gesu, Department of Radiology, Rome (Italy); Pistorio, Angela [Ospedale pediatrico Gaslini, Department of Epidemiology and Biostatistics, Genova (Italy); Bracaglia, Claudia [Ospedale Pediatrico Bambino Gesu, Department of Rheumatology, Rome (Italy); Boavida, Peter; Ording, Lil Sophie Mueller [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Juhan, Karen Lambot [Hopital Necker Enfants Malades, Department of Radiology, Paris (France); Rosendahl, Karen [University Hospital North Norway, Department of Radiology, Tromsoe (Norway)

    2012-09-15

    MRI is a sensitive tool for the evaluation of synovitis in juvenile idiopathic arthritis (JIA). The purpose of this study was to introduce a novel MRI-based score for synovitis in children and to examine its inter- and intraobserver variability in a multi-centre study. Wrist MRI was performed in 76 children with JIA. On postcontrast 3-D spoiled gradient-echo and fat-suppressed T2-weighted spin-echo images, joint recesses were scored for the degree of synovial enhancement, effusion and overall inflammation independently by two paediatric radiologists. Total-enhancement and inflammation-synovitis scores were calculated. Interobserver agreement was poor to moderate for enhancement and inflammation in all recesses, except in the radioulnar and radiocarpal joints. Intraobserver agreement was good to excellent. For enhancement and inflammation scores, mean differences (95 % CI) between observers were -1.18 (-4.79 to 2.42) and -2.11 (-6.06 to 1.83). Intraobserver variability (reader 1) was 0 (-1.65 to 1.65) and 0.02 (-1.39 to 1.44). Intraobserver agreement was good. Except for the radioulnar and radiocarpal joints, interobserver agreement was not acceptable. Therefore, the proposed scoring system requires further refinement. (orig.)

  8. Unusual combined fracture dislocation of the wrist and metacarpophalangeal joints: a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Mohamed Faouzi Hamdi

    2011-01-01

    Volar perilunate fracture dislocation is an extremely rare carpal injury, but associated with metacarpophalangeal joint dislocation of both the ipsilateral index and middle finger has never been reported. We report one case of a 28-year-old man following a high-energy trauma.After performing closed reduction of the metacarpophalangeal joint injury, open reduction of the wrist injury through volar approach was done, and a K-wire fixation was used to stabilize the scaphoid fracture and lunotriquetral joint. After a 16 months' follow-up period, the wrist regained a full range of motion without symptoms, and the fractured bone was strengthened in a good position.

  9. Three groups in the 28 joints for rheumatoid arthritis synovitis--analysis using more than 17,000 assessments in the KURAMA database.

    Directory of Open Access Journals (Sweden)

    Chikashi Terao

    Full Text Available Rheumatoid arthritis (RA is a joint-destructive autoimmune disease. Three composite indices evaluating the same 28 joints are commonly used for the evaluation of RA activity. However, the relationship between, and the frequency of, the joint involvements are still not fully understood. Here, we obtained and analyzed 17,311 assessments for 28 joints in 1,314 patients with RA from 2005 to 2011 from electronic clinical chart templates stored in the KURAMA (Kyoto University Rheumatoid Arthritis Management Alliance database. Affected rates for swelling and tenderness were assessed for each of the 28 joints and compared between two different sets of RA patients. Correlations of joint symptoms were analyzed for swellings and tenderness using kappa coefficient and eigen vectors by principal component analysis. As a result, we found that joint affected rates greatly varied from joint to joint both for tenderness and swelling for the two sets. Right wrist joint is the most affected joint of the 28 joints. Tenderness and swellings are well correlated in the same joints except for the shoulder joints. Patients with RA tended to demonstrate right-dominant joint involvement and joint destruction. We also found that RA synovitis could be classified into three categories of joints in the correlation analyses: large joints with wrist joints, PIP joints, and MCP joints. Clustering analysis based on distribution of synovitis revealed that patients with RA could be classified into six subgroups. We confirmed the symmetric joint involvement in RA. Our results suggested that RA synovitis can be classified into subgroups and that several different mechanisms may underlie the pathophysiology in RA synovitis.

  10. Computer-aided and manual quantifications of MRI synovitis, bone marrow edema-like lesions, erosion and cartilage loss in rheumatoid arthritis of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Haitao [The First Affiliated Hospital of Chongqing Medical University, Department of Radiology, Chongqing (China); University of California, San Francisco (UCSF), Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Rivoire, Julien; Hoppe, Michael; Link, Thomas M.; Li, Xiaojuan [University of California, San Francisco (UCSF), Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Srikhum, Waraporn [University of California, San Francisco (UCSF), Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Thammasat University, Department of Radiology, Pathumthani (Thailand); Imboden, John [San Francisco General Hospital, University of California, Department of Medicine, San Francisco and Division of Rheumatology, San Francisco, CA (United States)

    2014-12-10

    To investigate the reliability and validity of computer-aided automated and manual quantification as well as semiquantitative analysis for MRI synovitis, bone marrow edema-like lesions, erosion and cartilage loss of the wrist in rheumatoid arthritis (RA) compared to the OMERACT-RAMRIS. Wrist MRI was performed at 3 T in 16 patients with RA. Synovial volume and perfusion, bone marrow edema-like lesion (BMEL) volume, signal intensity and perfusion, and erosion dimensions were measured manually and using an in-house-developed automated software algorithm; findings were correlated with the OMERAC-RAMRIS gradings. In addition, a semiquantitative MRI cartilage loss score system was developed. Intraclass correlation coefficients (ICCs) were used to test the reproducibility of these quantitative and semiquantitative techniques. Spearman correlation coefficients were calculated between lesion quantifications and RAMRIS and between the MRI cartilage score and radiographic Sharp van der Heijde joint space narrowing scores. The intra- and interobserver ICCs were excellent for synovial, BMEL and erosion quantifications and cartilage loss grading (all >0.89). The synovial volume, BMEL volume and signal intensity, and erosion dimensions were significantly correlated with the corresponding RAMRIS (r = 0.727 to 0.900, p < 0.05). Synovial perfusion parameter maximum enhancement (Emax) was significantly correlated with synovitis RAMRIS (r = 0.798). BMEL perfusion parameters were not correlated with the RAMRIS BME score. Cartilage loss gradings from MRI were significantly correlated with the Sharp joint space narrowing scores (r = 0.635, p = 0.008). The computer-aided, manual and semiquantitative methods presented in this study can be used to evaluate MRI pathologies in RA with excellent reproducibility. Significant correlations with standard RAMRIS were found in the measurements using these methods. (orig.)

  11. Cricoarytenoid joint involvement in rheumatoid arthritis: radiologic evaluation.

    Science.gov (United States)

    Greco, Antonio; Fusconi, Massimo; Macri, Gian Franco; Marinelli, Caterina; Polettini, Elisabetta; Benincasa, Anna Teresa; de Vincentiis, Marco

    2012-01-01

    Rheumatoid arthritis rarely involves the cricoarytenoid joint. The possible consequent symptom includes hoarseness, dysphagia, odynophagia, dysfunctional dysphonia, and acute dyspnea. Etiologic diagnosis is possible with high-resolution computed tomography, which can show spacing of the articular cartilage, density and volume alterations, and subluxation of the cartilage. However, these radiologic signs are not pathognomonic for rheumatoid arthritis, and they should be combined with anamnestic data.

  12. Septic arthritis of the temporomandibular joint: a case report.

    Science.gov (United States)

    Yang, Sung-Won; Cho, Jin-Yong; Kim, Hyeon-Min

    2016-08-01

    Septic arthritis of the temporomandibular joint (TMJ) is a rare disease. The most common symptoms of this disease are acute malocclusion, limited mouth opening, swelling, and tenderness of affected TMJ. These symptoms are often confused with internal derangement of the articular disc, rheumatoid arthritis, retrodiscitis, or osteoarthritis. Therefore, differential diagnosis by image examination is required. Usually, antimicrobial treatment and surgical drainage by needle aspiration, arthroscopy, or arthrotomy are effective treatment approaches. In this study, a patient who was diagnosed with septic arthritis was treated with arthrocentesis and antibiotics without significant complications. We present a case report with a review of the literature.

  13. Magnetic resonance imaging for the wrist joint of the coal miners in vibration department

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, X.Z.; Liu, R.L.; Hu, S.D.; Zhang, W.; Xu, W.X.; Ge, L.X. [Central Hospital of Zaozhuang Mine Corporation, Zaozhuang (China)

    2006-04-15

    To study the magnetic resonance imaging (MRI) in the wrist joint of coal miners who work in excavation and vibration department. Forty-three coal miners with the hand-arm vibration disease served as the observation group while 20 workers who were not working in the vibration department acted as the control group. The patients in the observation group were divided into five subgroups according to the time when they received vibration. The regularity of the development of signs and symptoms of MRI was observed and analyzed. The hydroarthrosis was most found in MRI. There were significant difference in hydroarthrosis osteoporosis and osteomyelitis between the observation group and the control group. The edema of bone marrow and the avascular necrosis of ossa carpi were found only in the observation group and not found in the control group. The hydroarthrosis and the edema of bone marrow occurred most in the early stage of vibration. The signal in the edema of the bone marrow of the distal end of the radius was decreased in the GE sequence with the specificity. Changes in the wrist joint occur in the early stage of the vibration work, and can be found in the MRI. The edema of the bone marrow of the distal end of the radius is of great value in the diagnosis of the hand-arm vibration disease.

  14. Principles and experimentation of wrist prostheses of the universal joint type.

    Science.gov (United States)

    Kapandji, I A

    1982-01-01

    The till now wrist prosthesis have a poor rotatory stability either they are flexible or rigid; specially the spheric ones, they are unable, from their very conception, to transmit the pronation-supination; the condylar ones have an incomplete stability because of their insufficient embedding. The prono-supination transmission needs a "universal joint" prosthesis, whose sellar surfaces are deeply embedded; so, it is possible to get in the same time firm stability and normal ranges of motion. The articular components, crescent roll shaped, are chained each other in perpendicularly plans and fixed in the radius and in the carpus-metacarpus. This is the mono-articular prosthesis, radio-carpal, type A. With an ulna piece, articulated with the radial one by a spherical pivot, we have a bi-articular prosthesis, type B, including the lower radio-ulnar joint: so we have the true total wrist prosthesis. Experimented on cadaveric specimens, these two prostheses, inserted by dorsal approach, have physiologic ranges of motion and absolute rotatory stability. Further studies may define the best dimensions of the prosthesis according to individual variations and ancillary tools set, before beginning the clinical experimentation.

  15. Antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease: a cost effectiveness analysis

    NARCIS (Netherlands)

    P. Krijnen (Pieta); C.J. Kaandorp; E.W. Steyerberg (Ewout); D. van Schaardenburg (Dirkjan); H.J. Moens; J.D.F. Habbema (Dik)

    2001-01-01

    textabstractOBJECTIVE: To assess the cost effectiveness of antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease. METHODS: In a decision analysis, data from a prospective study on bacterial arthritis in 4907 patients with joint dise

  16. Load transfer through the radiocarpal joint and the effects of partial wrist arthrodesis on carpal bone behaviour: a finite element study.

    Science.gov (United States)

    Gíslason, M K; Stansfield, B; Bransby-Zachary, M; Hems, T; Nash, D H

    2012-11-01

    A finite element model of the wrist was developed to simulate mechanical changes that occur after surgery of the wrist. After partial arthrodesis, the wrist will experience altered force transmission during loading. Three different types of partial arthrodesis were investigated - radiolunate, radioscaphoid, and radioscapholunate - and compared with the healthy untreated wrist. The results showed that the compressive forces on the radiocarpal joint decreased compared with the untreated wrist with both radiolunate and radioscaphoid fusions. The load transmission through the midcarpal joints varied depending on arthrodesis type. The forces in the extrinsic ligaments decreased with the fusion, most noticeably in the dorsal radiotriquetral ligament, but increased in the dorsal scaphotriquetral ligament. From the results of the study it can be concluded that the radioscapholunate fusion shows the most biomechanically similar behaviour out of the three fusion types compared with the healthy wrist. The modelling described in this paper may be a useful approach to pre-operative planning in wrist surgery.

  17. Septic arthritis of the temporomandibular joint in an infant

    Directory of Open Access Journals (Sweden)

    Raymond Chuk

    2015-07-01

    Full Text Available Infantile temporomandibular joint septic arthritis is an uncommon paediatric infection, but one which carries the potential for severe morbidity and mortality. Early diagnosis and aggressive medical and possibly surgical management is indicated for the best outcomes. The presenting clinical features are non-specific in a neonate and an infant; as such a high degree of clinical suspicion is required. We present the case of an eleven-month-old boy who has made a full recovery from an acute temporomandibular joint septic arthritis and review the relevant literature.

  18. Septic Arthritis of the Temporomandibular Joint in an Infant.

    Science.gov (United States)

    Chuk, Raymond; Arvier, John; Laing, Barbara; Coman, David

    2015-04-24

    Infantile temporomandibular joint septic arthritis is an uncommon paediatric infection, but one which carries the potential for severe morbidity and mortality. Early diagnosis and aggressive medical and possibly surgical management is indicated for the best outcomes. The presenting clinical features are non-specific in a neonate and an infant; as such a high degree of clinical suspicion is required. We present the case of an eleven-month-old boy who has made a full recovery from an acute temporomandibular joint septic arthritis and review the relevant literature.

  19. No erosive progression revealed by MRI in rheumatoid arthritis patients treated with etanercept, even in patients with persistent MRI and clinical signs of joint inflammation

    DEFF Research Database (Denmark)

    Døhn, Uffe Møller; Skjødt, Henrik; Hetland, Merete;

    2007-01-01

    The aim of this study is to investigate the course of magnetic resonance imaging (MRI) signs of inflammatory and destructive changes in rheumatoid arthritis (RA) wrist and metacarpophalangeal (MCP) joints during etanercept treatment. MRI of the non-dominant wrist and second to fifth MCP joints...... was performed in five clinical active RA patients before and 4 and 16 weeks after initiation of etanercept treatment. MRI was evaluated according to the EULAR-OMERACT RA MRI reference image atlas. The median 28-joint count disease activity score (DAS28; erythrocyte sedimentation rate based) was 5.6 (range 5...... patient showed erosive regression, while no patient showed erosive progression on MRI during 16 weeks of etanercept therapy; even though clinical and MRI signs of joint inflammation remained. This small study supports that erosive progression judged by MRI is minimal in RA patients treated with etanercept...

  20. Early biomarkers of joint damage in rheumatoid and psoriatic arthritis.

    Science.gov (United States)

    Mc Ardle, Angela; Flatley, Brian; Pennington, Stephen R; FitzGerald, Oliver

    2015-06-01

    Joint destruction, as evidenced by radiographic findings, is a significant problem for patients suffering from rheumatoid arthritis and psoriatic arthritis. Inherently irreversible and frequently progressive, the process of joint damage begins at and even before the clinical onset of disease. However, rheumatoid and psoriatic arthropathies are heterogeneous in nature and not all patients progress to joint damage. It is therefore important to identify patients susceptible to joint destruction in order to initiate more aggressive treatment as soon as possible and thereby potentially prevent irreversible joint damage. At the same time, the high cost and potential side effects associated with aggressive treatment mean it is also important not to over treat patients and especially those who, even if left untreated, would not progress to joint destruction. It is therefore clear that a protein biomarker signature that could predict joint damage at an early stage would support more informed clinical decisions on the most appropriate treatment regimens for individual patients. Although many candidate biomarkers for rheumatoid and psoriatic arthritis have been reported in the literature, relatively few have reached clinical use and as a consequence the number of prognostic biomarkers used in rheumatology has remained relatively static for several years. It has become evident that a significant challenge in the transition of biomarker candidates to clinical diagnostic assays lies in the development of suitably robust biomarker assays, especially multiplexed assays, and their clinical validation in appropriate patient sample cohorts. Recent developments in mass spectrometry-based targeted quantitative protein measurements have transformed our ability to rapidly develop multiplexed protein biomarker assays. These advances are likely to have a significant impact on the validation of biomarkers in the future. In this review, we have comprehensively compiled a list of candidate

  1. Early biomarkers of joint damage in rheumatoid and psoriatic arthritis.

    LENUS (Irish Health Repository)

    Mc Ardle, Angela

    2015-01-01

    Joint destruction, as evidenced by radiographic findings, is a significant problem for patients suffering from rheumatoid arthritis and psoriatic arthritis. Inherently irreversible and frequently progressive, the process of joint damage begins at and even before the clinical onset of disease. However, rheumatoid and psoriatic arthropathies are heterogeneous in nature and not all patients progress to joint damage. It is therefore important to identify patients susceptible to joint destruction in order to initiate more aggressive treatment as soon as possible and thereby potentially prevent irreversible joint damage. At the same time, the high cost and potential side effects associated with aggressive treatment mean it is also important not to over treat patients and especially those who, even if left untreated, would not progress to joint destruction. It is therefore clear that a protein biomarker signature that could predict joint damage at an early stage would support more informed clinical decisions on the most appropriate treatment regimens for individual patients. Although many candidate biomarkers for rheumatoid and psoriatic arthritis have been reported in the literature, relatively few have reached clinical use and as a consequence the number of prognostic biomarkers used in rheumatology has remained relatively static for several years. It has become evident that a significant challenge in the transition of biomarker candidates to clinical diagnostic assays lies in the development of suitably robust biomarker assays, especially multiplexed assays, and their clinical validation in appropriate patient sample cohorts. Recent developments in mass spectrometry-based targeted quantitative protein measurements have transformed our ability to rapidly develop multiplexed protein biomarker assays. These advances are likely to have a significant impact on the validation of biomarkers in the future. In this review, we have comprehensively compiled a list of candidate

  2. [Comparative outcome assessment of the wrist joint--mediocarpal partial arthrodesis and total arthrodesis].

    Science.gov (United States)

    Krimmer, H; Wiemer, P; Kalb, K

    2000-11-01

    Total wrist fusion still represents the main treatment for severe posttraumatic disorders of the wrist due to longstanding scaphoid nonunion (SNAC-wrist) or scapholunate dissociation (SLAC-wrist). During the last decade, midcarpal fusion has become more and more popular as it preserves motion. The question, however, remained if the preserved motion is of real benefit from a patient point of view, as complete pain relief is rare following this type of limited wrist fusion. The purpose of this study was to compare the outcome of both treatments with the modified Cooney wrist score and the DASH questionnaire. Between 1993 and 1997, 138 patients with progressive carpal collapse were treated either by midcarpal fusion (97) or total wrist fusion (41). Overall satisfaction was high in both groups with 86% (midcarpal fusion) and 84% (total wrist fusion). The traditional wrist score (70 versus 52 points) and the DASH questionnaire (33 versus 45 points) revealed the superiority of midcarpal fusion. The correlation between the wrist score and the DASH was statistically high (p wrist fusion for treatment of progressive carpal collapse (SLAC- and SNAC-wrist). The DASH represents a sensitive tool to evaluate the outcome of salvage procedures for treatment of disorders of the wrist.

  3. Clinical and radiological manifestations of the rheumatoid wrist after the Sauvé-Kapandji procedure.

    Science.gov (United States)

    Momohara, Shigeki; Mamizuka, Kyoko; Yonemoto, Kouichi; Tomatsu, Taisuke; Inoue, Kazuhiko

    2004-01-01

    A retrospective study was performed to investigate the clinical and radiological results of the Sauvé-Kapandji (S-K) procedure for the rheumatoid wrist. One hundred and eight rheumatoid wrists in 98 patients were operated on in our institute from 1992 to 2000, and in 82 wrists we used the S-K procedure. In other cases, synovectomy alone was performed on 16 wrists, and partial and total arthrodeses were performed concurrently on 5 wrists each. Carpal bones and/or radiocarpal joints in which the union could not be assessed radiologically were found in 49 wrists (59.8%) after the S-K procedure, and among them there was definite non-fusion of the carpal bone and radiocarpal joints in 29 wrists (35.4%). However, definite fusion of carpal bones and/or radiocarpal joints was found in 33 wrists (40.2%). The formation of carpal bones and partial radiocarpal fusion with some mobility was detected in some cases. Therefore, the S-K procedure may stabilize the carpus in the rheumatoid wrist to some extent while maintaining a functionally important range of motion and relieving pain. However, it does not stop the disease process and cannot reestablish or maintain carpal height. We concluded that the S-K procedure is the treatment of choice for the rheumatoid wrist, and if the wrist is unstable, as seen with arthritis mutilans, we then perform either radio-lunate partial arthrodesis or total wrist arthrodesis.

  4. Comparison of regression models for estimation of isometric wrist joint torques using surface electromyography

    Directory of Open Access Journals (Sweden)

    Menon Carlo

    2011-09-01

    Full Text Available Abstract Background Several regression models have been proposed for estimation of isometric joint torque using surface electromyography (SEMG signals. Common issues related to torque estimation models are degradation of model accuracy with passage of time, electrode displacement, and alteration of limb posture. This work compares the performance of the most commonly used regression models under these circumstances, in order to assist researchers with identifying the most appropriate model for a specific biomedical application. Methods Eleven healthy volunteers participated in this study. A custom-built rig, equipped with a torque sensor, was used to measure isometric torque as each volunteer flexed and extended his wrist. SEMG signals from eight forearm muscles, in addition to wrist joint torque data were gathered during the experiment. Additional data were gathered one hour and twenty-four hours following the completion of the first data gathering session, for the purpose of evaluating the effects of passage of time and electrode displacement on accuracy of models. Acquired SEMG signals were filtered, rectified, normalized and then fed to models for training. Results It was shown that mean adjusted coefficient of determination (Ra2 values decrease between 20%-35% for different models after one hour while altering arm posture decreased mean Ra2 values between 64% to 74% for different models. Conclusions Model estimation accuracy drops significantly with passage of time, electrode displacement, and alteration of limb posture. Therefore model retraining is crucial for preserving estimation accuracy. Data resampling can significantly reduce model training time without losing estimation accuracy. Among the models compared, ordinary least squares linear regression model (OLS was shown to have high isometric torque estimation accuracy combined with very short training times.

  5. Juvenile idiopathic arthritis overview and involvement of the temporomandibular joint: prevalence, systemic therapy.

    Science.gov (United States)

    Carrasco, Ruy

    2015-02-01

    The temporomandibular joint (TMJ) is one of the many joints involved in the inflammatory arthritides. As imaging of joints has developed, so have the data regarding extent and prevalence of TMJ involvement in these diseases. TMJ disease is especially prevalent in juvenile arthritis. The adult and pediatric inflammatory arthritides share common pathophysiology but are still markedly different. The preponderance of TMJ arthritis research exists in juvenile arthritis. This article discusses classification, treatment, and TMJ involvement in juvenile idiopathic arthritis.

  6. Iliacus pyomyositis mimicking septic arthritis of the hip joint.

    Science.gov (United States)

    Chen W-S; Wan Y-L

    1996-01-01

    The iliacus muscle is closely associated with the psoas muscle, femoral nerve, hip joint, pelvic and intraabdominal structures; thus, its disorders may present as lower abdominal pain, hip pain, or femoral neuropathy. Iliacus pyomyositis, a primary bacterial infection of the skeletal muscle not secondary to a contiguous skin, bone, or soft-tissue infection, presenting as hip pain, femoral neuropathy, and sympathetic effusion of the hip joint in an 8-year-old boy mimicked septic arthritis of the hip joint. Computed tomography was helpful in delineating the accurate location of the lesion. Surgical drainage and appropriate antibiotic therapy led to complete resolution and full functional recovery.

  7. Rheumatoid Arthritis

    Science.gov (United States)

    Rheumatoid arthritis (RA) is a form of arthritis that causes pain, swelling, stiffness and loss of function in ... wrist and fingers. More women than men get rheumatoid arthritis. It often starts in middle age and is ...

  8. [Treatment Strategies for Septic Arthritis of the Sternoclavicular Joint].

    Science.gov (United States)

    Kuhtin, O; Schmidt-Rohlfing, B; Dittrich, M; Lampl, L; Hohls, M; Haas, V

    2015-10-01

    Septic arthritis of the sternoclavicular joint (SCJ) is a relatively rare disease. Due to serious complications including mediastinitis and generalised sepsis early diagnosis and rapid onset of treatment are mandatory. The disease often affects immunocompromised patients, diabetics, or patients with other infectious diseases. The therapeutic options range from administration of antibiotics to extended surgery including reconstructive procedures. Apart from rare situations where conservative treatment with antibiotics is sufficient, joint resection followed by plastic surgical procedures are required. We present a retrospective analysis with data from two hospitals. From January 2008 to December 2012 23 patients with radiographically confirmed septic arthritis of various aetiology were included. Fourteen (60.8 %) male, nine (39.2 %) female patients with an average age of 60.3 ± 14.2 years (range: 23-88 years) with septic arthritis of the SCJ were treated. Seven (30.4 %) patients suffered from Diabetes mellitus, nine (39.1 %) had underlying diseases with a compromised immune system. In 14 (60.8 %) out of 23 patients a bacterial focus was detected. Only six (26 %) patients suffered from confined septic arthritis of the SCG, in 17 (73,9 %) patients osteomyelitis of the adjacent sternum, and the clavicle was present. In addition, 15 (65.2 %) patients already suffered from mediastinitis at the time of diagnosis, eight (35 %) patients even from septicaemia. In conclusion, septic arthritis requires an active surgical treatment. Limited incision of the joint and debridement alone is only successful at early stages of the disease. The treatment concept has to include the local joint and bone resection as well as complications like mediastinitis. After successful treatment of the infection, the defect of the chest wall requires secondary reconstructive surgery using a pedicled pectoralis muscle flap.

  9. Arthritis

    Science.gov (United States)

    ... injected into painful joints or given by mouth. Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat autoimmune arthritis. They include methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide. ...

  10. Characterization of nitrotyrosine as a biomarker for arthritis and joint injury

    DEFF Research Database (Denmark)

    Misko, T P; Radabaugh, M R; Highkin, M

    2013-01-01

    OBJECTIVES: To characterize the utility of nitrotyrosine (NT) as a biomarker for arthritis and joint injury. DESIGN: Synovial fluid, plasma, and urine from patients diagnosed with osteoarthritis (OA), rheumatoid arthritis (RA), anterior cruciate ligament (ACL) injury, meniscus injury and pseudogout...

  11. Photoacoustic imaging of inflammatory arthritis in human joints

    Science.gov (United States)

    Jo, Janggun; Xu, Guan; Marquardt, April; Francis, Sheeja; Yuan, Jie; Girish, Dhanuj; Girish, Gandikota; Wang, Xueding

    2016-02-01

    The ducal imaging with photoacoustic imaging (PAI) that is an emerging technology and clinical ultrasound imaging that is an established modality is developed for the imaging of early inflammatory arthritis. PAI is sensitive to blood volume, not limited by flow like ultrasound, holding great promise for the earliest detection of increase in blood volume and angiogenesis - a key early finding inflammation PAI has the capability of assessing inflammation in superficial human soft tissues, offering potential benefits in diagnosis, treatment and monitoring of inflammatory arthritis. PAI combined with ultrasonography (US), is a real time dual-modality system developed and tested to identify active synovitis in metacarpophalangeal (MCP) joints of 10 arthritis patients and 10 normal volunteers. Photoacoustic images of the joints were acquired at 580-nm laser wavelength, which provided the desired balance between the optical contrast of hemoglobin over bone cortex and the imaging depth. Confirmed by US Doppler imaging, the results from ten patients and ten normal volunteers demonstrated satisfactory sensitivity of PAI in assessing enhanced blood flow due to active synovitis. This preliminary study suggests that photoacoustic imaging, by identifying early increase in blood volume, related to increased vascularity, a hallmark of joint inflammation, could be a valuable supplement to musculoskeletal US.

  12. Septic arthritis of the distal interphalangeal joint in 12 horses.

    Science.gov (United States)

    Honnas, C M; Welch, R D; Ford, T S; Vacek, J R; Watkins, J P

    1992-01-01

    The medical records of 12 horses with septic arthritis of a distal interphalangeal joint were reviewed to determine clinical features and response to treatment. Sepsis was caused by trauma or an injection that resulted in an open or contaminated distal interphalangeal joint. All horses were severely lame. Treatment included broad-spectrum parenterally administered antimicrobial drugs (ten horses), percutaneous through-and-through joint lavage (eight horses), indwelling drains (three horses), immobilization of the limb in a cast (three horses), intraarticular injection of sodium hyaluronate (one horse), intraarticular injection of antimicrobial drugs (five horses), curettage of the distal phalanx (one horse), and cancellous bone grafting to promote fusion (one horse). Five horses were euthanatized. Ankylosis of the affected joint developed in five horses, four of which are pasture sound. Two horses treated medically are sound although one underwent subsequent palmar digital neurectomy for treatment of navicular syndrome.

  13. Special aspects of wrist arthritis management for SLAC and SNAC wrists using midcarpal arthrodesis: results of bilateral operations and conversion to total arthrodesis.

    Science.gov (United States)

    Gohritz, Andreas; Gohla, Thomas; Stutz, Nicolas; Moser, Veith; Koch, Hilmar; Krimmer, Hermann; Lanz, Ulrich

    2005-01-01

    Although midcarpal wrist arthrodesis is recognized as a standard procedure to treat scapholuate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) of the wrist, little has been reported about patients with bilateral involvement and the number, cause, and results of failed cases requiring conversion to total wrist arthrodesis. This study investigated the results of 20 patients with bilateral procedures and of 22 patients who underwent total wrist fusion after failed midcarpal arthrodesis out of an overall group of 907 patients treated by this method during a 12-year period. Of these, 16 bilateral and 20 converted cases were reexamined after an average of 48 months and 42 months, respectively. Patients after bilateral midcarpal arthrodesis experienced a pain reduction by an average of 54% of the preoperative pain values at rest and by 56% at stress on the visual analog scale (scale range: 0 to 100) and from intolerable (3.7) to pain only during stress (1.9) on the verbal scale (scale range: I to 4). A mean arc of wrist extension and flexion of 53 degrees on the right and 49 of the left wrist was preserved. The mean DASH score was 45 points and 70% of the patients felt impaired only during certain activities. Total arthrodesis reduced pain in 18 of 20 reexamined wrists by 67% of the previous values after the failed partial arthrodesis at rest and by 46% at stress on the visual analog scale andfrom intolerable pain (3.7) to pain only during stress (2.1) on the verbal scale. Seven of the 20 reexamined patients noted complete pain relief at rest and two also under stress conditions. The DASH score averaged 39 points. A mean Krimmer score of 46 points and a mean Buck-Gramcko and Lohman evaluation of 6 points represented a satisfactory result. Grip strength of the operated hand averaged 53% of the opposite side. Subjectively, 30% felt impaired only during certain activities, 55%felt considerably and 15% strongly limited in daily life. However, all but

  14. High incidence and treatment of flexor carpi radialis tendinitis after trapeziectomy and abductor pollicis longus suspensionplasty for basal joint arthritis.

    Science.gov (United States)

    Low, T H; Hales, P F

    2014-10-01

    We reviewed the incidence and treatment of flexor carpi radialis tendinitis in 77 patients (81 thumbs) who had trapeziectomy and abductor pollicis longus suspensionplasty for thumb carpometacarpal joint arthritis. Eighteen patients, 20 wrists (25%) had flexor carpi radialis tendinitis. The onset was 2-10 months (mean 4.7) after surgery. Two cases had preceding trauma. Eight cases (40%) responded to splinting and steroid injection. Ten patients, 12 wrists (60%) underwent surgery after failing non-operative treatment. Eleven wrists had frayed or partially torn flexor carpi radialis tendon and one had a complete tendon rupture with pseudotendon formation. Flexor carpi radialis tenotomy and pseudotendon excision were performed. All operated patients obtained good pain relief initially post-operatively. However, the pain recurred in two patients after 8 months. One required a local steroid injection for localized tenderness at the site of the proximal tendon stump. The other patient required a revision operation for scaphotrapezoid impingement. Both obtained complete pain relief. Our study has shown a high incidence of flexor carpi radialis tendinitis following trapeziectomy and abductor pollicis longus suspensionplasty. Patients should be warned about this potential complication.

  15. Lower limb joint replacement in rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Clement Nicholas D

    2012-06-01

    Full Text Available Abstract Introduction There is limited literature regarding the peri-operative and surgical management of patients with rheumatoid disease undergoing lower limb arthroplasty. This review article summarises factors involved in the peri-operative management of major lower limb arthroplasty surgery for patients with rheumatoid arthritis. Methods We performed a search of the medical literature, using the PubMed search engine (http://www.pubmed.gov. We used the following terms: ‘rheumatoid’ ‘replacement’ ‘arthroplasty’ and ‘outcome’. Findings The patient should be optimised pre-operatively using a multidisciplinary approach. The continued use of methotrexate does not increase infection risk, and aids recovery. Biologic agents should be stopped pre-operatively due the increased infection rate. Patients should be made aware of the increased risk of infection and periprosthetic fracture rates associated with their disease. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR and total knee replacement (TKR have superior survival rates over uncemented components. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. Patella resurfacing as part of a TKR is associated with improved outcomes. The results of total ankle replacement remain inferior to THR and TKR. RA patients achieve equivalent pain relief, but their rehabilitation is slower and their functional outcome is not as good. However, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimise their outcome.

  16. Comparative Study on the Application of Ultrasonography and Magnetic Resonance Imaging in Diagnosis of Patients with Wrist RheumatoidArthritis%超声和MRI在类风湿性关节炎腕关节病变的对比研究

    Institute of Scientific and Technical Information of China (English)

    类婷婷; 李春梅; 唐国璋; 邢倩; 李睿; 韩彤亮

    2016-01-01

    Objective To explore the effectiveness of application of US (Ultrasonography) and MRI (Magnetic Resonance Imaging) in diagnosis of patients with wrist RA (Rheumatoid Arthritis). Methods 40 patients with RA were divided into two groups (Early Group and Late Group) according to the course of disease. All patients with wrist RA were scanned by using US and MRI so as to calculate the detection rates of two examination methods in detection of wrist joint synovitis, joint effusion, bone erosion and tendinitis. The effectiveness of application of two methods in diagnosis of the wrist lesions was compared. Results US and MRI showed no statistically significant difference in diagnosis of synovitis and joint effusion of two groups (P>0.05). US was superior to MRI in detection of tendinitis lesions, while MRI was better than US in detection of bone erosion (P0.05),超声对肌腱炎的诊断优于MRI(P<0.05),而MRI诊断骨侵蚀优于超声(P<0.05),且能显示骨髓水肿。结论超声能较好评估腕关节滑膜炎、关节积液、骨侵蚀、肌腱腱鞘炎等病变,与MRI具有等同的诊断价值,可以作为类风湿关节炎诊断的评价方法。

  17. Parvimonas micra: A rare cause of native joint septic arthritis.

    Science.gov (United States)

    Baghban, Adam; Gupta, Shaili

    2016-06-01

    Parvimonas micra is a fastidious, anaerobic, gram positive coccus, which is found in normal human oral and gastrointestinal flora. It has also been known as Peptostreptococcus micros and Micromonas micros with its most recent re-classification in 2006. It has been described in association with hematogenous seeding of prosthetic joints [1,2]. Several cases of discitis and osteomyelitis have been described in association with dental procedures and periodontal disease often with a subacute presentation. However, cases of native joint septic arthritis are limited [3-5]. Per our literature review, there is one case of native knee septic arthritis described in 1999, with a prolonged time to diagnosis and treatment due to difficulty culturing P. micra. The previously reported patient experienced significant joint destruction and morbidity [6]. Advances in culture techniques and new methods of organism identification including MALDI-TOF and 16s rRNA sequencing have lead to increased identification of this organism, which may be a more frequent bone and joint pathogen than previously realized.

  18. Pyogenic arthritis of sacroiliac joint in children

    Directory of Open Access Journals (Sweden)

    Rakonjac Zoran

    2009-01-01

    Full Text Available Introduction Pyogenic infection of sacroiliac joint (SIJ is very rare in children. It is the result of haematogenous spread primarily affecting the joint. The process is usually monoarticular. By rule, sequestra are rarely formed, there are no greater bone destructions, but there is usually early bone sclerosing. Case outline Due to the pain in the lumbosacral area spreading down the right leg and positive Lazarevic's sign, a 13-yearold boy was referred to a neuropediatrician. He was suffering from lumbosciatica. In the first three sick days, laboratory tests were done as well as X-ray examination. High febrility and laboratory results indicated the existence of infection of unknown localization. Diagnostic examination: radiography of the lungs and heart, computerized tomography (CT, nuclear magnetic resonance (NMR, ultrasound (US of hips and painful sacroiliac area and US of abdomen could not localise the infection. Radiography of SIJ (Barschoni focused the attention on SIJ. Scintigraphy of the skeleton with 99mTc-DPD pointed to the intensified collection of radiopharmaceuticals in the area around SIJ. Localized changes, erythema and signs of abscess in the projection of SIJ appeared the fifth day since the appearance of the disease. Incision was performed as well as evacuation of purulent content, and bacterial analysis isolated Staphylococcus aureus. Therapy with antibiotics was applied according to the antibiogram three weeks parenterally (intravenously and two weeks per os. After five weeks, clinical and laboratory results were normal. The patient has been monitored for eight months since the appearance of the disease. Conclusion In children with symptoms and signs of lumbosciatica, among other things, attention should be paid, differentially and diagnostically speaking, to pyogenic infection of SIJ. The skeletal scintigraphy helps early diagnosis of pyogenic infection of SIJ, when localized clinical signs have not been formed yet. In our

  19. Sauvé-Kapandji procedure in a patient with wrist disarticulation: case report.

    Science.gov (United States)

    Gong, Hyun Sik; Chung, Myung Ki; Baek, Goo Hyun

    2014-01-01

    The advantage of preserving the distal radioulnar joint in wrist disarticulation is that full forearm rotation is possible if the joint is intact, which improves the capability of the amputee. The Sauvé-Kapandji procedure has been performed to treat rheumatoid or post-traumatic chronic instability and/or arthritis of the distal radioulnar joint. We report a patient with wrist disarticulation that presented to us with limited supination of the wrist due to an injured distal radioulnar joint. We performed the Sauvé-Kapandji procedure, and the patient could regain functional supination of the forearm without losing the ulnar styloid flare that improved prosthetic suspension. This case suggests that the Sauvé-Kapandji procedure can be performed to maintain the advantage of wrist disarticulation even when the initial trauma involves an irreparable injury of the distal radioulnar joint.

  20. Septic arthritis of a native knee joint due to Corynebacterium striatum.

    Science.gov (United States)

    Westblade, Lars F; Shams, Farah; Duong, Scott; Tariq, Oosman; Bulbin, Alan; Klirsfeld, Dava; Zhen, Wei; Sakaria, Smita; Ford, Bradley A; Burnham, Carey-Ann D; Ginocchio, Christine C

    2014-05-01

    We report a case of septic arthritis of a native knee joint due to Corynebacterium striatum, a rare and unusual cause of septic arthritis of native joints. The isolate was identified by a combination of phenotypic, mass spectrometric, and nucleic acid-based assays and exhibited high-level resistance to most antimicrobials.

  1. The many shades of enhancement: timing of post-gadolinium images strongly influences the scoring of juvenile idiopathic arthritis wrist involvement on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Rieter, Jasper F.M.M.; Nusman, Charlotte M.; Hemke, Robert; Maas, Mario [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Tanturri de Horatio, Laura [Ospedale Pediatrico Bambino Gesu, Department of Radiology, Rome (Italy); Ording Mueller, Lil-Sofie [Oslo University Hospital, Department of Radiology, Oslo (Norway); Avenarius, Derk F.M. [Faculty of Health Sciences at the University of Tromsoe, Tromsoe (Norway); Rossum, Marion A.J. van [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Emma Children' s Hospital, Amsterdam (Netherlands); Malattia, Clara [Ospedale Pediatrico Gaslini, Department of Paediatrics, Genoa (Italy); Rosendahl, Karen [Haukeland University Hospital, Radiology Department, Section of Pediatric Radiology, Bergen (Norway); University of Bergen, Department of Clinical Medicine, K1, Bergen (Norway)

    2016-10-15

    Potential long-term side effects of treatment for juvenile idiopathic arthritis are concerning. This has necessitated accurate tools, such as MRI, to monitor treatment response and allow for personalized therapy. To examine the extent to which timing of post-contrast MR images influences the scoring of inflammatory change in the wrist in children with juvenile idiopathic arthritis. We studied two sets of post-contrast 3-D gradient echo MRI series of the wrist in 34 children with juvenile idiopathic arthritis. These images were obtained immediately after administration of intravenous contrast material and again after approximately 10 min. The dataset was drawn from a prospective multicenter project conducted 2006-2010. We assessed five wrist locations for synovial enhancement, effusion and overall inflammation. Examinations were scored by one radiologist in two sessions - the first was based on the early post-contrast images, and the later session, for which the previous findings were masked, was based on the later post-contrast images. Fifty-two of the 170 locations (30.6%) received a higher synovial enhancement score based on the late post-contrast images as compared to the early images. Sixty of the 170 (35%) locations received a higher total inflammation score. The mean scores of synovial enhancement and total inflammation were significantly higher when based on the late post-contrast images as compared to the early post-contrast images. An MRI-based scoring system for the presence and degree of synovitis should be based on a standardized MR-protocol with a fixed interval between intravenous contrast injection and post-contrast images. (orig.)

  2. Ulnar-sided wrist pain after four-corner fusion in a previously-asymptomatic ulnar positive wrist: a case report.

    Science.gov (United States)

    Gong, Hyun Sik; Jeon, Su Ha; Baek, Goo Hyun

    2009-01-01

    Scaphoid excision and four-corner fusion is one of the treatment choices for patients who have stage II or III SLAC (scapholunate advanced collapse)/SNAC (scaphoid non-union advanced collapse) wrist arthritis. We report a case of ulnar-sided wrist pain which occurred after four-corner fusion for stage II SNAC wrist with a previously-asymptomatic ulnar positive variance, and was successfully treated by ulnar shortening osteotomy. This case highlights a possible coincidental pathology of the ulnocarpal joint in the setting of post-traumatic radiocarpal arthrosis.

  3. Ultrasound-detected activity in rheumatoid arthritis on methotrexate therapy: Which joints and tendons should be assessed to predict unstable remission?

    Science.gov (United States)

    Janta, Iustina; Valor, Lara; De la Torre, Inmaculada; Martínez-Estupiñán, Lina; Nieto, Juan Carlos; Ovalles-Bonilla, Juan Gabriel; Martínez-Barrio, Julia; Bello, Natalia; Hinojosa, Michelle; Montoro, María; González, Carlos Manuel; López-Longo, Javier; Monteagudo, Indalecio; Carreño, Luis; Naredo, Esperanza

    2016-03-01

    The aim of the study was to investigate the predictive value of different reduced joint ultrasound (US) assessments of synovitis and tenosynovitis in relation to unstable remission in a cohort of rheumatoid arthritis (RA) patients on methotrexate therapy. Forty-seven RA patients (38 women, 9 men), being treated with methotrexate (MTX), in clinical remission as judged by their consultant rheumatologist were evaluated for disease activity according to the Disease Activity Score (DAS) 28 at baseline and 6 months. Sustained remission and unstable remission were defined according to the baseline and 6-month DAS28 and changes in RA therapy during the follow-up. Each patient underwent at baseline a B-mode and power Doppler (PD) assessment of 44 joints and 20 tendons/tendon compartments by a rheumatologist blinded to the clinical and laboratory data. B-mode synovial hypertrophy (SH), synovial PD signal, B-mode tenosynovitis, and Doppler tenosynovitis were scored 0-3. The presence and index of synovial PD signal in 44 joints [odds ratio (OR) 8.21 (p = 0.016) and OR 2.20 (p = 0.049), respectively] and in 12 joints [OR 5.82 (p = 0.041) and OR 4.19 (p = 0.020), respectively], the presence of SH in wrist and MCP joints [OR 4.79 (p = 0.045)], and the presence of synovial PD signal in wrist-MCP-ankle-MTP joints [OR 4.62 (p = 0.046)] were predictors of unstable remission. The 12-joint or wrist-hand-ankle-MTP US assessments can predict unstable remission in RA patients in apparent clinical remission being treated with MTX.

  4. Rib cartilage graft for posttraumatic or degenerative arthritis at wrist level: 10-year results.

    Science.gov (United States)

    Obert, Laurent; Lepage, Daniel; Ferrier, Maxime; Tropet, Yves

    2013-08-01

    Background Posttraumatic arthritides of the radiocarpal joint, secondary to scaphoid nonunion advanced collapse (SNAC), scapholunate advanced collapse (SLAC), or Kienböck disease or in cases of intraarticularmalunion of the distal radius, are classically solved by some type of arthrodesis procedure. Osteochondral grafting provides a possible motion-sparing option that can diminish pain in the active patient. Description of Technique A chondrocostal graft harvested from the ninth rib was inserted and fixed with a plate in place of the articular defect in cases of a malunited intra-articular distal radius fracture (7 cases) or to replace the proximal pole of the scaphoid in cases of SNAC or SLAC (18 cases). In Kienböck disease, the graft was inserted as a free cartilage spacer (4 cases). Results Harvesting the graft from the ninth rib had minimal morbidity without pleural injury in the reported series. Graft union was achieved in all cases of fixation. No graft resorption or necrosis were observed on X-ray and magnetic resonance imaging (MRI) evaluation at the longest follow-up of 10 years. Histological analysis performed at the time of plate removal showed the vitality of the graft. Two thirds of the patients had excellent or good results using the Green and O'Brien score. Conclusions Reconstruction of a partially destroyed articular surface using a costal graft is reliable and provides an alternative option for resurfacing the articular surface with viable cartilage.

  5. Sternoclavicular joint septic arthritis with chest wall abscess in a healthy adult: a case report

    OpenAIRE

    Tanaka, Yoshihito; Kato, Hisaaki; SHIRAI, Kunihiro; NAKAJIMA, Yasuhiro; YAMADA, Noriaki; Okada, Hideshi; Yoshida, Takahiro; Toyoda, Izumi; Ogura, Shinji

    2016-01-01

    Background Septic arthritis of the sternoclavicular joint is rare. It can be associated with serious complications such as osteomyelitis, chest wall abscess, and mediastinitis. In this report, we describe a case of an otherwise healthy adult with septic arthritis of the sternoclavicular joint with chest wall abscess. Case presentation A 68-year-old Japanese man presented to our hospital complaining of pain and erythema near the right sternoclavicular joint. Despite 1 week of oral antibiotics,...

  6. Dynamic contrast-enhanced imaging of the wrist in rheumatoid arthritis: dedicated low-field (0.25-T) versus high-field (3.0-T) MRI

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ryan K.L.; Griffith, James F.; Wang, D.F.; Yeung, David K.W. [The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince Of Wales Hospital, Hong Kong, SAR (China); Shi, L. [The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Division of Neurology, Hong Kong, SAR (China); Li, Edmund K.; Tam, L.S. [The Chinese University of Hong Kong, Department of Medicine, Division of Rheumatology, Prince Of Wales Hospital, Hong Kong, SAR (China)

    2015-08-15

    To compare the assessment of wrist synovitis severity, synovial volume and synovial perfusion parameters on a dedicated low-field (0.25-T) to that of a high-field (3-T) whole-body MR system in patients with rheumatoid arthritis (RA). Twenty-one patients (mean age 50.0 ± 9.8 years) with active RA were recruited prospectively. Dynamic contrast-enhanced MRI examination of the most severely affected wrist was performed at both 0.25 T and 3 T. Three MRI-derived parameters, synovitis severity (RAMRIS grade), synovial volume (ml{sup 3}) and synovial perfusion indices (maximum enhancement and enhancement slope), were compared. Comparing 0.25- and 3-T MRI, there was excellent agreement for semiquantitative assessment (r: 0.80, p < 0.00001) of synovitis (RAMRIS) as well as quantitative assessment (r: 0.94, p < 0.00001) of synovial volume. Good agreement for synovial Emax (r: 0.6, p = 0.002) and fair agreement (r: 0.5, p = 0.02) for synovial Eslope was found. Imaging of the RA wrist at 0.25 T yields excellent correlation with 3 T with regard to the synovitis activity score (RAMRIS) and synovial volume measurement. Fair to good correlation between low- (0.25-T) and high-field (3-T) MR systems was found for perfusion parameters, being better for Emax than for Eslope. (orig.)

  7. Diagnostic performance of three-dimensional MR maximum intensity projection for the assessment of synovitis of the hand and wrist in rheumatoid arthritis: A pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Li, Xubin, E-mail: lixb@bjmu.edu.cn [Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Reseaech Center for Cancer, Tianjin, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060 (China); Liu, Xia; Du, Xiangke [Department of Radiology, Peking University People' s Hospital, Beijing 100044 (China); Ye, Zhaoxiang [Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Reseaech Center for Cancer, Tianjin, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060 (China)

    2014-05-15

    Purpose: To evaluate the diagnostic performance of three-dimensional (3D) MR maximum intensity projection (MIP) in the assessment of synovitis of the hand and wrist in rheumatoid arthritis (RA) compared to 3D contrast-enhanced magnetic resonance imaging (CE-MRI). Materials and methods: Twenty-five patients with RA underwent MR examinations. 3D MR MIP images were derived from the enhanced images. MR images were reviewed by two radiologists for the presence and location of synovitis of the hand and wrist. The diagnostic sensitivity, specificity and accuracy of 3D MIP were, respectively, calculated with the reference standard 3D CE-MRI. Results: In all subjects, 3D MIP images yielded directly and clearly the presence and location of synovitis with just one image. Synovitis demonstrated high signal intensity on MIP images. The k-values for the detection of articular synovitis indicated excellent interobserver agreements using 3D MIP images (k = 0.87) and CE-MR images (k = 0.91), respectively. 3D MIP demonstrated a sensitivity, specificity and accuracy of 91.07%, 98.57% and 96.0%, respectively, for the detection of synonitis. Conclusion: 3D MIP can provide a whole overview of lesion locations and a reliable diagnostic performance in the assessment of articular synovitis of the hand and wrist in patients with RA, which has potential value of clinical practice.

  8. Patterns of magnetic resonance imaging bone erosion in rheumatoid arthritis--which bones are most frequently involved and show the most change?

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Møller Døhn, Uffe; Duer-Jensen, A

    2011-01-01

    To investigate by magnetic resonance imaging (MRI) which bones in wrists and metacarpophalangeal (MCP) joints most frequently show bone erosions, and which most frequently demonstrate erosive progression, in early and established rheumatoid arthritis (RA).......To investigate by magnetic resonance imaging (MRI) which bones in wrists and metacarpophalangeal (MCP) joints most frequently show bone erosions, and which most frequently demonstrate erosive progression, in early and established rheumatoid arthritis (RA)....

  9. Effect of radiosynovectomy in patients with inflammatory joint disorders not caused by rheumatoid arthritis; Wirksamkeit der Radiosynoviorthese bei degenerativ-entzuendlichen und chronisch-entzuendlichen Gelenkerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Kroeger, S.; Klutmann, S.; Bohuslavizki, K.H.; Clausen, M. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin; Sawula, J.A.; Brenner, W.; Henze, E. [Kiel Univ. (Germany). Klinik fuer Nuklearmedizin

    1999-07-01

    Aim: Effect of radiosynovectomy (RS) should be evaluated both by subjective and objective parameters in patients with osteoarthritis and in patients with inflammatory joint disorders not caused by rheumatoid arthritis. Methods: A total of 98 joints in 61 patients were investigated. Patients were divided into two groups. The first group included 35 patients with therapy-resistant effusions caused by severe osteoarthritis (46 joints). The second group consisted of 26 patients (52 joints) with ankylosing spondylitis, reactive arthritis, undifferentiated spondylarthropathy, psoriatic arthritis, pigmented villo-nodular synovitis, and recurrent synovitis following surgery. Effect of RS was evaluated by a standardized questionnaire and quantified by T/B-ratios derived from blood pool images prior to and after RS. Results: Within the first patient group suffering from osteoarthritis, 40% showed a good or excellent improvement of clinical symptoms, 51% were unchanged, and in 9% symptoms worsened. Similar results were found in the second patient group. The majority of unchanged results were small finger joints. In contrast, wrist and knee joints showed a better improvement. Good correlation between results of bone scan and patients subjective impression was found in 38% and 67% in the first and the second patient group, respectively. Conclusion: Radiosynovectomy might be an effective treatment in osteoarthritis and inflammatory joint disorders not caused by rheumatoid arthritis. (orig.) [German] Ziel: Der Therapieerfolg der Radiosynoviorthese (RSO) sollte bei aktivierter Arthrose und anderen chronisch-entzuendlichen Gelenkerkrankungen anhand der subjektiven Befindlichkeit und objektiver Parameter evaluiert werden. Methoden: Es wurden insgesamt 98 Gelenke bei 61 Patienten behandelt. Entsprechend der Grunderkrankung umfasste die erste Gruppe 35 Patienten mit einer therapieresistenten, aktivierten Arthrose (46 Gelenke). Die zweite Patientengruppe beinhaltete 26 Patienten (52

  10. Presence of Arp Specifically Contributes to Joint Tissue Edema Associated with Early-Onset Lyme Arthritis

    OpenAIRE

    Hove, Petronella R.; Haldorson, Gary J; Magunda, Forgivemore; Bankhead, Troy

    2014-01-01

    Antiserum to the Borrelia burgdorferi arthritis-related protein, Arp, has been shown to prevent or reduce arthritis in immunodeficient mice. To directly investigate the requirement for this lipoprotein in the generation of Lyme arthritis, we utilized targeted deletion to generate a B. burgdorferi clone that lacked only the arp gene locus. Infection of Lyme disease-susceptible C3H/HeN mice with the arp deletion mutant demonstrated significantly reduced tibiotarsal joint swelling during the fir...

  11. Median nerve neuropathy in the forearm due to recurrence of anterior wrist ganglion that originates from the scaphotrapezial joint: Case Report

    Directory of Open Access Journals (Sweden)

    Okada Kiyoshi

    2012-01-01

    Full Text Available Abstract Background Median nerve neuropathy caused by compression from a tumor in the forearm is rare. Cases with anterior wrist ganglion have high recurrence rates despite surgical treatment. Here, we report the recurrence of an anterior wrist ganglion that originated from the Scaphotrapezial joint due to incomplete resection and that caused median nerve neuropathy in the distal forearm. Case presentation A 47-year-old right-handed housewife noted the appearance of soft swelling on the volar aspect of her left distal forearm, and local resection surgery was performed twice at another hospital. One year after the last surgery, the swelling reappeared and was associated with numbness and pain in the radial volar aspect of the hand. Magnetic resonance imaging revealed that the multicystic lesion originated from the Scaphotrapezial joint and had expanded beyond the wrist. Exploration of the left median nerve showed that it was compressed by a large ovoid cystic lesion at the distal forearm near the proximal end of the carpal tunnel. We resected the cystic lesion to the Scaphotrapezial joint. Her symptoms disappeared 1 week after surgery, and complications or recurrent symptoms were absent 13 months after surgery. Conclusions A typical median nerve compression was caused by incomplete resection of an anterior wrist ganglion, which may have induced widening of the cyst. Cases with anterior wrist ganglion have high recurrence rates and require extra attention in their treatment.

  12. ASSOCIATION BETWEEN ULTRASOUND SIGNS OF JOINT INFLAMMATION AND RADIOGRAPHIC PROGRESSION IN PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    O. G. Alekseeva

    2016-01-01

    Full Text Available Rheumatoid arthritis (RA is a chronic inflammatory disease causing joint destructive changes and disability.Objective: to investigate the association between the ultrasound signs of active inflammation and destruction of the joints, as evidenced by radiography, in RA patients treated with a treat-to-target strategy and to study whether ultrasound study (USS of the joints can be used to predict the occurrence of their destructive changes.Subjects and methods. The investigation included 81 patients (medium age 56 [46; 62] years with RA, who had been followed up at the V.A. Nasonova Research Institute of Rheumatology within the first Russian strategic study of pharmacotherapy for RA – REMARCA (Russian invEstigation of MethotrexAte and biologicals for eaRly aCtive Arthritis. In all the patients, methotrexate (Metoject, MEDAS, Germany as the first disease-modifying anti-rheumatic drug was subcutaneously injected at an initial dose of 10 mg/week with its rapid escalation up to 20–25 mg/week. Then the therapy was added by biologicals as the need arose. Clinical and laboratory parameters were analyzed immediately before and then after 12, 24, 36, and 48 weeks. Efficacy was assessed using the European League Against Rheumatism (EULAR criteria, CDAI, and SDAI. USS of eight articular areas (the wrist, second and third metacarpophalangeal, second and third proximal interphalangeal, second and fifth metatarsophalangeal joints in the hand and foot of the clinically dominant side was carried out in all the patients before treatment and then after 12, 24, 36, and 48 weeks. Semiquantitative gray-scale (GS assessment and power Doppler (PD were performed. Radiographic examination was done before and after 48 weeks of therapy. The Sharp method modified by van der Heijde was employed to estimate X-ray changes.Results and discussion. In the group of patients with radiographic progression, the activity of inflammation, as evidenced by PD USS, was significantly

  13. Risk factors for septic arthritis in patients with joint disease: A prospective study

    NARCIS (Netherlands)

    C.J. Kaandorp; D. van Schaardenburg (Dirkjan); P. Krijnen (Pieta); J.D.F. Habbema (Dik); M.A.F.J. van de Laar (Mart)

    1995-01-01

    markdownabstractObjective. To quantify potential risk factors for septic arthritis, in order to identify a basis for prevention. Methods. The occurrence of potential risk factors for septic arthritis in patients with joint diseases attending a rheumatic disease clinic was prospectively monitored

  14. Acute septic arthritis of the acromioclavicular joint caused by Haemophilus parainfluenzae: a rare causative origin.

    Science.gov (United States)

    Hong, Myong-Joo; Kim, Yeon-Dong; Ham, Hyang-Do

    2015-04-01

    Septic arthritis of the acromioclavicular (AC) joint is a rare entity with symptoms that include erythema, swelling, and tenderness over the AC joint, fever, and limitation of shoulder motion with pain. In previous reports, Staphylococcus and Streptococcus species have been mentioned as common causative organisms. Haemophilus parainfluenzae is a normal inhabitant of the oral cavity, respiratory tract, gastrointestinal tract, and urogenital tract. However, it sometimes causes opportunistic infections leading to septic arthritis and osteomyelitis. AC joint infection associated with H.parainfluenzae is very rare, and only one case has been reported in the literature. Moreover, septic arthritis in immunocompetent patients is also very rare. Here, we report the case of a healthy patient with H. parainfluenzae-related septic arthritis of the AC joint.

  15. TOTAL JOINT REPLACEMENT OF THE LOWER EXTREMITY IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

    OpenAIRE

    Стюарт Б. Гудмэн

    2014-01-01

    Joint replacement of the lower extremity in Juvenile Idiopathic Arthritis (JIA) is becoming more commonly performed worldwide. These young adults experience severe pain and disability from end-stage arthritis, and require joint replacement of the hip or knee to alleviate pain, and restore ambulation and function. These procedures are very challenging from the anesthesia and surgical point of view, due to small overall proportions, numerous bony and other deformities and soft tissue contractur...

  16. Septic arthritis of a lumbar facet joint; Arthrite septique interapophysaire posterieure lombaire

    Energy Technology Data Exchange (ETDEWEB)

    Ben Hamouda, M.; Rajhi, H.; Golli, M.; Ganouni, A.; Bergaoui, N. [Centre Hospitalier Universitaire de Monastir (Tunisia); Chaouch, A. [Centre Hospitalier Universitaire de Mahdia (Tunisia); Hassine, H. [Centre Hospitalier Universitaire de Sahloul, Sousse (Tunisia)

    1997-05-01

    Septic arthritis of the posterior lumbar joints is extremely rare. The clinical picture of the unusual site of infection can easily lead to confusion with spondylo-discitis which is more common. We report a case of a 50-year-old women with Staphylococcus aureus septic arthritis of the left L5-S1 lumbar facet joint. CT scan was helpful to establish the diagnosis and to guide the percutaneous needle biopsy. (authors). 10 refs.

  17. Therapeutic Drug-Monitoring of Methotrexate-Polyglutamates in Rheumatoid Arthritis

    NARCIS (Netherlands)

    E. den Boer (Ethan)

    2014-01-01

    markdownabstract__Abstract__ Rheumatoid Arthritis (RA) is a chronic autoimmune disease, characterized by the swelling of joints, uncontrolled proliferation of synovial tissue and multisystem co-morbidities. RA mainly affects the joints of the hands, feet, knees, wrist and elbows, with joint damage

  18. Early detection of temporomandibular joint arthritis in children with juvenile idiopathic arthritis - the role of contrast-enhanced MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kalle, Thekla von; Stuber, Tina; Winkler, Peter [Olgahospital Klinikum Stuttgart, Pediatric Radiology, Radiologisches Institut, Stuttgart (Germany); Maier, Jan; Hospach, Toni [Olgahospital Klinikum Stuttgart, Pediatric Rheumatology, Stuttgart (Germany)

    2015-03-01

    Early treatment of temporomandibular joint (TMJ) arthritis is crucial in children with juvenile idiopathic arthritis (JIA) to prevent permanent functional impairment. As involvement of TMJs is often asymptomatic, contrast-enhanced MRI is regarded as the most sensitive noninvasive diagnostic tool. To evaluate the degree of contrast enhancement in TMJs of children and adolescents with JIA in comparison to normal controls from a previous study. Dynamic contrast-enhanced MRI of 50 children and adolescents with JIA (6.3 to 18 years of age; mean: 12 years) were retrospectively analysed. We assessed morphological abnormalities and postcontrast time-intensity curves of the soft joint tissue and the mandibular condyle. Ratios were calculated to quantify postcontrast signal intensities (SI) in relation to precontrast SI at initial (1 min postcontrast) and maximum (6 min postcontrast) increase. Time-intensity curves followed similar biphasic patterns in normal and pathological joints. In joints with morphological signs of arthritis, mean SI ratios were on average higher than in normal joints of the reference group, but ranges of values widely overlapped. Arthritis: mean initial increase of SI 62% (±2 S.D. 18-105%), mean maximum SI 106% higher than precontrast (±2 S.D. 46-166%). Normal: mean initial increase of SI 49% (±2 S.D. 14- 85%), mean maximum of SI 73% (±2 S.D. 23-123%). Given this considerable overlap of results in dynamic contrast-enhanced MRI, the degree of contrast enhancement alone did not allow differentiation between TMJs with and without signs of inflammation. Thickening of the soft joint tissue seems to remain the earliest sign to reliably indicate TMJ arthritis. (orig.)

  19. Gadolinium-enhanced MRI features of acute gouty arthritis on top of chronic gouty involvement in different joints.

    Science.gov (United States)

    Emad, Yasser; Ragab, Yasser; El-Naggar, Ahmed; El-Shaarawy, Nashwa; Abd-Allah, Mayada A; Gamal, Rania M; Fathy, Ahmed; Hawass, Mona; Rasker, Johannes J

    2015-11-01

    The aims of the current study are to describe gadolinium-enhanced MRI features of an acute flare of established gouty arthritis in different joints and to examine a possible association between serum uric acid and MRI signs indicative of ongoing inflammation and/or structural joint damage as well as association with disease characteristics and laboratory findings. Twenty-seven male patients with established chronic gout agreed to participate, mean age 47.6 years, and mean disease duration in months 43.2 (±31.8). For all patients, detailed demographic, disease characteristics, and laboratory findings were obtained and correlated with MRI findings. In 27 patients with established gout, a total of 50 MRI studies were performed of the following joints: feet joints (n = 23), ankles (n = 18), knees (n = 5), and hand and wrist joints (n = 4). MRI revealed capsular thickening in 19 patients, bone marrow edema (BME) in 15, soft tissue edema (STE) in 20, joint effusion in 21, bone erosions in 17, cartilaginous erosions in 4, and tenosynovitis in 9 cases. In 17 cases, tophaceous lesions were found. Post contrast MRI showed synovial thickening in seven cases. Positive correlations were observed between serum uric acid levels and the following MRI findings: capsular thickening (r = 0.552, p = 0.003), BME (r = 0.668, p ≤ 0.0001), STE (r = 0.559, p = 0.002), and tenosynovitis (r = 0.513, p = 0.006). Using MRI in chronic gout, important features can be detected like BME, minute cartilaginous erosions, and hypertrophic synovial inflammation in post contrast MR images. Serum uric acid (SUA) was positively correlated with capsular thickening, BME, STE, and tenosynovitis.

  20. Baicalin Inhibits IL-17-Mediated Joint Inflammation in Murine Adjuvant-Induced Arthritis

    Directory of Open Access Journals (Sweden)

    Xue Yang

    2013-01-01

    Full Text Available T-helper-17 (Th17 cells are implicated in a number of inflammatory disorders including rheumatoid arthritis. Antagonism of Th17 cells is a treatment option for arthritis. Here, we report that Baicalin, a compound isolated from the Chinese herb Huangqin (Scutellaria baicalensis Georgi, relieved ankle swelling and protected the joint against inflammatory destruction in a murine adjuvant-induced arthritis model. Baicalin inhibited splenic Th17 cell population expansion in vivo. Baicalin prevented interleukin- (IL- 17-mediated lymphocyte adhesion to cultured synoviocytes. Baicalin also blocked IL-17-induced intercellular adhesion molecule 1, vascular cell adhesion molecule 1, IL-6, and tumor necrosis factor-alpha mRNA expression in cultured synoviocytes. Collectively, these findings suggest that Baicalin downregulates the joint inflammation caused by IL-17, which is likely produced by an expanded population of splenic Th17 cells in experimental arthritis. Baicalin might be a promising novel therapeutic agent for treating rheumatoid arthritis in humans.

  1. Presence of Arp specifically contributes to joint tissue edema associated with early-onset Lyme arthritis.

    Science.gov (United States)

    Hove, Petronella R; Haldorson, Gary J; Magunda, Forgivemore; Bankhead, Troy

    2014-01-01

    Antiserum to the Borrelia burgdorferi arthritis-related protein, Arp, has been shown to prevent or reduce arthritis in immunodeficient mice. To directly investigate the requirement for this lipoprotein in the generation of Lyme arthritis, we utilized targeted deletion to generate a B. burgdorferi clone that lacked only the arp gene locus. Infection of Lyme disease-susceptible C3H/HeN mice with the arp deletion mutant demonstrated significantly reduced tibiotarsal joint swelling during the first 6 weeks of infection compared to a wild-type control. The severity of joint swelling was restored to wild-type levels in mice infected with an arp mutant clone complemented in cis. Interestingly, the reduced swelling of joint tissues exhibited by mice infected with the arp deletion mutant did not directly correspond to reduced underlying arthritis. Histopathology data at 2 weeks postinfection showed some reduction in arthritis severity caused by the arp mutant clone; however, by 8 weeks, no significant difference was observed between joint tissues infected by the wild-type or arp mutant clones. The spirochete load in the joint tissues of mice infected with the arp mutant was found to be greater than that exhibited by the wild-type control. Our findings demonstrate that this lipoprotein contributes to the generation of early-onset joint swelling and suggests that arp expression has a negative secondary effect on total spirochete numbers in joint tissues.

  2. Arthritis of the first metatarsophalangeal joint is not always gout: a prospective cohort study in primary care patients

    NARCIS (Netherlands)

    Kienhorst, L.B.E.; Janssens, H.J.E.M.; Fransen, J.; Lisdonk, E.H. van de; Janssen, M.

    2014-01-01

    OBJECTIVES: Arthritis of the first metatarsophalangeal joint has been considered pathognomonic for gout, but it is unknown how frequently other forms of arthritis occur in this joint. The aims were to determine the validity of the general practitioner's clinical diagnosis using joint fluid analysis

  3. A minimal wrist arthroplasty for early wrist osteoarthritis.

    Science.gov (United States)

    Wollstein, Ronit; Carlson, Lois

    2013-05-01

    Background The most common forms of salvage surgery for wrist arthritis of any stage are four corner fusion and proximal row carpectomy. Younger, high demand patients with early arthritis may not be candidates for this type of salvage surgery. We describe a technique and preliminary case series of a minimal radiocarpal arthroplasty aimed at patients with initial and isolated wrist arthritis (stage 1). This procedure does not preclude any procedure that may become necessary in the future. Patients A series of nineteen male heavy laborers with scapholunate advanced collapse (SLAC grade 1-2) wrist osteoarthritis that felt the wrist arthritis was prohibiting their function enough to warrant surgery, but were unwilling to undergo a salvage procedure, were treated with the technique. The average age was 57.2 (± 7.7) years. The average follow up period was 40.3 months (9-63 months). All patients returned to heavy labor. No revision surgery was needed within the follow up period. Range of motion (ROM) and grip strength did not significantly improve. Patient satisfaction was high despite imperfect results. Conclusions Minimal arthroplasty as described may provide a temporary solution for active patients with symptomatic early wrist arthritis who are not candidates for salvage wrist surgery. Longer -term follow up as well as investigation of additional stabilization procedures is necessary.

  4. Enteropathic arthritis in the sacroiliac joint. Imaging and differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Mester, Adam R. E-mail: mester@radi.sote.hu; Mako, Erno K.; Karlinger, Kinga; Gyoerke, Tamas; Tarjan, Zsolt; Marton, Erika; Kiss, Katalin

    2000-09-01

    Objectives: A new high resolution computed tomography (HRCT) scoring system of sacroiliac joint (SIJ) involvement in enteropathic arthritis is introduced. Patients and methods: SIJ's of 100 patients were studied. A total of 25 patients presented with pain syndrome, 25 with suspicious seronegative spondylarthritis, 25 with inflammatory bowel diseases and 25 without joint or bowel diseases, as a control group. HRCT was carried out in all 100 patients. For comparison, a plain film radiography (PFR), conventional CT (slices of 10 mm) and bone scan were used. Results: Quantitative differences: In the pain syndrome group, there were no erosions identified neither intraarticular calcifications. Disc degeneration was seen in 12/25 cases. In 4/25 patients, vacuum phenomena appeared in the SIJ. In 3/25 patients, ventral capsular calcification occurred in the ventral sacroiliac ligament (anterior capsule complex). In the seronegative spondylarthritis group, 16/25 patients had positive findings, while PFR documented erosions only in 3/25 cases. In the bowel diseases group, erosions were detected in 17/25 cases with HRCT, while the plain film was positive only in three cases and in seven cases the findings were questionable. Intraarticular calcification with erosion was documented in three cases and in seven cases without erosion. The bone scan was positive in 7/25 of this cases, but in 5/7 there was mismatching with HRCT. Important new finding was the HRCT detected erosion which was not detected on BS but was obvious on Anti-Granulocyte-Antibody scintigraphy. In the control group, only degenerative changes were seen in 4/25 cases and no erosions. Conclusion: HRCT is: (1) the reliable imaging of definitive (often 'cold stage') sacroileitis; (2) gives optimal detection of erosion; and (3) appears to be the only method in the documentation of calcifications in the posterior ligamental portion of the SIJ.

  5. Is the frequent sonographic anechoic area distally in metacarpophalangeal joints a sign of arthritis?

    Science.gov (United States)

    Ten Cate, David Folkert; Luime, Jolanda Jacoba; Hazes, Johanna Maria Wilhelmina; Kleinrensink, Gerrit-Jan; Jacobs, Johannes Wilhelmus Gerardus

    2014-10-01

    In clinical practice, ultrasonography (US) often reveals, in the dorsal scan, a small anechoic area distally in both inflamed and clinically non-inflamed metacarpophalangeal joints. This "distal anechogenicity in the metacarpophalangeal joint" (DAEM) might thus be scored false positively as arthritis. We aimed to investigate whether the DAEM is a sign of arthritis. We evaluated the prevalence of DAEMs in 24 non-arthritic subjects. We then compared the dimensions of the DAEM in 10 non-arthritic subjects with a DAEM and 7 consecutive rheumatoid arthritis (RA) outpatients, using 2-D and 3-D ultrasound. Furthermore, we dissected two fresh-frozen postmortem hand specimens after US. A DAEM was observed in the metacarpophalangeal 2 (MCP2) joints of 54% of the 24 non-selected non-arthritic individuals; in none of those did the joint exhibit a power Doppler signal. A DAEM was observed in 86% of the 7 RA patients. Dimensions of DAEMs did not statistically significantly differ between these groups. At 3-D imaging and dissection, the DAEM was found to be an extension of the metacarpophalangeal joint capsule. In conclusion, DAEMs occur frequently and are not a sign of arthritis, but are distal joint recesses. This should be taken into account when using current sensitive ultrasonographic scoring systems grading arthritis.

  6. Assessment of joint pain in teenagers with juvenile arthritis

    Directory of Open Access Journals (Sweden)

    T A Shelepina

    2009-01-01

    Full Text Available Assessment of joint pain in teenagers with juvenile arthritisObjective. To assess mean total pain score in teenagers with juvenile arthritis (JA and its values in groups differing on sex, variant of course, activity measures, degree of functional disturbances. To assess advisability of application of these parameters in real clinical practice. Material and methods. 73 pts with JA (mean age 14,7±1,7 years, mean disease duration7,2±4,4 years were included. 18 from them had systemic, 42 – polyarticular and 13 – olygoarticular variant. 16 pts were examined repeatedly with interval exceeding one year. Total quantity of examinations was 94. 17 pts were examined at admission and at discharge. Pain was measured on visual analog scale (VAS and on McGill Pain Questionnaire (83 examinations including 3 scale: sensor (description of pain, affective (their influence on emotional state and evaluative (verbal assessment of pain intensity. General health assessment on VAS was performed in 59 pts (in 8 from them at admission and at discharge. Summary mean measures and their values in groups differing in sex, course variant, activity measure, functional class at pts admission to and at discharge from the Institute of Rheumatology of RAMS. Statistical treatment was performed with Biomed program(descriptive statistic, χ2, Student’s pared test. Results. Mean pain score on VAS in all teenagers with JA was 31,3±17,3. It was significantlyhigher in boys with systemic variant (in comparison with polyarticular, in pts with ESR elevation above 30, in pts with functional class 3 and higher at admission to the department. Pain score was significantly lower in pts with olygoarticular variant in comparison with mean value and with value in polyarthritis. Pain above 70 mm on VAS was found in pts with polyarticular damage in systemic and polyarticular variants in active phase of the disease and in severe functional disability. Summated (on sensor and affective scales

  7. Pitfalls in scoring MR images of rheumatoid arthritis wrist and metacarpophalangeal joints

    DEFF Research Database (Denmark)

    McQueen, F; Østergaard, Mikkel; Peterfy, C;

    2005-01-01

    are discussed. Normal structures such as interosseous ligaments and nutrient foramina may appear prominent on certain images and need to be identified correctly. Pathological change in the rheumatoid hand involves many tissues and when substantial damage has occurred, it may be difficult to identify individual...... structures correctly. Bone erosion, bone oedema, synovitis, and tenosynovitis frequently occur together and in close proximity to each other, potentially leading to false positive scoring of any of these. Examples are given to illustrate the various dilemmas the user of this atlas may face when scoring...

  8. Bone marrow oedema assessment by magnetic resonance imaging in rheumatoid arthritis wrist and metacarpophalangeal joints

    DEFF Research Database (Denmark)

    Krabbe, Simon; Eshed, Iris; Pedersen, Susanne Juhl

    2014-01-01

    OBJECTIVE: The aim of this study was to examine the influence of different MRI unit field strengths, coil types and image resolutions on the OMERACT RA MRI scoring system (RAMRIS) of bone marrow oedema (BME) and image quality. METHODS: Forty-one patients and 12 healthy controls participated...... STIR image sets were anonymized and scored according to RAMRIS and parameters of image quality were measured. RESULTS: The BME sum scores were similar overall when comparing the different MRI units, coil types and voxel sizes, yet significantly higher at the higher resolution of 1.5T Extr compared......-88%]. The smallest detectable difference was better at 0.6, 1.5 and 3T (9-29% of maximum value) than at 0.23T (40%). Image quality was lowest at 0.23T. CONCLUSION: No major, consistent differences were found between BME scores using STIR sequences obtained at different field strengths, coil types and image...

  9. Ultrasound detects subclinical joint inflammation in the hands and wrists of patients with systemic lupus erythematosus without musculoskeletal symptoms

    Science.gov (United States)

    Malheiro, Rui; Oliveira, João F; Pinheiro, Sofia; Vieira, Luís S; Moraes-Fontes, Maria Francisca

    2017-01-01

    Objectives To assess the prevalence and severity of ultrasonographic abnormalities of the hand and wrist of asymptomatic patients with systemic lupus erythematosus (SLE) and compare these findings with those from patients with SLE with musculoskeletal signs or symptoms and healthy controls. Methods We conducted a prospective cross-sectional study that evaluated bilaterally, with grey-scale and power Doppler (PD) ultrasound (US), the dorsal hand (2nd to 5th metacarpophalangeal and 2nd to 5th proximal interphalangeal joints) and wrist (radiocarpal, ulnocarpal and intercarpal joints) of 30 asymptomatic patients with SLE, 6 symptomatic patients with SLE and 10 controls. Synovial hypertrophy (SH) and intra-articular PD signal were scored using semiquantitative grading scales (0–3). Individual scores were graded as normal (SH≤1 and PD=0) or abnormal (SH≥2 or PD≥1). Global indexes for SH and PD were also calculated. US findings were correlated with clinical and laboratory data and disease activity indexes. Results US detected SH (score ≥1) in 77% asymptomatic patients with SLE, mostly graded as minimal (score 1: 63%). 23% of the asymptomatic patients with SLE showed abnormal US PD findings (SH≥2 or PD≥1). SH was present in all symptomatic patients with SLE, mostly graded as moderate (grade 2: 67%), and with associated PD signal (83%). SH (score 1) was identified in 50% of controls, however, none presented abnormal US PD findings. SH index in the asymptomatic SLE group was higher than in the control group (2.0 (0–5) vs 0.5 (0–2), median (range), p=0.01) and lower than in the symptomatic SLE group (7.0 (4–23), median (range), p<0.001). No significant correlation was demonstrated between US PD findings and clinical or laboratory variables and disease activity indexes. Conclusion A small subgroup of asymptomatic patients with SLE may present subclinical joint inflammation. Global US scores and PD signal may be important in disease evaluation and

  10. Effect of methotrexate on the temporomandibular joint and facial morphology in juvenile rheumatoid arthritis patients.

    Science.gov (United States)

    Ince, D O; Ince, A; Moore, T L

    2000-07-01

    Juvenile rheumatoid arthritis is a disease characterized by chronic inflammation in one or more joints; it affects children and adolescents up to 18 years of age. This disease may cause significant skeletal joint destruction, and the temporomandibular joint, like other joints, may become severely affected resulting in aberrant mandibular growth, abnormal dentofacial development, and/or altered orofacial muscle function. Methotrexate is the most common remittive agent used in juvenile rheumatoid arthritis to modify the course of inflammatory destruction of peripheral joints. The purpose of this study was: (1) to evaluate the effect of methotrexate therapy on the prevalence of temporomandibular joint lesions and aberration in craniofacial development in children afflicted with juvenile rheumatoid arthritis; (2) to further examine the relationship between the temporomandibular joint/cephalometric findings and rheumatologic data (ie, age at onset, duration of disease); and (3) to evaluate further pauciarticular- and polyarticular-onset disease in juvenile rheumatoid arthritis and the prevalence of temporomandibular joint lesions and facial dysmorphology. The following information was obtained from 45 patients with juvenile rheumatoid arthritis: (1) routine rheumatologic clinical examination data; (2) anamnestic temporomandibular joint evaluation data; (3) clinical temporomandibular joint examination data; (4) lateral cephalometric measurement data; (5) posteroanterior cephalometric measurement data; and (6) individually corrected axial tomographic data. The results demonstrated the following: (1) radiographic evidence of condylar degeneration was apparent in 63% of all patients with juvenile rheumatoid arthritis with pauciarticular patients showing less temporomandibular involvement than polyarticular patients; (2) polyarticular juvenile rheumatoid arthritis patients receiving methotrexate showed less severe temporomandibular joint involvement than the polyarticular

  11. Septic arthritis in a lumbar facet joint: a rare cause of an epidural abscess

    Energy Technology Data Exchange (ETDEWEB)

    Heenan, S.D. [Dept. of Neuroradiology, Atkinson Morley`s Hospital, London (United Kingdom); Britton, J. [Dept. of Neuroradiology, Atkinson Morley`s Hospital, London (United Kingdom)

    1995-08-01

    A 10-year-old boy presented with a 7-day history of back pain and pyrexia. MRI showed an epidural abscess arising from septic arthritis in a lumbar facet joint. To our knowledge, there are only two previously reported cases of septic arthritis of a facet joint leading to an epidural abscess. This case illustrates how infection in a synovial joint may extend into the extradural space and might be the route of infection in more cases than has previously been recognised. (orig.)

  12. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 3: an international multicenter reliability study using the RA-MRI Score

    DEFF Research Database (Denmark)

    Lassere, M; McQueen, F; Østergaard, Mikkel;

    2003-01-01

    We examined inter-reader agreement of the revised OMERACT 5 Rheumatoid Arthritis MRI Score (RAMRIS v3). Magnetic resonance (MR) images of 10 sets of metacarpophalangeal (MCP) joints 2-5 and 8 sets of rheumatoid arthritis (RA) wrists [1.5 T, coronal and axial T1 and T2 spin-echo, +/- fat saturation...

  13. Chronic joint symptoms and prior arthritis diagnosis in community surveys: implications for arthritis prevalence estimates.

    OpenAIRE

    Feinglass, Joe; Nelson, Cynthia; Lawther, Timothy; Chang, Rowland W.

    2003-01-01

    OBJECTIVES: Alternative definitions of arthritis in community surveys provide very different estimates of arthritis prevalence among older Americans. This telephone interview study examines prevalence estimates based on the current Behavioral Risk Factor Surveillance System (BRFSS) arthritis case definition. METHODS: Interviews were conducted with 851 Chicago residents age 45 and older. Logistic regression was used to compare the age and sex controlled prevalence of poor health, restricted ac...

  14. Temporomandibular Joint Ankylosis as a Complication of Neonatal Septic Arthritis; Report of two cases

    OpenAIRE

    Al-Saadi, Noor J.; Bakathir, Abdulaziz A; Al-Hashmi, Ahmed K.; Al-Ismaili, Mohammad I.

    2015-01-01

    Temporomandibular joint (TMJ) ankylosis as a complication of neonatal septic arthritis is rarely reported in the literature. We report two clinical cases of unilateral TMJ ankylosis occurring in paediatric patients subsequent to neonatal septic arthritis. The first case was a 15-month-old male infant who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in May 2010. According to the published English scientific literature, he is the youngest person yet to be diagnosed with thi...

  15. Development of Intra-Articular Drug Delivery to Alter Progression of Arthritis Following Joint Injury

    Science.gov (United States)

    2012-04-01

    Arthritis Following Joint Injury Steven A. Olson, M.D. W81XWH-10-1-0890 Duke University Durham, NC 27705 15 September 2011 - 14 March ...4 Appendices – Abstract accepted for presentation at ORASI ( Osteoarthritis Research Society International) meeting in...NC 2Department of Biomedical Engineering, Duke University, Durham, NC PURPOSE: Post-traumatic arthritis (PTA) is a form of osteoarthritis (OA

  16. Infectious Arthritis

    Science.gov (United States)

    Most kinds of arthritis cause pain and swelling in your joints. Joints are places where two bones meet, such as your elbow or knee. Infectious arthritis is an infection in the joint. The infection ...

  17. Improvement of large-joint ultrasonographic synovitis is delayed in patients with newly diagnosed rheumatoid arthritis: results of a 12-month clinical and ultrasonographic follow-up study of a local cohort.

    Science.gov (United States)

    Harman, Halil; Tekeoğlu, İbrahim; Takçı, Sibel; Kamanlı, Ayhan; Nas, Kemal; Harman, Sibel

    2015-08-01

    We analyzed the longitudinal changes in gray-scale ultrasonography (GSUS) and power Doppler ultrasonography (PDUS) parameters and correlated them with clinical, functional, and radiologic outcomes in patients with newly diagnosed rheumatoid arthritis (RA). GSUS and PDUS examinations, 44-joint disease activity score (DAS44) calculations, measurements of erythrocyte sedimentation rate, and C-reactive protein levels were performed in 68 RA patients at baseline and after 1, 3, 6, 9, and 12 months. Metacarpophalangeal joints, wrist, elbow, knee, ankle, metatarsophalangeal joints, and wrist and ankle tendons were examined by GSUS and PDUS. The laboratory and clinical findings began to decrease significantly at 1 month (P US) variables began at 3 months. After 6 months, all of the joint synovitis scores, except those of the knee, elbow, and ankle joints, showed a statistically significant reduction compared to baseline scores (P US synovitis at large joints such as the knee, elbow, and ankle tended to be delayed compared to that at small joints. PD synovitis that is persistent despite disease-modifying anti-rheumatic drug therapy may cause radiographic bone erosions.

  18. Mycobacterium avium-intracellulare cellulitis occurring with septic arthritis after joint injection: a case report

    Directory of Open Access Journals (Sweden)

    Murdoch David M

    2007-02-01

    Full Text Available Abstract Background Cellulitis caused by Mycobacterium avium-intracellulare has rarely been described. Mycobacterium avium-intracellulare is a rare cause of septic arthritis after intra-articular injection, though the causative role of injection is difficult to ascertain in such cases. Case presentation A 57-year-old with rheumatoid arthritis treated with prednisone and azathioprine developed bilateral painful degenerative shoulder arthritis. After corticosteroid injections into both acromioclavicular joints, he developed bilateral cellulitis centered over the injection sites. Skin biopsy showed non-caseating granulomas, and culture grew Mycobacterium avium-intracellulare. Joint aspiration also revealed Mycobacterium avium-intracellulare infection. Conclusion Although rare, skin and joint infections caused by Mycobacterium avium-intracellulare should be considered in any immunocompromised host, particularly after intra-articular injection. Stains for acid-fast bacilli may be negative in pathologic samples even in the presence of infection; cultures of tissue specimens should always be obtained.

  19. Validation of the OMERACT Magnetic Resonance Imaging Joint Space Narrowing Score for the Wrist in a Multireader Longitudinal Trial

    DEFF Research Database (Denmark)

    Glinatsi, Daniel; Lillegraven, Siri; Haavardsholm, Espen A;

    2015-01-01

    exercise. METHODS: Coronal T1-weighted MR image sets of 1 wrist from 20 patients with early RA were assessed twice for JSN at 17 sites at baseline and after 36 or 60 months by 4 readers blinded to patient data but not time order. The joints were scored 0-4 according to the OMERACT RAMRIS-JSN score....... Intraclass correlation coefficients (ICC), smallest detectable change (SDC), percentage exact/close agreement (PEA/PCA), and standardized response mean (SRM) were calculated. RESULTS: Median baseline and change score was 10.3 and 1.9, respectively. Intrareader ICC for baseline and change scores was good (≥ 0.......50) to very good (≥ 0.80) for all and 3 of 4 readers, respectively. Interreader ICC was very good for change (0.93), while poor for baseline score if all 4 readers were included (0.36), but very good if 1 reader was excluded (0.87). Intrareader and interreader SDC was low (2.34-3.18), except...

  20. Septic arthritis of the adult ankle joint secondary to Salmonella enteritidis: a case report.

    LENUS (Irish Health Repository)

    Munigangaiah, Sudarshan

    2011-09-01

    Salmonella septic arthritis in healthy individuals is a rare phenomenon. However, septic arthritis of the native adult ankle joint in healthy patients has not been previously described in the published data. This is a case report of a 70-year-old farmer who presented with a 2-week history of a painful, swollen right ankle and an inability to bear weight. He had no history of ankle injury or any predisposing conditions. Joint aspirations were positive for Salmonella enteritidis that was successfully treated with right ankle arthrotomy and washout, along with a 6-week course of intravenous antibiotic therapy.

  1. Juvenile idiopathic arthritis

    Science.gov (United States)

    ... arthritis (JRA); Juvenile chronic polyarthritis; Still disease; Juvenile spondyloarthritis ... wrists, or knees. It also affects the eyes. Spondyloarthritis of children resembles the disorder in adults and ...

  2. Polyarticular septic arthritis in an immunocompetent patient.

    Science.gov (United States)

    Clements, J; Dinneen, A; Heilpern, G

    2013-03-01

    Septic arthritis is an uncommon condition with an incidence of 2-3/100,000. It is clinically notable, however, as it is a rapidly destructive joint disease with significant associated morbidity and mortality. Polyarticular septic arthritis has an estimated incidence of 15% of all cases of infectious arthritis. We report a case of polyarticular septic arthritis with involvement of bilateral shoulders and wrist to highlight the importance of early diagnosis and treatment as well as the high mortality rates associated with this condition. Bilateral septic shoulder arthritis poses a challenge to treat, and its significance should not be underestimated as even with early surgical intervention and aggressive antibiotic and fluid resuscitation death is a sad but perhaps not uncommon outcome. It is therefore imperative that the diagnosis of polyarticular septic arthritis is kept prominent in the physician's mind when confronted with a patient with symptomatic polyarthralgia.

  3. Unusual case of paediatric septic arthritis of the lumbar facet joints due to Kingella kingae.

    Science.gov (United States)

    Le Hanneur, M; Vidal, C; Mallet, C; Mazda, K; Ilharreborde, B

    2016-11-01

    A 32-month-old boy presented with febrile limping that had developed over 6days, associated with right lumbosacral inflammatory swelling. Magnetic resonance imaging (MRI) showed joint effusion of the right L5-S1 zygapophyseal joint, complicated by destructive osteomyelitis of the L5 articular process and paraspinal abscess. Surgery was decided to evacuate the fluid accumulation and rule out differential diagnoses. The diagnosis of septic arthritis of the facet joint was confirmed intraoperatively; real-time quantitative PCR analysis identified Kingella kingae. This is the first substantiated paediatric case of zygapophyseal joint septic arthritis due to K. kingae. K. kingae is the most common pathogen responsible for invasive osteoarticular infection in children under 4years of age. Since empiric antibiotics are effective in early stages, physicians should consider the possibility of spinal infections due to K. kingae when a limping child under 4years of age presents with a fever.

  4. Bilateral sternoclavicular joint septic arthritis secondary to indwelling central venous catheter: a case report

    Directory of Open Access Journals (Sweden)

    Pradhan Charita

    2008-04-01

    Full Text Available Abstract Introduction Septic arthritis of the sternoclavicular joint is rare, comprising approximately 0.5% to 1% of all joint infections. Predisposing causes include immunocompromising diseases such as diabetes, HIV infection, renal failure and intravenous drug abuse. Case presentation We report a rare case of bilateral sternoclavicular joint septic arthritis in an elderly patient secondary to an indwelling right subclavian vein catheter. The insidious nature of the presentation is highlighted. We also review the literature regarding the epidemiology, investigation and methods of treatment of the condition. Conclusion SCJ infections are rare, and require a high degree of clinical suspicion. Vague symptoms of neck and shoulder pain may cloud the initial diagnosis, as was the case in our patient. Surgical intervention is often required; however, our patient avoided major intervention and settled with parenteral antibiotics and washout of the joint.

  5. Ultrasonography and color Doppler in juvenile idiopathic arthritis

    DEFF Research Database (Denmark)

    Laurell, Louise; Court-Payen, Michel; Nielsen, Susan;

    2012-01-01

    The wrist region is one of the most complex joints of the human body. It is prone to deformity and functional impairment in juvenile idiopathic arthritis (JIA), and is difficult to examine clinically. The aim of this study was to evaluate the role of ultrasonography (US) with Doppler in diagnosis...

  6. Lyme disease in the differential diagnosis of rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Ahmet Karadağ

    2016-03-01

    Full Text Available Clinically, there are some differences between rheumatoid arthritis (RA and Lyme disease. Although Lyme arthritis exhibits marked differences from RA, it can cause erosion at joint due to chronic proliferative synovitis as similar to RA. In the literature, a case was reported where both entities were seen together. In this manuscript, we aimed to present a case with symmetric arthritis at small hand joints and arthralgia at wrist that mimicked RA but diagnosed as Lyme disease by history, clinical presentation and laboratory findings, and successfully treated.

  7. Arthrodesis of the proximal interphalangeal joint affected with septic arthritis in 8 horses.

    OpenAIRE

    Groom, L J; Gaughan, E M; Lillich, J D; Valentino, L W

    2000-01-01

    Arthrodesis was performed to treat septic arthritis of the proximal interphalangeal joint of 8 horses. Records of the horses were reviewed to determine outcome and possible factors that influenced success or failure. All horses were female. Seven horses had 1 joint treated and 1 horse was treated for bilateral pelvic limb involvement. The duration of sepsis before surgery ranged from 1 to 66 days. Bone lysis and production was radiographically apparent in 7 horses before surgery. Six horses h...

  8. Burden of disease in treated rheumatoid arthritis patients: going beyond the joint

    NARCIS (Netherlands)

    Cutolo, M.; Kitas, G.D.; Riel, P.L.C.M. van

    2014-01-01

    OBJECTIVE: The disease burden in rheumatoid arthritis (RA) extends beyond the joint. This article evaluates the physical and psychosocial extra-articular burden of treated RA and relationships among diverse disease manifestations. METHODS: MEDLINE searches identified papers published in English from

  9. Abscess Formation after Septic Arthritis in the Sternoclavicular Joint of Two Healthy Men

    DEFF Research Database (Denmark)

    Henriksen, Jeppe; Tang, Mariann; Hjortdal, Vibeke

    2015-01-01

    Abscess formation after septic arthritis in the sternoclavicular joint is a rare phenomenon in healthy people without immune suppression, intravenous drug abuse, or diabetes. Here we report two cases with formation of abscess in two middle-aged men, with no relevant comorbidities and no obvious...

  10. Contrast-enhanced power Doppler ultrasonography of the metacarpophalangeal joints in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Szkudlarek, Marcin; Court-Payen, Michel; Strandberg, Charlotte;

    2003-01-01

    The aim of this study was to examine, with dynamic contrast-enhanced MRI as the reference, if contrast-enhanced power Doppler ultrasonography (CE PDUS) of rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints provides additional information for evaluation of synovial inflammation compared...... additional information in selected cases but did not in the present study increase the sensitivity of the method...

  11. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis.

    NARCIS (Netherlands)

    Janssens, H.J.E.M.; Fransen, J.; Lisdonk, E.H. van de; Riel, P.L.C.M. van; Weel, C. van; Janssen, M.

    2010-01-01

    BACKGROUND: Most cases of acute gouty arthritis are diagnosed in primary care and without joint fluid analysis in many instances. Our objectives were to estimate the validity of this diagnosis by family physicians and to develop a diagnostic rule. METHODS: Patients with monoarthritis recruited in an

  12. Recommendations of the ESSR Arthritis Subcommittee on Ultrasonography in Inflammatory Joint Disease

    DEFF Research Database (Denmark)

    Plagou, Athena; Teh, James; Grainger, Andrew J;

    2016-01-01

    This article presents the recommendations of the European Society of Musculoskeletal Radiology Arthritis Subcommittee on the use of ultrasonography (US) in rheumatic disease, focused on the examination of joints in the adult population. The recommended examination technique and protocols used in ...

  13. Physiotherapeutic procedures in patients with rheumatoid arthritis with maximum difficulties in the joints of the hand area

    OpenAIRE

    LEDVINOVÁ, Eva

    2014-01-01

    This bachelor thesis is focused on physiotherapeutic methods used in patients with rheumatoid arthritis whose difficulties are mainly in the joints of their hand. Rheumatoid arthritis is a chronic inflammatory joint disease in most cases with a protracted course and it may cause joint deformations. These lead to handling issues which complicate normal daily activities of the patients. Thus this disease causes both physical disability of the patient and as well significantly disrupts their soc...

  14. [Non-traumatic osteoarthritis of the wrist: chondrocalcinosis].

    Science.gov (United States)

    Romano, S

    2003-12-01

    Post-traumatic arthritis of the wrist is a common disorder, mostly after scapho lunate or scaphoid injury. Some patients in our experience and in literature have no known trauma, are bilateral and have a mean age much higher than usual post-traumatic cases. Radiological (during an often-extensive medical history) and biological studies of these patients led us to think there is a form of chondrocalcinosis of the wrist, with a four stages evolution, similar to SLAC and SNAC wrist but with often no scapho lunate gap, vertical embedding of the scaphoid in the radius and chalky incrustation of the joint. We called that form of dislocation of the carpus: scaphoid chondrocalcinosis advanced collapse or SCAC wrist. Surgical treatment of advanced cases is described. Scaphoidectomy and resection of triquetrum are performed, associated with hamato-luno-capitate fusion. Other rare forms are described and literature (mostly radiological and rheumatological because these patients are often been mistaken as SLAC wrist) is studied.

  15. First metatarsophalangeal joint arthrodesis for the treatment of tophaceous gouty arthritis.

    Science.gov (United States)

    Kim, Yong Sang; Park, Eui Hyun; Lee, Ho Jin; Koh, Yong Gon

    2014-02-01

    In tophaceous gouty arthritis, surgeons face the choice between preservation of the involved joint and arthrodesis after tophi excision. Magnetic resonance imaging (MRI) can allow evaluation of the distribution of tophaceous deposits, which can be difficult to visualize on radiography. The goal of this study was to evaluate the characteristic MRI features of tophaceous lesions and to compare the clinical outcomes of arthrodesis after tophi excision with those of simple tophi excision. The authors reviewed 16 feet in 15 consecutive patients diagnosed with tophaceous gouty arthritis of the first metatarsophalangeal (MTP) joint who underwent surgery. Nine feet (group A) were treated with simple tophi excision, whereas the other 7 (group B) underwent first MTP joint arthrodesis after tophi excision. For clinical evaluation, the visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale, and patient satisfaction assessments were used. Magnetic resonance imaging was performed to evaluate the characteristics of tophaceous deposits in the first MTP joint. Mean VAS and AOFAS scores and patient satisfaction significantly differed between the 2 groups at final follow-up (P=.007, .005, and .002, respectively). In group A, progression of arthritis of the first MTP joint was observed in 6 of 9 cases at final follow-up. The tophaceous lesions of these 6 cases were found to be located intra-articularly on MRI. Arthrodesis after tophi excision should be considered for treating tophaceous gouty arthritis of the first MTP joint when tophi are located intra-articularly and loss of cartilage involved is greater than 50% of the entire joint.

  16. Juvenile Arthritis

    Science.gov (United States)

    Juvenile arthritis (JA) is arthritis that happens in children. It causes joint swelling, pain, stiffness, and loss of motion. It can affect any joint, but ... of JA that children get is juvenile idiopathic arthritis. There are several other forms of arthritis affecting ...

  17. Physical examination of the wrist.

    Science.gov (United States)

    Young, Darryl; Papp, Steven; Giachino, Alan

    2007-04-01

    Physical examination of the wrist requires knowledge of wrist anatomy and pathology to make a diagnosis or narrow the differential diagnosis. Symptoms are provoked by palpation and signs are produced by manipulation. Negative findings elsewhere in the wrist are important. Final diagnosis may require diagnostic imaging. By having all three methods of assessment agree one is assured of correct diagnosis. The physical examination of the wrist is not unlike that of other joints, in that a systematic approach includes observation, range of motion, palpation, and special tests.

  18. Arthritis of the sternoclavicular joint masquerading as rupture of the cervical oesophagus: a case report

    Directory of Open Access Journals (Sweden)

    Katsoulis Iraklis E

    2009-01-01

    Full Text Available Abstract Introduction Sternoclavicular septic arthritis is a rare condition and accounts only for 1% of cases of septic arthritis in the general population. The most common risk factors are intravenous drug use, central-line infection, distant-site infection, immunosuppression, trauma and diabetes mellitus. This is a report of an unusual case where this type of arthritis was masquerading as rupture of the cervical oesophagus. Case presentation A 63-year-old man presented complaining of right neck pain and dysphagia following a bout of violent coughing. Physical examination revealed cellulitis extending from the right sternoclidomastoid region to the anterior upper chest. Computed tomography showed inflammatory changes behind the right sternoclavicular joint with mediastinitis and ipsilateral pleural effusion. These findings raised the suspicion of spontaneous rupture of the cervical oesophagus. Management involved jejunal feeding along with broad-spectrum antibiotics. The inflammation, however, relapsed after discontinuation of the antibiotics and this time, computed tomography pointed to a diagnosis of arthritis of the sternoclavicular joint. The patient responded completely to a 6-week course of oral penicillin, flucloxacillin and metronidazole. Conclusion Sternoclavicular arthritis is a rare condition that has been associated with a variety of predisposing factors. It may, however, occur in otherwise completely healthy individuals and should be included in the differential diagnosis of other inflammatory conditions of the neck and upper chest.

  19. Effect of Electro-acupuncture on Rat Joint Patho-morphology of Chronic Adjuvant Arthritis Model

    Institute of Scientific and Technical Information of China (English)

    张幼美; 胡玲; 唐纯志; 曹伟

    2003-01-01

    Objective:To study the effect of electro-acupuncture (EA) on pathomorphological changes of joints in rat model of chronic adjuvant arthritis. Methods: The rat chronic adjuvant arthritis model was established by subcutaneous injection of 0.1 ml of complete Freund's adjuvant to the left hind sole. Forty Wistar rats were randomly divided into the model group, the low frequency (2 Hz) EA group, the high frequency EA (100 Hz) group and the body acupuncture group. After being modeled except the model group, the other three groups were treated with EA or body acupuncture in Yanglingquan points (bilateral) for 3 weeks, the left ankle joints and metatarsal joints of rats were taken for pathological examination by fixing with 10% formalin and embedding in paraffin, sectioning and staining with HE. Results: Obvious inflammatory cell infiltration, loosened synovial tissue, damage of articular cartilage and proliferation of synovial cells and granulation tissue were observed in the sections of joints in model rats. These pathological changes were significantly improved after treatment, and the effect in the high frequency EA group were significantly superior to that in the low frequency EA and body acupuncture group. Conclusion: High frequency EA could significantly improve the pathomorphological changes of joints in chronic adjuvant arthritis rat models.

  20. Effect of Electro—acupuncture on Rat Joint Pathomorphology of Chronic Adjuvant Arthritis Model

    Institute of Scientific and Technical Information of China (English)

    ZHANGYou-mei; HULing; 等

    2003-01-01

    Objective:To study the effect of electro-acupuncture(EA) on pathomorphological changes of joints in rat model of chronic adjuvant arthritis.Methods:The rat chronic adjuvant arthritis model was established by subcutaneous injection of 0.1 ml of complete Freunds adjuvant to the left hind sole.Forty Wistar rats were randomly divided into the model group,the low frequency(2Hz) EA group,the high frequency EA(100Hz)group and the body acupuncture group.After being modeled except the model group,the other three groups were treated with EA or body acupuncture in Yanglingquan points(bilater-al)for 3weeks,the left ankle joints and metatarsal joints of rats were taken for pathological examination by fixing with 10% formalin and embedding in paraffin,sectioning and staining with HE.Results:Obvious inflammatory cell infiltration,loosened synovial tissue,damage of articular cartilage and proliferation of synovial cells and granulation tissue were observed in the sections of joints in model rats.These pathologi-cal changes were significantly improved after treatment,and the effect in the high frequency EA group were significantly superior to that in the low frequency EA and body acupuncture group.Conclusion:High frequency EA could significantly improve the pathomorphological changes of joints in chronic adjuvant ar-thritis rat models.

  1. MRI pattern of arthritis in systemic lupus erythematosus: a comparative study with rheumatoid arthritis and healthy subjects

    Energy Technology Data Exchange (ETDEWEB)

    Tani, Chiara; Possemato, Niccolo; Delle Sedie, Andrea; Bombardieri, Stefano; Mosca, Marta [University of Pisa, Rheumatology Unit, Department of Clinical and Experimental Medicine, Pisa (Italy); D' aniello, Dario; Caramella, Davide [Radiology Unit, University of Pisa, Pisa (Italy)

    2014-10-24

    In this study we aimed to describe the magnetic resonance imaging (MRI) pattern of the distribution of bone marrow edema (BME) and joint erosion in hands and wrists of patients with systemic lupus erythematosus (SLE) with arthritis in comparison with rheumatoid arthritis (RA) and healthy subjects (H). SLE patients with arthritis (n = 50), patients with RA (n = 22), and H (n = 48) were enrolled. Every patient underwent a non-dominant hand (2nd-5th metacarpophalangeal joints) and wrist MRI without contrast injection with a low-field extremity dedicated 0.2-Tesla instrument. BME was observed in two SLE patients in the hand (4 %) and in 15 in the wrist (13 %) versus three (30 %), and 14 (63 %) RA patients. No BME was found in H. Erosions were observed in the hand in 24 SLE patients (48 %), 15 RA patients (68 %), and 9 H (18 %); in the wrist, in 41 (82 %) SLE, all RA and 47 (97 %) H. The cumulative erosive burden in SLE was significantly higher than in H (c = 0.002) but similar to RA patients. Joint involvement of the wrist in SLE is similar to RA and is not as rare as expected, as shown by the comparison with healthy subjects. On the contrary, the involvement of the hand in SLE is significantly lower compared to RA. (orig.)

  2. Coordination of intrinsic and extrinsic hand muscle activity as a function of wrist joint angle during two-digit grasping.

    Science.gov (United States)

    Johnston, Jamie A; Bobich, Lisa R; Santello, Marco

    2010-04-26

    Fingertip forces result from the activation of muscles that cross the wrist and muscles whose origins and insertions reside within the hand (extrinsic and intrinsic hand muscles, respectively). Thus, tasks that involve changes in wrist angle affect the moment arm and length, hence the force-producing capabilities, of extrinsic muscles only. If a grasping task requires the exertion of constant fingertip forces, the Central Nervous System (CNS) may respond to changes in wrist angle by modulating the neural drive to extrinsic or intrinsic muscles only or by co-activating both sets of muscles. To distinguish between these scenarios, we recorded electromyographic (EMG) activity of intrinsic and extrinsic muscles of the thumb and index finger as a function of wrist angle during a two-digit object hold task. We hypothesized that changes in wrist angle would elicit EMG amplitude modulation of the extrinsic and intrinsic hand muscles. In one experimental condition we asked subjects to exert the same digit forces at each wrist angle, whereas in a second condition subjects could choose digit forces for holding the object. EMG activity was significantly modulated in both extrinsic and intrinsic muscles as a function of wrist angle (both p<0.05) but only for the constant force condition. Furthermore, EMG modulation resulted from uniform scaling of EMG amplitude across all muscles. We conclude that the CNS controlled both extrinsic and intrinsic muscles as a muscle synergy. These findings are discussed within the theoretical frameworks of synergies and common neural input across motor nuclei of hand muscles.

  3. Imatinib mesylate inhibits osteoclastogenesis and joint destruction in rats with collagen-induced arthritis (CIA).

    Science.gov (United States)

    Ando, Wataru; Hashimoto, Jun; Nampei, Akihide; Tsuboi, Hideki; Tateishi, Kosuke; Ono, Takeshi; Nakamura, Norimasa; Ochi, Takahiro; Yoshikawa, Hideki

    2006-01-01

    Macrophage colony-stimulating factor (M-CSF) is a key factor for osteoclastogenesis at the bone-pannus interface in patients with rheumatoid arthritis as well as a receptor activator of NF-kappaB ligand (RANKL). Imatinib mesylate inhibits the phosphorylation of c-fms, a receptor for M-CSF. The present study investigates the effect of imatinib mesylate on joint destruction in rats with collagen-induced arthritis (CIA) and on osteoclastogenesis in vitro. Imatinib mesylate (50 or 150 mg/kg), dexamethasone, or vehicle was administered daily to CIA rats for 4 weeks from the onset of arthritis. Hind-paw swelling and body weight were measured weekly. At weeks 2 and 4, the metatarsophalangeal (MTP) joints and the ankle and subtalar joints were radiographically and histologically assessed. The effect of imatinib mesylate on osteoclast formation from rat bone marrow cells with M-CSF and soluble RANKL (sRANKL) in vitro was also examined. Radiographic assessment showed that 150 mg/kg imatinib mesylate suppressed the destruction of the MTP and the ankle and subtalar joints at week 2, and MTP joint destruction at week 4 in CIA rats, although hind-paw swelling was not suppressed. The number of TRAP-positive cells at the bone-pannus interface was significantly reduced in the group administered with 150 mg/kg imatinib mesylate compared with that given vehicle at week 4. Imatinib mesylate dose-dependently inhibited the proliferation of M-CSF-dependent osteoclast precursor cells in vitro as well as osteoclast formation induced by M-CSF and sRANKL. These findings suggest that imatinib mesylate could prevent joint destruction in patients with rheumatoid arthritis.

  4. Surgical management of the juvenile idiopathic arthritis patient with multiple joint involvement.

    Science.gov (United States)

    Abdel, Matthew P; Figgie, Mark P

    2014-10-01

    Juvenile idiopathic arthritis (JIA) is recognized as a heterogenous group of disorders in which the common factor is persistent arthritis in at least 1 joint occurring before the age of 16 years. Although conservative management with nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs can be effective, approximately 10% of JIA patients have end-stage degenerative changes requiring total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). This article discusses the overall epidemiology, coordination of care, and medical and surgical management of JIA patients undergoing THA and TKA.

  5. Diagnosis and treatment of intraosseous ganglion cysts of the wrist joint%腕关节骨内腱鞘囊肿的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    刘坤; 田文; 刘波; 杨勇; 田光磊

    2014-01-01

    目的:探讨腕关节骨内腱鞘囊肿的临床特点和治疗方法。方法2008年7月至2012年7月,收治18例(20侧)腕关节骨内腱鞘囊肿患者。男5例,女13例,平均33.5岁。月骨11例,舟骨6例,三角骨、大多角骨和小多角骨各1例。主要症状为腕部酸胀不适、疼痛,伴握力下降和活动度降低。X 线平片显示腕骨内圆形或类圆形骨密度减低区,边界清楚,有硬化缘。CT 及 MRI 显示病灶内为液体。均采用病灶刮除+自体松质骨移植术治疗,术后腕关节功能位固定4周。结果18例获3个月至4年的随访,平均15个月。病理证实为腱鞘囊肿者18例。术后疼痛消失10例,减轻7例,3例无缓解。16例握力下降者有14例得到改善。6例术后腕关节屈伸活动度下降。复发1例。术后改良Mayo腕关节评分优10例,良8例,一般2例。结论腕关节骨内腱鞘囊肿是慢性腕关节疼痛原因之一,其确诊需将临床症状、影像学表现、术中所见和病理结果相结合,手术效果满意。%Objective To investigate the clinical characteristics and treatment methods of intraosseous ganglion cysts of the wrist joint. Methods From July 2008 to July 2012, 18 patients ( 20 wrists ) with intraosseous ganglion cysts in the wrist joint were adopted. There were 5 males and 13 females, whose average age was 33.5 years old. There were 11 cases in the lunate, 6 cases in the scaphoid, 1 case in the triangular bone, 1 case in the large multangular bone and 1 case in the small multangular bone. The main complaint was chronic wrist pain, decreased grip strength and limitation of wrist extension-lfexion movement. The X-ray showed circular and quasi-circular areas of reduced bone mineral density within the carpal bone with a clear boundary and slightly sclerotic margin. The CT and MRI revealed the liquid content. All the patients were treated by curettage of the ganglion cysts and autologous cancellous bone

  6. 75 FR 36427 - Joint Meeting of the Arthritis Advisory Committee and the Drug Safety and Risk Management...

    Science.gov (United States)

    2010-06-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Joint Meeting of the Arthritis Advisory Committee and the...: Arthritis Advisory Committee and the Drug Safety and Risk Management Advisory Committee. ] General...

  7. Radiographic temporomandibular joint abnormality in adults with micrognathia and juvenile rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Larheim, T.A.; Haanaes, H.R.; Dale, K. (Oslo Univ. (Norway))

    1981-01-01

    Radiographic findings of the upper and lower jaw bone of 20 adult patients with micrognathia, bird face, and juvenile rheumatoid arthritis are reported. In all patients a symmetrically underdeveloped mandible with the chin posteriorly positioned was found at cephalometry. Arthritic lesion of the temporomandibular joint, mostly symmetric, with limitation of movement and secondary arthrosis, was observed in all patients. Complete absence of the mandibular head was frequent (75%). The fossa was generally flat, probably due to growth disturbance of the tubercle. Abnormal anterior position of the mandibular head occurred in almost half of the patients. The degree of mandibular growth disturbance seemed to be correlated to the severity of the arthritis, indicating the arthritis to be a causal mechanism of micrognathia.

  8. CCR5 small interfering RNA ameliorated joint inflammation in rats with adjuvant-induced arthritis.

    Science.gov (United States)

    Duan, Hongmei; Yang, Pingting; Fang, Fang; Ding, Shuang; Xiao, Weiguo

    2014-12-01

    Rheumatoid arthritis (RA) is a systemic inflammatory disease. C-C chemokine receptor type 5 (CCR5) is found in inflamed synovium of RA patients and is necessary for formation of RA. We aimed to check whether delivery of CCR5-specific small interfering RNA (siRNA) via electroporation suppresses local inflammation in arthritis rats. Vectors encoding siRNA that target CCR5 or negative control siRNA were constructed for gene silencing and the silencing effects of suppressing CCR5 expression in synovium examined by western blot. The vector with strongest effect was delivered into the knee joint of adjuvant-induced arthritis (AIA) rats by the in vivo electroporation method 7, 10, 13, and 16 days after immunization with Complete Freund's adjuvant. During an observation of 28 days, behavior, paw swelling, arthritis and histopathologic scoring were estimated. The expression level of CCR5 in synovium was evaluated by western blot and real-time PCR. Anti-CCR5 D1 siRNA was effectively inhibited CCR5 expression in vitro. Moreover, delivery of the siRNA into inflammatory joint also suppressed the expression of CCR5 in vivo and markedly suppressed paw swelling and inflammation. Local electroporation of anti-CCR5 siRNA into the left inflamed joints could achieve the silencing of CCR5 gene and alleviate local inflammation just in the knee joint injected with siRNA other than the opposite joint. Inhibition of CCR5 expression may provide a potential for treatment of RA.

  9. Clinical outcome and imaging changes after intraarticular (IA) application of etanercept or methylprednisolone in rheumatoid arthritis: Magnetic resonance imaging and ultrasound-Doppler show no effect of IA injections in the wrist after 4 weeks

    DEFF Research Database (Denmark)

    Boesen, M.; Boesen, L.; Jensen, K.E.

    2008-01-01

    Objective. To assess the magnetic resonance imaging (MRI) and ultrasound (US) changes in the wrist of patients with rheumatoid arthritis (RA) 4 weeks after an US guided intraarticular (IA) injection. Methods. Contrast enhanced MRI and US-Doppler were performed at baseline and 4 weeks after IA......-29) in the total group was unchanged after 4 weeks (p = 0.13), whereas MRI erosion score increased in the total group from baseline, 17.88 (range 7-40), to 4 weeks, 18.25 (range 7-40) (p .... Conclusion. In contrast to the clinical evaluation, imaging measures of relevance for the estimation of inflammation, US-Doppler, US RI, MRI synovitis, and bone-marrow edema did not change 4 weeks after a single IA injection of either methylprednisolone or etanercept in the wrist. Within the same period...

  10. [The temporomandibular joint in juvenile idiopathic arthritis: what radiologists need to look for on magnetic resonance imaging].

    Science.gov (United States)

    De La Hoz Polo, M; Navallas, M

    2014-01-01

    The term "juvenile idiopathic arthritis" (JIA) encompasses a group of arthritis of unknown cause with onset before the age of 16 years that last for at least 6 weeks. The prevalence of temporomandibular joint involvement in published series ranges from 17% to 87%. Temporomandibular joint involvement is difficult to detect clinically, so imaging plays a key role in diagnosis and monitoring treatment. MRI is the technique of choice for the study of arthritis of the temporomandibular joint because it is the most sensitive technique for detecting acute synovitis and bone edema. Power Doppler ultrasonography can also detect active synovitis by showing the hypervascularization of the inflamed synovial membrane, but it cannot identify bone edema. This article describes the MRI technique for evaluating the temporomandibular joint in patients with juvenile idiopathic arthritis, defines the parameters to look for, and illustrates the main findings.

  11. Lumbar facet joint septic arthritis presenting atypically as acute abdomen – A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Aysha Rajeev

    2016-01-01

    Conclusion: The atypical presentation of facet joint septic arthritis is one of the reasons why early diagnosis is elusive. Definitive diagnoses with MRI and bacterial culture as well as prolonged antibiotic therapy are recommended in this condition.

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

    Science.gov (United States)

    Księżopolska-Orłowska, Krystyna

    2015-01-01

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

  13. Septic arthritis of the temporomandibular joint caused by Aspergillus flavus infection as a complication of otitis externa.

    Science.gov (United States)

    Varghese, Lalee; Chacko, Rabin; Varghese, George M; Job, Anand

    2015-03-01

    Septic arthritis of the temporomandibular joint (TMJ) is a very rare complication of otitis externa that can lead to ankylosis and destruction of the joint. We report the case of a 74-year-old man who developed aspergillosis of the TMJ following otitis externa. To the best of our knowledge, this is the first reported case of TMJ septic arthritis secondary to otitis externa caused by Aspergillus flavus. The patient was successfully managed with condylectomy, debridement, and drug treatment with voriconazole.

  14. ADVANTAGES OF BACKWARD PEDALING TO DETERMINE THE FUNCTIONAL ABILITY OF HYPERTROPHY ARTHRITIS KNEE JOINT

    Directory of Open Access Journals (Sweden)

    Subbulakshmi

    2015-11-01

    Full Text Available BACKGROUND Biomechanical effects of backward pedaling within 45 degrees of knee flexion without resistance in hypertrophy arthritis knee joint were examined. OBJECTIVE Advantages of backward pedaling to determine the functional ability of hypertrophy arthritis knee. SETTINGS AND DESIGN In this study, 10 patients with the age of 45-50 years of hypertrophic arthritis in knee joint were selected. Pre-test and post-test experimental group design was used. METHODS AND MATERIALS The selected patients were advised to perform backward pedaling within 45 degrees of knee flexion without resistance with the duration of ten minutes per day for 3 weeks. The Lysholm’s knee rating scale was a measurement tool used for this study. The measurement was recorded for Pre-test on 1st day and for Post-test on 21st day respectively. STATISTICAL ANALYSIS The rate of progression in improvement in these days was calculated and the results are statistically significant at 95% level, when paired t-test was done. CONCULSION Back pedaling within 45 degrees of knee flexion have the biomechanical functions of increasing the moment arm of quadriceps femoris, length-tension relationship, eccentric contraction with less or no patellofemoral and tibiofemoral compression forces, activate the quadriceps femoris to generate the greatest torque is effective in the improvement of functional ability in hypertrophy arthritis knee.

  15. RHEUMATOID ARTHRITIS. PHYSICAL MEASURES IN TREATMENT OF CHILDREN.

    Science.gov (United States)

    EISING, L M; SOULES, B

    1964-05-01

    Prognosis in rheumatic arthritis in children is good, provided total care is given, deformity prevented and function maintained. Bed rest is desirable until active inflammation of the joints has subsided. During convalescence a balance between rest and exercise must be maintained to avoid recurrence of inflammation of the joints. When there is progressive deformity or disabling pain in the wrist, a molded leather wrist-cuff splint can control the deformity, decrease or abolish pain and lessen swelling. If there is valgus deformity of the knee or external rotation of the tibia, with no more than ten degrees of knee flexion deformity, correction can be obtained by simple manipulations.

  16. Primary meningococcal septic arthritis of the ankle joint: a case report.

    Science.gov (United States)

    Gee, Christopher; Tandon, Tarang; Avasthi, Adish; Jerwood, Susie; Rao, Biyyam M; Cavanagh, Simon

    2014-01-01

    We present the case of a healthy 18-year-old female who presented with history of an acute onset, painful, swollen right ankle joint. Microbiologic samples from the ankle aspirate grew Neisseria meningitidis. She had had no previous contact with a patient with meningitis nor any existing or preceding clinical symptoms of meningitis. She was treated with surgical drainage with mini-open arthrotomy and a repeat washout at 48 hours. The identification of the organism was expedited using the Analytical Profiling Index (bioMérieux UK, Basingstoke, UK). Our patient was treated with 2 weeks of third-generation cephalosporin antibiotics. At the final follow-up visit, the inflammatory markers had returned to normal, with a normal ankle joint and no evidence of long-term sequelae of septic arthritis. Primary septic arthritis with N. meningitidis is exceptionally rare in the adult population and has been most often reported in the knee. To the best of our knowledge, this is the first reported case of primary septic arthritis of the native adult ankle joint in a healthy individual due to N. meningitides that was diagnosed and treated appropriately with no residual sequelae of the disease.

  17. Wrist pain

    Science.gov (United States)

    ... with your wrist, such as typing on a computer keyboard, using a computer mouse, playing racquetball or handball, sewing, painting, writing, ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  18. Contrast-enhanced power Doppler ultrasonography of the metacarpophalangeal joints in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Szkudlarek, Marcin; Court-Payen, Michel; Strandberg, Charlotte;

    2003-01-01

    The aim of this study was to examine, with dynamic contrast-enhanced MRI as the reference, if contrast-enhanced power Doppler ultrasonography (CE PDUS) of rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints provides additional information for evaluation of synovial inflammation compared...... with PDUS. One MCP joint in each of 15 RA patients and 3 healthy control persons were examined with PDUS before and after intravenous bolus Levovist contrast injection. Corresponding rates of early synovial enhancement (RESE), previously shown to be closely related to histopathological synovitis, were...... calculated from dynamic contrast-enhanced MR images obtained the same day. Prior to ultrasonography, the joint was evaluated clinically. Levovist increased the flow signal in 7 of 9 joints with pre-contrast flow-signal and in 0 of 9 without pre-contrast signal. No healthy controls showed CE PDUS signal...

  19. An introduction to the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Edmonds, J; McQueen, F;

    2005-01-01

    This article gives a short overview of the development and characteristics of the OMERACT rheumatoid arthritis MRI scoring system (RAMRIS), followed by an introduction to the use of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. With this atlas, MRIs of wrist and metacarpophala......This article gives a short overview of the development and characteristics of the OMERACT rheumatoid arthritis MRI scoring system (RAMRIS), followed by an introduction to the use of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. With this atlas, MRIs of wrist...... and metacarpophalangeal joints of patients with rheumatoid arthritis can be scored for synovitis, bone oedema, and bone erosion, guided by standard reference images...

  20. Brucella arthritis of the sacro-iliac joint.

    Science.gov (United States)

    Porat, S; Shapiro, M

    1984-01-01

    We are reporting a case of culture-proven brucella sacro-iliitis. The treatment included surgical drainage and curettage together with tetracycline and streptomycin. A five-year follow-up showed complete cure: the patient was free of symptoms, the sacro-iliac joint was normal and a serologic test negative. The diagnostic difficulties, the differential diagnosis and the appropriate treatment are also discussed in this paper.

  1. Low-cost, low-field dedicated extremity magnetic resonance imaging in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Lindegaard, H M; Vallø, J; Hørslev-Petersen, K;

    2006-01-01

    OBJECTIVE: To study the ability of low-cost low-field dedicated extremity magnetic resonance imaging (E-MRI) to assess and predict erosive joint damage in the wrist and metacarpophalangeal (MCP) joints of patients with early rheumatoid arthritis. METHODS: 24 previously untreated patients with rhe......OBJECTIVE: To study the ability of low-cost low-field dedicated extremity magnetic resonance imaging (E-MRI) to assess and predict erosive joint damage in the wrist and metacarpophalangeal (MCP) joints of patients with early rheumatoid arthritis. METHODS: 24 previously untreated patients...... with rheumatoid arthritis with joint symptoms for treatment with conventional clinical or biochemical examinations, x rays of both hands and wrists, and E-MRI of the dominant wrist and MCP joints. RESULTS: At baseline, all...... patients showed magnetic resonance imaging (MRI) synovitis, and MRI erosions were detected in 21 bones (10 patients). 6 (29%) of these, distributed among two patients, were seen on x ray. One x ray erosion was not detected by MRI. At 1 year, MRI and x ray detected 15 and 8 new erosions, respectively...

  2. /sup 133/Xe clearance of the knee joint of patients suffering from arthritis and osteoarthrosis

    Energy Technology Data Exchange (ETDEWEB)

    Balint, G.; Reviczky, L.A.; Lendvay, J.; Boehm, U.; Kucsera, K.; Genti, Gy. (Orszagos Reuma es Fizioterapias Intezet, Budapest (Hungary))

    1982-01-01

    65 inflammed and 13 non-inflammed knee joints of patients suffering from osteoarthrosis were examined by the Xe/sup 133/ clearance method. The control group consisted of 27 patients with exsudative arthritis of the knee. The counts of 80 ..mu..C /sup 133/Xe given intraarticcularly were measured above the knee joint by NK 350 energy selective counter. The time needed to halve the count rate measured in the 4th minute after administration (biological half life (T1/2)) was significantly different in the three groups. It was the longest in the non-inflammed arthrosis, the shortest in the exsudative arthritis group. Significant differences were apparent regarding joint pain and tenderness in all the three groups. Though the synovial protein level and the C/sub 3/ complement level were significantly different, in the three groups no relationship was found between the T1/2 and synovial/serum protein ratio or between the synovial/serum C/sub 3/ ratio. The authors concluded that /sup 133/Xe clearance, which measures the perfusion of the synovial membrane, can be used for measuring the inflammatory activity of knee joint synovitis.

  3. Primary Clinical Evaluation of the Joint Replacement for the Treatment of the First Metatarsophalangeal Arthritis

    Institute of Scientific and Technical Information of China (English)

    Qi-yi Li; Jin Jin; Xi-sheng Weng; Jin Lin; Yi-dan Zhang; Gui-xing Qiu

    2011-01-01

    Objective To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant. Methods A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant. There were 2 males and 10 females with a mean age of 61.4 (range, 56-75) years old. Of them, 9 cases (11 feet) were hallux valgus with osteoarthritis; 1 case (2 feet) was rheumatic arthritis; 2 cases (2 feet) were traumatic arthritis. The subjective and objective results were evaluated during follow-up.Results All of the patients were followed up regularly with an average of 24.7 months, ranging from 12 to 38 months. Ten patients were completely satisfied with the operation; 1 patient showed partial satisfaction, and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hyperosteogeny surrounding the cut bone surface 3 years after the operation. Osteolysis around the implant occurred in 2 cases without clinical symptoms, and no special treatment was given.Conclusion The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.

  4. Distal radioulnar joint injuries

    Directory of Open Access Journals (Sweden)

    Binu P Thomas

    2012-01-01

    Full Text Available Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint , forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments.The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis.

  5. Gadolinium-enhanced MRI features of acute gouty arthritis on top of chronic gouty involvement in different joints

    NARCIS (Netherlands)

    Emad, Yasser; Ragab, Yasser; El-Naggar, Ahmed; El-Shaarawy, Nashwa; Abd-Allah, Mayada A.; Gamal, Rania M.; Fathy, Ahmed; Hawass, Mona; Rasker, Hans

    2015-01-01

    The aims of the current study are to describe gadolinium-enhanced MRI features of an acute flare of established gouty arthritis in different joints and to examine a possible association between serum uric acid and MRI signs indicative of ongoing inflammation and/or structural joint damage as well as

  6. Potential of optical spectral transmission measurements for joint inflammation measurements in rheumatoid arthritis patients

    Science.gov (United States)

    Meier, A. J. Louise; Rensen, Wouter H. J.; de Bokx, Pieter K.; de Nijs, Ron N. J.

    2012-08-01

    Frequent monitoring of rheumatoid arthritis (RA) patients enables timely treatment adjustments and improved outcomes. Currently this is not feasible due to a shortage of rheumatologists. An optical spectral transmission device is presented for objective assessment of joint inflammation in RA patients, while improving diagnostic accuracy and clinical workflow. A cross-sectional, nonrandomized observational study was performed with this device. In the study, 77 proximal interphalangeal (PIP) joints in 67 patients have been analyzed. Inflammation of these PIP joints was also assessed by a rheumatologist with a score varying from 1 (not inflamed) to 5 (severely inflamed). Out of 77 measurements, 27 were performed in moderate to strongly inflamed PIP joints. Comparison between the clinical assessment and an optical measurement showed a correlation coefficient r=0.63, p<0.001, 95% CI [0.47, 0.75], and a ROC curve (AUC=0.88) that shows a relative good specificity and sensitivity. Optical spectral transmission measurements in a single joint correlate with clinical assessment of joint inflammation, and therefore might be useful in monitoring joint inflammation in RA patients.

  7. Ankylosis of the distal interphalangeal joint in a horse after septic arthritis and septic navicular bursitis.

    Science.gov (United States)

    Honnas, C M; Schumacher, J; Kuesis, B S

    1992-04-01

    A 6-month-old 300-kg Quarter Horse filly was treated for septic arthritis of the distal interphalangeal joint and septic navicular bursitis that developed as a result of a deep puncture to the foot. Initial treatment consisted of establishing ventral drainage for the navicular bursa, lavage of the distal interphalangeal joint, and administration of broad-spectrum antimicrobial drugs and non-steroidal anti-inflammatory drugs. Because of continuing sepsis in the distal interphalangeal joint, subsequent treatment included packing the defect in the bottom of the foot with cancellous bone in an attempt to prevent ascending contamination of the joint, placing the limb in a short limb cast, and inserting a Penrose drain into the joint for passive drainage of septic exudate. The goal of treatment was to encourage ankylosis of the distal interphalangeal joint. Because of the filly's persistent lameness and laxity of the lateral collateral ligament in the contralateral carpus, the palmar nerves of the affected foot were injected with a long-acting local anesthetic at the level of the proximal sesamoid bones to encourage weight-bearing. Ankylosis of the distal interphalangeal joint was complete 9 months after the puncture, but a grade-2 lameness remained and the horse had a varus deformity resulting from ligamentous laxity of the lateral collateral ligament in the contralateral carpus.

  8. Wrist arthrography: a simple method

    Energy Technology Data Exchange (ETDEWEB)

    Berna-Serna, Juan D.; Reus, Manuel; Alonso, Jose [Virgen de la Arrixaca University Hospital, Department of Radiology, El Palmar (Murcia) (Spain); Martinez, Francisco; Domenech-Ratto, Gines [University of Murcia, Department of Human Anatomy, Faculty of Medicine, Murcia (Spain)

    2006-02-01

    A technique of wrist arthrography is presented using an adhesive marker-plate with radiopaque coordinates to identify precisely sites for puncture arthrography of the wrist and to obviate the need for fluoroscopic guidance. Radiocarpal joint arthrography was performed successfully in all 24 cases, 14 in the cadaveric wrists and 10 in the live patients. The arthrographic procedure described in this study is simple, safe, and rapid, and has the advantage of precise localisation of the site for puncture without need for fluoroscopic guidance. (orig.)

  9. Trapeziometacarpal narrow pseudarthrosis: a new surgical technique to treat thumb carpometacarpal joint arthritis.

    Science.gov (United States)

    Rubino, M; Civani, A; Pagani, D; Sansone, V

    2013-10-01

    We describe a technique that arose from the observation of the clinical outcome of failed arthrodeses of the thumb carpometacarpal joint. In these cases a pseudoarthrosis developed which, surprisingly, rarely lead to a poor clinical outcome. Thus we developed a simple technique which deliberately caused the formation of a narrow pseudoarthrosis in the carpometacarpal joint. We present a retrospective review of 248 consecutive patients treated for Eaton stages II and III osteoarthritis. We observed a statistically significant improvement in mean appositional and oppositional pinch strength, mean DASH score (63.8 pre-operatively to 10.5 at final follow-up), and the mean pain score (8.3 to 0.2). We conclude that trapeziometacarpal limited excision arthroplasty is a simple and reliable alternative to existing surgical techniques for treating Stage II or III thumb carpometacarpal joint arthritis.

  10. Temporomandibular Joint Ankylosis as a Complication of Neonatal Septic Arthritis; Report of two cases

    Directory of Open Access Journals (Sweden)

    Noor J. Al-Saadi

    2015-11-01

    Full Text Available Temporomandibular joint (TMJ ankylosis as a complication of neonatal septic arthritis is rarely reported in the literature. We report two clinical cases of unilateral TMJ ankylosis occurring in paediatric patients subsequent to neonatal septic arthritis. The first case was a 15-month-old male infant who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in May 2010. According to the published English scientific literature, he is the youngest person yet to be diagnosed with this condition. The second case was a five-year-old female who presented to the Al-Nahda Hospital, Muscat, Oman, in October 2011. Both cases presented with facial asymmetry and trismus. They subsequently underwent gap arthroplasty and interpositional temporalis muscle and fascia grafts which resulted in an immediate improvement in mouth opening. Postoperatively, the patients underwent active jaw physiotherapy which was initially successful. Both patients were followed up for a minimum of two years following their surgeries.

  11. Association between condylar morphology and inflammation in experimental temporomandibular joint TMJ arthritis

    DEFF Research Database (Denmark)

    Kristensen, Kasper Dahl; Stoustrup, Peter bangsgaard; Küseler, Annelise;

      Background: In juvenile idiopathic arthritis involvement of the temporomandibular joints (TMJs) is often associated with severe mandibular growth deviations. The relation between condylar growth deviations, inflammation severity, the micro-architectural composition, and the bone quality has...... not previously been investigated. Aim: We studied the effects of antigen-induced arthritis on the bony structures in rabbit mandibular condylar development, in particular the morphological changes and the bone micro-architecture. Materials and Methods: Included were juvenile rabbits with ovalbumin-induced TMJ...... morphology was not associated with overall mandibular growth. Conclusion: We show that severe inflammation in the TMJs during mandibular development is associated with morphological changes of the mandibular condyle. Morphological changes may occur because of deficient development of condylar cartilage...

  12. Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis--a probabilistic approach

    DEFF Research Database (Denmark)

    Rezaei, Hamed; Torp-Pedersen, Søren; af Klint, Erik;

    2014-01-01

    INTRODUCTION: This study aimed to assess the utility of musculoskeletal ultrasound (MSUS) in patients with joint symptoms using a probabilistic approach. METHODS: One hundred and three patients without prior rheumatologic diagnosis and referred to our clinic for evaluation of inflammatory arthritis...... by the responsible rheumatologist where the probability of a) any inflammatory arthritis and b) rheumatoid arthritis was given on a 5-point scale ranging from 0 to 20% up to 80 to 100% probability. Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints...... for presence/absence of inflammatory arthritis and rheumatoid arthritis was increased significantly following ultrasound performance. The proportion of patient for whom diagnostic certainty for inflammatory arthritis was maximal was 33.0% before and 71.8% after musculoskeletal ultrasound (P

  13. Reduced mandibular growth in experimental arthritis in the temporomandibular joint treated with intra-articular corticosteroid.

    Science.gov (United States)

    Stoustrup, Peter; Kristensen, Kasper D; Küseler, Annelise; Gelineck, John; Cattaneo, Paolo M; Pedersen, Thomas K; Herlin, Troels

    2008-04-01

    The aim of this investigation was to study the effect of intra-articular (i.a.) corticosteroid injections (IACIs) in the temporomandibular joint (TMJ) on mandibular development in antigen-induced TMJ arthritis. Ten-week-old female New Zealand white rabbits (n = 42) were randomly divided into four groups: group A, control (no injections); group B, placebo (repeated i.a. TMJ saline injections); group C, untreated arthritis (repeated induction of TMJ arthritis); and group D, steroid (repeated induction of TMJ arthritis + IACI). All animals had two tantalum implants inserted in the right side of the mandible serving as stable landmarks for later growth analysis. One implant was inserted close to the symphysis and one in the molar region. Computerized tomographic (CT) full-head scans were carried out at 14 (T1) and 26 (T2) weeks of age. (Dropout of animals at T2; group C, n = 7, and group D, n = 3.) Absolute and relative intra- and inter-group growth variations were evaluated during the growth period by comparison of CT scans. One-way analysis of variance was used for T1 statistical analysis, and absolute intra-group and relative inter-group growth differences between T1 and T2 were evaluated by Student's t-tests. At T2, the animals in the group A had greater sagittal and vertical mandibular growth compared with the other three groups. TMJ arthritis caused diminished mandibular growth. However, relative mandibular growth was significantly less in group D. The findings of this study do not indicate a positive long-term effect in the use of IACI in the TMJ as an early treatment intervention against TMJ inflammation in growing individuals.

  14. The Wrist Joint Complex: Anatomical, Physiological and Biomechanical Aspects, Characteristics, Classification, and Treatment of Distal Radius Fractures

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Medina Gonzalez

    2016-08-01

    Full Text Available The distal radius fracture or wrist, is one of the most common fractures in children and in adults, especially in women. The causes are different, in the children is mainly due to sports injuries, the latter primarily related disorders including elderly osteoporosis. The aim of this work is to do review of the distal radial fracture in which elements of their history, different types of classifications and very updated aspects of the management of patients with this injury is included, including the use of external fixators. The authors address this issue with an extensive literature review and images and figures taken from the literature and made by the authors themselves.

  15. Quantification of joint inflammation in rheumatoid arthritis by time-resolved diffuse optical spectroscopy and tracer kinetic modeling

    Science.gov (United States)

    Ioussoufovitch, Seva; Morrison, Laura B.; Lee, Ting-Yim; St. Lawrence, Keith; Diop, Mamadou

    2015-03-01

    Rheumatoid arthritis (RA) is characterized by chronic synovial inflammation, which can cause progressive joint damage and disability. Diffuse optical spectroscopy (DOS) and imaging have the potential to become potent monitoring tools for RA. We devised a method that combined time-resolved DOS and tracer kinetics modeling to rapidly and reliably quantify blood flow in the joint. Preliminary results obtained from two animals show that the technique can detect joint inflammation as early as 5 days after onset.

  16. Gonococcal arthritis

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/000453.htm Gonococcal arthritis To use the sharing features on this page, please enable JavaScript. Gonococcal arthritis is inflammation of a joint due to a ...

  17. Fungal arthritis

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000444.htm Fungal arthritis To use the sharing features on this page, please enable JavaScript. Fungal arthritis is swelling and irritation (inflammation) of a joint ...

  18. US findings of metacarpophalangeal joints in children with idiopathic juvenile arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Karmazyn, Boaz [Riley Hospital for Children, Radiology, Indianapolis, IN (United States); Bowyer, Suzanne L.; Murphy Schmidt, Kara; Ballinger, Susan H.; Beam, Thuy T. [Indiana University, Pediatric Rheumatology, Indianapolis, IN (United States); Buckwalter, Kenneth [University Hospital, Radiology, Indianapolis, IN (United States); Ying, Jun [University of Cincinnati, Biostatistics, Institute for the Study of Health, Cincinnati, OH (United States)

    2007-05-15

    Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children, with frequent involvement of the metacarpophalangeal joints (MCPJ). To compare US findings with those of radiography and clinical examination. All MCPJs in 20 children with JIA (17 females, median age 9.7 years, range 3.6 to 16.8 years) were evaluated clinically and imaged with gray-scale and color Doppler US, and 90 MCPJs were also imaged radiographically. Each MCPJ was graded on physical examination from 0 (normal) to 4 (severe) by the patient's rheumatologist. US demonstrated abnormalities in 64 of 200 MCPJs (32.0%), including pannus vascularity and/or tenosynovitis in 55 joints (27.5%) (pannus vascularity in 43, tenosynovitis in 40) and bone destruction in 25 joints (12.5%). Overall, US abnormalities and physical examination scores were significantly associated (P < 0.001). However, interobserver agreement between US and clinical evaluation was poor (kappa 0.1) and between US and radiography was only fair (kappa 0.4). US of the MCPJ in children with JIA can demonstrate cartilage thinning, bone erosions, and pannus vascularity. Abnormal US findings are significantly correlated with severity of disease as evaluated clinically. (orig.)

  19. Radiographic abnormalities of the temporomandibular joint in children with juvenile rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Larheim, T.A.; Dale, K.; Tveito, L. (Oslo Sanitetsforening Rheumatism Hospital, University of Oslo, Oslo, Norway)

    1981-01-01

    Radiographic lesion of the temporomandibular joint was found in 41 of 100 children with juvenile rheumatoid arthritis using a combination of radiographic techniques. In patients with abnormality, unilateral lesion occurred in 41 per cent. In patients with definite affection, a varying degree of destruction was observed in 93 per cent, restricted translatory movement of the mandibular head in 83 per cent. In many cases dystrophic or dysplasia-like changes occurred, with stump and thick, anteriorly positioned mandibular head and flat fossa. The lesions seemed to be most frequently associated with the polyarticular type, early onset and long duration of the disease.

  20. Abscess Formation after Septic Arthritis in the Sternoclavicular Joint of Two Healthy Men

    Directory of Open Access Journals (Sweden)

    Jeppe Henriksen

    2015-01-01

    Full Text Available Abscess formation after septic arthritis in the sternoclavicular joint is a rare phenomenon in healthy people without immune suppression, intravenous drug abuse, or diabetes. Here we report two cases with formation of abscess in two middle-aged men, with no relevant comorbidities and no obvious sites of infection. The abscesses were both treated surgically with debridement followed by negative pressure wound therapy and antibiotics. The cases differ in diagnostic procedures and delay of diagnosis and broach the issues of handling a rare disease.

  1. Septic arthritis of a lumbar facet joint: Detection with bone SPECT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Swayne, L.C.; Dorsky, S.; Caruana, V.; Kaplan, I.L. (Morristown Memorial Hospital, NJ (USA))

    1989-08-01

    We present a rare case of septic arthritis of a lumbar facet joint with an associated epidural abscess resulting from Staphylococcus aureus. The infection was initially detected with planar bone scintigraphy and precisely localized with single photon emission computed tomography bone scintigraphy, despite an initially negative radiologic evaluation that included radiographs of the lumbar spine, lumbar myelography, and a postmyelography x-ray computed tomography scan. In the appropriate clinical setting, a bone scan demonstrating unilateral increased activity within the spine should raise the suspicion of inflammatory involvement of the posterior elements.

  2. The use of etanercept as a non-surgical treatment for temporomandibular joint psoriatric arthritis: a case report.

    Science.gov (United States)

    Lamazza, L; Guerra, F; Pezza, M; Messina, A M; Galluccio, A; Spink, M; De Biase, A

    2009-06-01

    Psoriatic arthritis (PsA) is a chronic inflammatory disease of the skin and joints characterized by extensive intra-articular bone resorption and silver-red scaly plaques most commonly found on extensor surfaces of the skin. When this arthritis affects the temporomandibular joint (TMJ) and does not successfully halt in its early degenerative process, patients may undergo invasive joint reconstruction that irreversibly changes the TMJ physiologic joint dynamics. This study presents a case of TMJ PsA: anterior open bite, limited range of motion, and erythematous desquamative plaques of the upper limb extensors surfaces. The patient previously received non-steroidal anti-inflammatory drugs, immunosuppressors, and corticosteroids over a four-year period while suffering the idiosyncratic drug side effects from long-term therapy without improvement in joint function or rash resolution. The treatment team then chose etanercept, a synthetic fusion protein therapy that binds with tumor necrosis factor (TNF)-alpha, to interrupt reactive inflammatory arthritis. The patient received the TNF-alpha inhibitor monthly for two years. This last treatment led to full remission of both joint symptomatology and skin lesions. Our results should encourage general dental practitioners' involvement in curing patients with psoriatic arthritis when it affects the TMJ.

  3. Artrodese do punho com fixação mínima preservando as articulações carpometacarpianas Wrist arthrodesis with minimal internal fixation preserving the carpometacarpal joints

    Directory of Open Access Journals (Sweden)

    Arlindo Gomes Pardini Júnior

    2010-01-01

    structures. In general, the results are very satisfactory, particularly for pain relief, and in the majority of cases, there is considerable functional improvement. Various techniques are described, with different methods of internal fixation, most of which include the carpometacarpal joints (CMJ in the fusion. The objective of this study is to evaluate the results of wrist arthrodesis through a technique which is simpler, more biological, more inexpensive, and does not involve the carpometacarpal joints. METHODS: 15 patients with wrist arthrodesis were evaluated (6 with sequelae of trauma, 4 Rheumatoid Arthritis, 3 Kienbock's grade IV, 1 Preiser and 1 panarthrosis. The technique consisted of the use of an iliac bone plate and internal fixation with Kirschner wires, avoiding the carpometacarpal joints. RESULTS: The evaluation was based on consolidation time (93% in 7 weeks; movements of the fingers and pronosupination; pinch and grasp strength; functional evaluation through the DASH questionnaire, pain and patient satisfaction. In general, the results were similar to those of other, more aggressive techniques, and the non-inclusion of the carpometacarpal joints did not affect the final result. CONCLUSION: wrist arthrodesis with fixation using Kirschner wires and the use of an iliac bone plate, preserving the carpometacarpal joints, gives good or excellent results which are similar to those of other techniques described. However it presents major advantages over other methods: it is less aggressive, less expensive, and does not have the inconvenience and complications associated the use of plates and screws.

  4. Asymptomatic SLAC wrist: does it exist?

    Science.gov (United States)

    Fassler, P R; Stern, P J; Kiefhaber, T R

    1993-07-01

    Twenty-five patients (30 wrists) had x-ray evidence of scapholunate advanced collapse. Twenty-two wrists had no pain; 12 of these were diagnosed and treated for carpal tunnel syndrome. Eight wrists had mild pain. All patients were reevaluated an average of 2 years later. At that time, 20 wrists were totally free of symptoms and 10 had occasional pain, especially with increased activity (no patients required analgesics). No patient had undergone surgical management for the scapholunate advanced collapse. We believe that there are some patients (especially older and low-demand persons) in whom x-ray evidence of arthritis and clinical findings do not correlate. In these circumstances surgical intervention for treatment of the arthritis may not be warranted.

  5. Scaphocapitolunate arthrodesis and radial styloidectomy for posttraumatic degenerative wrist disease.

    Science.gov (United States)

    Klausmeyer, Melissa A; Fernandez, Diego L; Caloia, Martin

    2012-08-01

    Long-standing scaphoid nonunion, scaphoid malunion, and chronic scapholunate dissociation result in malalignment of the carpal bones, progressive carpal collapse, instability, and osteoarthritis of the wrist. The most commonly used procedures to treat scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrists are the four-corner fusion (4CF) and the proximal row carpectomy (PRC). The purpose of this study was to evaluate the clinical outcome of a different treatment modality: radial styloidectomy and scaphocapitolunate (SCL) arthrodesis. This treatment option is chosen in an effort to maintain the joint contact surface and load transmission across the radiocarpal joint. We conducted a retrospective review of 20 patients (average age 62 years, range: 27 to 75 years) treated from 1994 to 2010. Seven patients were treated for SNAC, 12 patients for SLAC wrists, and 1 for degenerative joint disease following a transscapho-transcapitate perilunar dislocation. Sixteen patients had Herbert screw fixation, and four had Spider plate fixation. All patients had autologous bone graft used for the arthrodesis. The mean follow-up was 4.6 years (range: 2 to 9.6 years). Patients were evaluated clinically and radiographically. Nineteen of 20 arthrodeses healed on an average of 9.6 weeks. One patient was reoperated 8 months after the initial operation with salvage of the SCL arthrodesis with a spider plate with an adequate result. The mean active flexion-extension arc was 70 degrees and the radioulnar deviation arc was 23 degrees. Pain decreased in all patients, 13 of whom were pain free postoperatively. The average postoperative disabilities of arm, shoulder, and hand score was 24. Radiographically, neither radiolunate nor radioscaphoid arthritis was noted on follow-up. SCL arthrodesis with radial styloidectomy resulted in an adequate residual range of motion and pain relief. This method preserves the normal ulnar sided joints of the carpus and

  6. Significance of arthrosonography in the diagnosis of metatarsophalangeal joint injury in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Rita Aleksandrovna Osipyants

    2013-01-01

    Full Text Available Objective: to estimate the contribution of arthrosonography to the diagnosis of metatarsophalangeal joint (MTPJ injury and to reveal predictors for functional impairments in patients with rheumatoid arthritis (RA. Subjects and methods. The investigation enrolled 50 patients with the RA diagnosis meeting to the American College of Rheumatology 1987 criteria. According to disease duration, the patients were divided into two groups: 1 9 patients with an early RA history of less than 2 years (ERA; 2 41 patients with a RA history of over 2 years (LRA. All the patients underwent clinical joint evaluation, laboratory and instrumental examination, including joint X-ray and ultrasonography (USG. Results. An inflammatory process in the foot joints is significantly more frequently detected on ultrasound than clinically (p < 0.0001. The detection rate of erosions, as evidenced by USG, was significantly higher than that by X-ray, in ERA in particular (p = 0.01. Comparison analysis of patients with low and high HAQ scores showed the relationship between functional status, age, pain degree, and inflammatory process in the fifth MTPJ, as shown by USG. There were no associations with disease duration, traditional clinical and laboratory parameters of RA activity, and erosive changes in the feet. Conclusion. Joint USG in daily clinical practice makes it possible to objectively evaluate pathological changes in the feet and the probability of work disability due to RA.

  7. Tuberculous osteomyelitis/arthritis of the first costo-clavicular joint and sternum.

    Science.gov (United States)

    Patel, Prasan; Gray, Robin R

    2014-12-28

    A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography (CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acid-fact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.

  8. Tuberculous osteomyelitis/arthritis of the first costoclavicular joint and sternum

    Institute of Scientific and Technical Information of China (English)

    Prasan; Patel; Robin; R; Gray

    2014-01-01

    A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography(CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acidfact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.

  9. Segmentation of joint and musculoskeletal tissue in the study of arthritis.

    Science.gov (United States)

    Pedoia, Valentina; Majumdar, Sharmila; Link, Thomas M

    2016-04-01

    As the most frequent cause of physical disability, musculoskeletal diseases such as arthritis and osteoporosis have a great social and economical impact. Quantitative magnetic resonance imaging (MRI) biomarkers are important tools that allow clinicians to better characterize, monitor, and even predict musculoskeletal disease progression. Post-processing pipelines often include image segmentation. Manually identifying the border of the region of interest (ROI) is a difficult and time-consuming task. Manual segmentation is also affected by inter- and intrauser variability, thus limiting standardization. Fully automatic or semi-automatic methods that minimize the user interaction are highly desirable. Unfortunately, an ultimate, highly reliable and extensively evaluated solution for joint and musculoskeletal tissue segmentation has not yet been proposed, and many clinical studies still adopt fully manual procedures. Moreover, the clinical translation of several promising quantitative MRI techniques is highly affected by the lack of an established, fast, and accurate segmentation method. The goal of this review is to present some of the techniques proposed in recent literature that have been adopted in clinical studies for joint and musculoskeletal tissue analyses in arthritis patients. The most widely used MRI sequences and image processing algorithms employed to accomplish segmentation challenges will be discussed in this paper.

  10. Significance of arthrosonography for knee joint damage diagnosis in patients with early rheumatoid arthritis

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    L V Sizova

    2008-01-01

    Full Text Available Objective. To assess significance of arthrosonography in diagnosis of in knee joint changes in patients with early rheumatoid arthritis (RA. Material and methods. 44 patients with early RA aged 19 to 73 years were examined. 29,5% of pts had early RA without primary osteoarthritis (OA, 70,5% had early RA with primary OA. Ultrasonography of knee joints was performed with Diasonics (USA, 1997 by the linear sensor with frequency of 7 MHz. The protocol of ultrasonic examination of knee joints was filled for each pt. Results. Clinical signs of of knee joint synovitis have been revealed in 61,5% of pts with early RA without primary OA, and in 80,6% of pts with early RA with primary OA, ultrasonic - in 100% of pts. Intraarticular knee joint effusion resulted in increase of suprapatellar bursa and lateral recesses size. Extraarticular inflammation was frequently shown by thickening of semymemranous muscles tendons, especially in pts with the early RA with primary OA (p<0,005. Degenerative changes in the group of pts with primary OA were more expressed in early RA and usually accompanied by non-uniform decrease of cartilage thickness and occurrence of osteophytes while cartilage in pts with early RA without primary OA had normal thickness or thickening because of swelling, and osteophytes were absent. Conclusion. Prevalence of knee joint intraarticular and extraarticular inflammatory changes over degenerate changes (symmetric thickening of the synovium, primary increase of the sizes of suprapatellar bursa and lateral recesses because of effusion, thickening of tendons of knee joints at the normal or increased thickness of cartilage because of inflammation can be considered sonographic sign of early RA. In pts with early RA coincided with primary OA these changes were usually found in combination with non-uniform decrease of cartilage thickness. In case of cartilage inflammatory edema, detection of osteophytes allows to confirm presence of OA in pts with

  11. Clinical experiences of treating septic arthritis in the equine by repeated joint lavage: a series of 39 cases.

    Science.gov (United States)

    Meijer, M C; van Weeren, P R; Rijkenhuizen, A B

    2000-08-01

    The condition of septic arthritis was treated in 12 foals with 21 affected joints (Group I) and in 27 adult horses. The adult horses were divided into three groups, based on aetiology of the condition: haematogenous (Group II, n = 6), iatrogenic (Group III, n = 6), and perforating trauma (Group IV, n = 15). The treatment consisted of an initial systemic antibiotic that anticipated the microbial agents that were considered most likely per group, repeated through-and-through joint lavages every other day and non-steroidal anti-inflammatory drugs. The antibiotics were adjusted to the results of bacteriological culture and susceptibility tests. Joint lavages were continued until the white blood cell count dropped below 15 G/l and bacteriological culture was negative, after which a single dose of a short-acting corticosteroid was administered intra-articularly. Joint recovery rate in group I was 71%. Patient recovery rate of the foals, however, was lower (42%). Three foals were killed for reasons other than arthritis; one foal because of an arthritis-related problem and three foals because of persistent arthritis. Overall joint recovery rate, equalling patient recovery rate, in the adult horses was 81%. The expected predominance of Streptococcus spp. in haematogenous arthritis in adult horses was not confirmed, indicating that in these cases also, an initial antibiotic treatment with a broad-spectrum combination is preferable. It is concluded that with intensive treatment, the prognosis of septic arthritis in the adult horse can be classified as fair to even good. Results in the foals are not as good, but this seems to be more due to the specific problems surrounding the equine neonate than to unresponsiveness to the treatment.

  12. Studies on YKL-40 in knee joints of patients with rheumatoid arthritis and osteoarthritis. Involvement of YKL-40 in the joint pathology

    DEFF Research Database (Denmark)

    Volck, B; Johansen, J S; Stoltenberg, M;

    2001-01-01

    OBJECTIVE: The presence of YKL-40 (human cartilage glycoprotein 39) in synovium, cartilage and synovial fluid (SF) from knee joints of patients with rheumatoid arthritis and osteoarthritis (OA) were related to histopathological changes in synovium and cartilage and to serum YKL-40 and other bioch...

  13. Computer-aided classification of rheumatoid arthritis in finger joints using frequency domain optical tomography

    Science.gov (United States)

    Klose, C. D.; Kim, H. K.; Netz, U.; Blaschke, S.; Zwaka, P. A.; Mueller, G. A.; Beuthan, J.; Hielscher, A. H.

    2009-02-01

    Novel methods that can help in the diagnosis and monitoring of joint disease are essential for efficient use of novel arthritis therapies that are currently emerging. Building on previous studies that involved continuous wave imaging systems we present here first clinical data obtained with a new frequency-domain imaging system. Three-dimensional tomographic data sets of absorption and scattering coefficients were generated for 107 fingers. The data were analyzed using ANOVA, MANOVA, Discriminant Analysis DA, and a machine-learning algorithm that is based on self-organizing mapping (SOM) for clustering data in 2-dimensional parameter spaces. Overall we found that the SOM algorithm outperforms the more traditional analysis methods in terms of correctly classifying finger joints. Using SOM, healthy and affected joints can now be separated with a sensitivity of 0.97 and specificity of 0.91. Furthermore, preliminary results suggest that if a combination of multiple image properties is used, statistical significant differences can be found between RA-affected finger joints that show different clinical features (e.g. effusion, synovitis or erosion).

  14. Long-term results of the Sauvé-Kapandji procedure in the rheumatoid wrist.

    Science.gov (United States)

    Papp, Miklós; Papp, Levente; Lenkei, Balázs; Károlyi, Zoltán

    2013-12-01

    This retrospective long-term study evaluates the clinical and radiological results of the Sauvé-Kapandji procedure in rheumatoid wrists. Fourteen patients with rheumatoid arthritis who had undergone a Sauvé-Kapandji procedure were examined 10 to 16.5 years after surgery. Range of motion and grip strength were measured. The patients' complaints related with instability of the ulnar stump, the residual pain in the wrist, and the function of the operated hand were assessed. The review also included a radiological examination. Pain was found to have decreased and the gripping strength of the hand to have increased in all the patients. The range of wrist rotation was significantly improved. On radiographs, there were no signs of increased ulnar translation of the carpus. We noted no instance of subluxation or dislocation of the ulnar stump. In this long-term evaluation, the Sauvé-Kapandji procedure was found to provide long-term improvement of the function of the wrist-hand complex, by eliminating the distal radio-ulnar joint which is a major source of pain in the rheumatoid wrist.

  15. Combination joint-preserving surgery for forefoot deformity in patients with rheumatoid arthritis.

    Science.gov (United States)

    Niki, H; Hirano, T; Okada, H; Beppu, M

    2010-03-01

    Proximal osteotomies for forefoot deformity in patients with rheumatoid arthritis have hitherto not been described. We evaluated combination joint-preserving surgery involving three different proximal osteotomies for such deformities. A total of 30 patients (39 feet) with a mean age of 55.6 years (45 to 67) underwent combined first tarsometatarsal fusion and distal realignment, shortening oblique osteotomies of the bases of the second to fourth metatarsals and a fifth-ray osteotomy. The mean follow-up was 36 months (24 to 68). The mean foot function index scores for pain, disability and activity subscales were 18, 23, and 16 respectively. The mean Japanese Society for Surgery of the Foot score improved significantly from 52.2 (41 to 68) to 89.6 (78 to 97). Post-operatively, 14 patients had forefoot stiffness, but had no disability. Most patients reported highly satisfactory walking ability. Residual deformity and callosities were absent. The mean hallux valgus and intermetatarsal angles decreased from 47.0 degrees (20 degrees to 67 degrees) to 9.0 degrees (2 degrees to 23 degrees) and from 14.1 degrees (9 degrees to 20 degrees) to 4.6 degrees (1 degree to 10 degrees), respectively. Four patients had further surgery including removal of hardware in three and a fifth-ray osteotomy in one. With good peri-operative medical management of rheumatoid arthritis, surgical repositioning of the metatarsophalangeal joint by metatarsal shortening and consequent relaxing of surrounding soft tissues can be successful. In early to intermediate stages of the disease, it can be performed in preference to joint-sacrificing procedures.

  16. Group C Neisseria meningitidis as a Cause of Septic Arthritis in a Native Shoulder Joint: A Case Report

    Directory of Open Access Journals (Sweden)

    Amy J. Garner

    2011-01-01

    Full Text Available Septic arthritis is an Orthopaedic emergency, threatening the joint within hours of onset. Up to 10% of cases of meningococcaemia have an associated septic arthritis. The aetiology of acute meningococcaemia in a variety of clinical syndromes is well documented in the literature. The pathogen Neisseria meningitidis can cause both primary and secondary manifestations of disseminated infection. Broad-range 16S rDNA PCR is a relatively new technique, useful in identifying aetiological agents in septic patients with negative blood cultures. Here, we describe the rare clinical scenario of a 76-year-old woman with primary meningococcal septic arthritis of a native shoulder joint without associated meningococcal bloodstream infection. We discuss the role of 16s rDNA Polymerase Chain Reaction (PCR in the identification of the infectious agent, Neisseria meningitidis, and the role of this technique in guiding subsequent management.

  17. Further optimization of the reliability of the 28-joint disease activity score in patients with early rheumatoid arthritis

    OpenAIRE

    Liseth Siemons; ten Klooster, Peter M.; Vonkeman, Harald E.; van de laar, Mart A. F. J.; Glas, Cees A. W.

    2014-01-01

    BACKGROUND: The 28-joint Disease Activity Score (DAS28) combines scores on a 28-tender and swollen joint count (TJC28 and SJC28), a patient-reported measure for general health (GH), and an inflammatory marker (either the erythrocyte sedimentation rate [ESR] or the C-reactive protein [CRP]) into a composite measure of disease activity in rheumatoid arthritis (RA). This study examined the reliability of the DAS28 in patients with early RA using principles from generalizability theory and evalua...

  18. Foot and ankle joint kinematics in rheumatoid arthritis cannot only be explained by alteration in walking speed

    NARCIS (Netherlands)

    Dubbeldam, R.; Nene, A.V.; Buurke, J.H.; Groothuis-Oudshoorn, C.G.M.; Baan, H.; Drossaers-Bakker, K.W.; Laar, van de M.A.F.J.; Hermens, H.

    2011-01-01

    Rheumatoid arthritis (RA) manifests itself in the foot and ankle of RA patients. The foot and ankle joint kinematics of these patients differ from that of healthy subjects. However, the factors that lead to these differences are not yet fully understood. The aim of this study was to analyse the effe

  19. Inhibition of joint damage and improved clinical outcomes with rituximab plus methotrexate in early active rheumatoid arthritis: the IMAGE trial

    NARCIS (Netherlands)

    P.P. Tak; W.F. Rigby; A. Rubbert-Roth; C.G. Peterfy; R.F. van Vollenhoven; W. Stohl; E. Hessey; A. Chen; H. Tyrrell; T.M. Shaw

    2011-01-01

    Objectives Rituximab is an effective treatment in patients with established rheumatoid arthritis (RA). The objective of the IMAGE study was to determine the efficacy of rituximab in the prevention of joint damage and its safety in combination with methotrexate (MTX) in patients initiating treatment

  20. Temporomandibular joint involvement in Juvenile Idiopathic Arthritis : reliability and validity of a screening protocol for the rheumatologist

    NARCIS (Netherlands)

    Steenks, Michel H.; Giancane, G; de Leeuw, Rob R. J.; Bronkhorst, Ewald M.; van Es, Robert J. J.; Koole, Ron; van Bruggen, H. Willemijn; Wulffraat, NM

    2015-01-01

    Background: In Juvenile Idiopathic Arthritis (JIA) the temporomandibular joint (TMJ) can be involved leading to pain, dysfunction and growth disturbances of the mandible and associated structures. There may be value to a three minute screening protocol allowing the rheumatologist to detect TMJ invol

  1. Rituximab inhibits structural joint damage in patients with rheumatoid arthritis with an inadequate response to tumour necrosis factor inhibitor therapies

    NARCIS (Netherlands)

    Keystone, E.; Emery, P.; Peterfy, C.G.; Tak, P.P.; Cohen, S.; Genovese, M.C.; Dougados, M.; Burmester, G.R.; Greenwald, M.; Kvien, T.K.; Williams, S.; Hagerty, D.; Cravets, M.W.; Shaw, T.

    2009-01-01

    OBJECTIVE: To determine if treatment with a B cell-targeted therapy can inhibit the progression of structural joint damage in patients with rheumatoid arthritis (RA), exhibiting an inadequate response to tumour necrosis factor (TNF) inhibitors. METHODS: In this phase III study, patients with an inad

  2. Disk abnormality coexists with any degree of synovial and osseous abnormality in the temporomandibular joints of children with juvenile idiopathic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Kirkhus, Eva; Smith, Hans-Joergen [Oslo University Hospital, Rikshospitalet, Department of Radiology and Nuclear Medicine, Oslo (Norway); University of Oslo, Institute of Clinical Medicine, Oslo (Norway); Arvidsson, Linda Z.; Larheim, Tore A. [University of Oslo, Department of Maxillofacial Radiology, Institute of Clinical Dentistry, Oslo (Norway); Flatoe, Berit; Hetlevik, Siri O. [Oslo University Hospital, Rikshospitalet, Department of Rheumatology, Oslo (Norway); University of Oslo, Institute of Clinical Medicine, Oslo (Norway)

    2016-03-15

    MRI manifestation of temporomandibular joint arthritis is frequently reported in children with juvenile idiopathic arthritis. However, little attention has been paid to temporomandibular joint disk abnormalities. To assess combinations of MRI findings in the symptomatic temporomandibular joint in children with juvenile idiopathic arthritis with focus on disk abnormalities. This was a retrospective study of 46 patients with juvenile idiopathic arthritis, mean age 12 years (range: 5-17 years). Mean disease duration was 70 months (standard deviation: 61 months). MR images of 92 temporomandibular joints were scored for thickness of abnormally enhancing synovium (synovitis), joint effusion, bone marrow oedema, abnormal bone shape, bone erosion and disk abnormalities. The 92 temporomandibular joints were categorized as A: No synovitis and normal bone shape (30/92; 33%), B: Synovitis and normal bone shape (14/92: 15%), C: Synovitis and abnormal bone shape (38/92; 41%) and D: No synovitis but abnormal bone shape (10/92; 11%). Thirty-six of the 46 patients (78%) had synovitis and 33/46 (72%) had abnormal bone shape, most frequently in combination (30/46; 65%). Disk abnormalities (flat disk, fragmented disk, adherent disk and displaced disk) were found in 29/46 patients (63%). Disk abnormalities were found in all categories of juvenile idiopathic arthritis involved temporomandibular joints (B: 8/14 [57%]; C: 25/38 [66%] and D: 7/10 [70%]). Disk displacement was found in half of the joints (7/14) in category B. Synovitis was most pronounced in this category. Disk abnormalities were frequent. Disk displacement also occurred in joints with early temporomandibular joint arthritis, i.e., with normal bone shape. Other disk abnormalities were found in joints with bone abnormalities. Attention should be paid to disk abnormalities both in early and long-standing temporomandibular joint arthritis in children with juvenile idiopathic arthritis. (orig.)

  3. Blisters associated with elective wrist surgery.

    Science.gov (United States)

    Steinberg, Tsipora; Chernofsky, Michael A; Luria, Shai

    2015-01-01

    Blistering of the skin has been reported after high energy trauma or arthroplasties of large joints. It is rare in wrist trauma and seldom reported following elective wrist surgery. We present three cases of skin blistering after elective wrist surgery. Two female patients aged 18 and 35 years and one male patient aged 53 years were treated with total wrist fusion, carpometacarpal fusion, and open wrist ligament repair. They reported burning pain at the blister site. The blisters were clear and treated with dressing changes. There were no infections or wound complications and all blisters resolved without sequelae. These complications were probably due to a combination of factors, including swelling, compression from dressing and splint, multiple surgical incisions, and the use of adhesive dressing. Reassurance and proper wound care are recommended for the complication of clear blistering following elective wrist surgery.

  4. Talonavicular joint abnormalities and walking ability of patients with rheumatoid arthritis.

    Directory of Open Access Journals (Sweden)

    Miyamoto N

    2004-04-01

    Full Text Available Rheumatoid arthritis (RA is often associated with deformities of the feet, and foot pain often arises in the talonavicular joint of patients with RA. The object of this study was to assess the relationship between magnetic resonance imaging (MRI findings of the talonavicular joint and walking ability. The subjects were 35 RA patients (10 feet in 5 males and 56 feet in 30 females aged 34-87 years (mean: 70 years +/- 12.1, with a disease duration from 1-54 years (mean: 14 years +/- 12.1. MRI findings were classified as follows: Grade 1, almost normal; Grade 2, early articular destruction; Grade 3, moderate articular destruction; Grade 4, severe articular destruction; and Grade 5, bony ankylosis dislocation. Walking ability was classified into one of 9 categories ranging from normal gait to bedridden status according to the system of Fujibayashi. As the grade of MRI images became higher the walking ability decreased, and these parameters showed a correlation by Spearman's rank correlation coefficient analysis (P = 0.003. Thus, in the present cohort group of patients with RA, the deterioration of walking ability increased with the severity of destruction of the talonavicular joint.

  5. Dynamic contrast-enhanced, extremity-dedicated MRI identifies synovitis changes in the follow-up of rheumatoid arthritis patients treated with rituximab

    DEFF Research Database (Denmark)

    Cimmino, Marco A; Parodi, Massimiliano; Zampogna, Giuseppe

    2014-01-01

    OBJECTIVES: The aim of this study is to assess prospectively the effect of rituximab (RTX) on MRI features of wrist joint disease in patients affected by rheumatoid arthritis (RA). METHODS: Ten patients (6F/4M, mean age 52.9±15.5 years) diagnosed with IgM rheumatoid factor, anti-CCP positive, RA ...

  6. Low-cost, low-field dedicated extremity magnetic resonance imaging in early rheumatoid arthritis: a 1-year follow-up study

    DEFF Research Database (Denmark)

    Lindegaard, H.M.; Vallø, J.; Hørslev-Petersen, K.;

    2006-01-01

    OBJECTIVE: To study the ability of low-cost low-field dedicated extremity magnetic resonance imaging (E-MRI) to assess and predict erosive joint damage in the wrist and metacarpophalangeal (MCP) joints of patients with early rheumatoid arthritis. METHODS: 24 previously untreated patients with rhe......OBJECTIVE: To study the ability of low-cost low-field dedicated extremity magnetic resonance imaging (E-MRI) to assess and predict erosive joint damage in the wrist and metacarpophalangeal (MCP) joints of patients with early rheumatoid arthritis. METHODS: 24 previously untreated patients...... with rheumatoid arthritis with joint symptoms for treatment with conventional clinical or biochemical examinations, x rays of both hands and wrists, and E-MRI of the dominant wrist and MCP joints. RESULTS: At baseline, all...... patients showed magnetic resonance imaging (MRI) synovitis, and MRI erosions were detected in 21 bones (10 patients). 6 (29%) of these, distributed among two patients, were seen on x ray. One x ray erosion was not detected by MRI. At 1 year, MRI and x ray detected 15 and 8 new erosions, respectively...

  7. Extra Domain B Fibronectin as a Target for Near-Infrared Fluorescence Imaging of Rheumatoid Arthritis Affected Joints In Vivo

    Directory of Open Access Journals (Sweden)

    Sonja Vollmer

    2009-11-01

    Full Text Available We investigated a molecular imaging approach for the detection of collagen-induced arthritis in rats by targeting the extra domain B (ED-B of the extracellular matrix protein fibronectin. ED-B is a highly conserved domain (identical in human and rats that is produced by alternative splicing during embryonic development and during vascular remodeling such as angiogenesis. The hallmark of rheumatoid arthritis is synovitis leading to both angiogenesis in the synovium and the promotion of cartilage and bone disruption. For in vivo diagnostics, the ED-B-binding single-chain antibody fragment AP39 was used as a targeting probe. It was covalently linked to the near-infrared dye tetrasulfocyanine (TSC to be visualized by near-infrared fluorescence imaging. The resulting AP39-TSC conjugate was intravenously administered to rats with collagen-induced arthritis and the respective controls. Ovalbumin-TSC was used as control conjugate. Optical imaging over a time period of 24 hours using a planar imaging setup resulted in a clear enhancement of fluorescence intensity in joints with moderate to severe arthritis compared with control joints between 3 and 8 hours postinjection. Given that AP39 is a fully human antibody fragment, this molecular imaging approach for arthritis detection might be translated to humans.

  8. Color Doppler ultrasound of the hand: observations on clinical utility in rheumatoid arthritis.

    Science.gov (United States)

    Saadeh, Constantine; Gaylor, Patrick; Lee, Doohi; Malacara, Jan; Gaylor, Michael

    2004-02-01

    The use of ultrasound with color Doppler in the evaluation of rheumatoid arthritis was followed in 25 patients with joint complaints. Small joint ultrasound of the metacarpophalangeal joints (MCPs) as well as the wrists was performed with supplementation by color Doppler. In addition, 6 patients were followed for at least 3 months after start of treatment of rheumatoid arthritis using the same technique. In patients with what appeared to be definite rheumatoid arthritis, ultrasound supported this diagnosis as evidenced by the finding of cortical defects, extensor tendon sheath thickening, and synovial proliferation. Increased activity by color Doppler ultrasonography was the most common finding. Significant decrease in color Doppler activity was noted in the 6 patients who were followed up after 3 months of therapy with disease-modifying agents. Therefore, the use of ultrasound with color Doppler could aid in the diagnosis and follow up of patients with rheumatoid arthritis.

  9. Fluoroscopy-guided intra-articular steroid injection for sternoclavicular joint arthritis secondary to limited cutaneous systemic sclerosis: a case report

    Science.gov (United States)

    Güler, Emel; Cüce, Isa; Erol, Kemal

    2017-01-01

    We report a case of fluoroscopy-guided intraarticular steroid injection for sternoclavicular joint (SCJ) arthritis caused by limited cutaneous systemic sclerosis (SSc). A 50-year-old woman diagnosed with limited cutaneous SSc presented with swelling and pain in the right SCJ. MRI revealed signs of inflammation consistent with right-sided sternoclavicular joint arthritis. After the failure of oral medications, we performed fluoroscopy-guided injection in this region. She reported complete resolution of her symptoms at 4 and 12-week follow-ups. This outcome suggests that a fluoroscopy-guided SCJ injection might be a safe and successful treatment option for sternoclavicular joint arthritis. PMID:28119772

  10. High prevalence of Kingella kingae in joint fluid from children with septic arthritis revealed by the BACTEC blood culture system.

    Science.gov (United States)

    Yagupsky, P; Dagan, R; Howard, C W; Einhorn, M; Kassis, I; Simu, A

    1992-05-01

    In an effort to improve detection of fastidious organisms, joint fluid aspirates of pediatric patients were inoculated into BACTEC 460 aerobic blood culture bottles, in addition to cultures on solid media. Culture records for the 1988 to 1991 period were reviewed to compare the performance of both methods for the recovery of pathogens. Overall, 216 children underwent a diagnostic joint tap, and 63 specimens grew significant organisms, including Kingella kingae in 14. While both methods were comparable for recovery of usual pathogens, with a single exception, K. kingae isolates were detected by the BACTEC system only. K. kingae appears to be a more common cause of septic arthritis in children than has been previously recognized. The BACTEC blood culture system enhances the recovery of K. kingae from joint fluid and improves bacteriologic diagnosis of pediatric septic arthritis.

  11. Sea urchin puncture resulting in PIP joint synovial arthritis: case report and MRI study.

    Science.gov (United States)

    Liram, N; Gomori, M; Perouansky, M

    2000-01-01

    Of the 600 species of sea urchins, approximately 80 may be venomous to humans. The long spined or black sea urchin, Diadema setosum may cause damage by the breaking off of its brittle spines after they penetrate the skin. Synovitis followed by arthritis may be an unusual but apparently not a rare sequel to such injury, when implantation occurs near a joint. In this case report, osseous changes were not seen by plain x-rays. Magnetic resonance imaging (MRI) was used to expose the more salient features of both soft tissue and bone changes of black sea urchin puncture injury 30 months after penetration. In all likelihood, this type of injury may be more common than the existing literature at present suggests. It is believed to be the first reported case in this part of the world as well as the first MRI study describing this type of joint pathology. Local and systemic reactions to puncture injuries from sea urchin spines have been described previously. These may range from mild, local irritation lasting a few days to granuloma formation, infection and on occasions systemic illness. The sea urchin spines are composed of calcium carbonate with proteinaceous covering. The covering tends to cause immune reactions of variable presentation. There are only a handful of reported cases with sea urchin stings on record, none of them from the Red Sea. However, this condition is probably more common than is thought and can present difficulty in diagnosis. In this case report, the inflammation responded well to heat treatment, mobilization and manipulation of the joint in its post acute and chronic stages. As some subtle changes in soft tissues and the changes in bone were not seen either on plain x-rays or ultrasound scan, gadolinium-enhanced MRI was used to unveil the marked changes in the joint.

  12. Radiographic damage in large joints in early rheumatoid arthritis : Relationship with radiographic damage in hands and feet, disease activity, and physical disability

    NARCIS (Netherlands)

    Kuper, HH; VanLeeuwen, MA; VanRiel, PLCM; Prevoo, MLL; Houtman, PM; Lolkema, WF; VanRijwijk, MH

    1997-01-01

    An assessment of the onset of radiographic damage in the large joints (hip, knees, shoulders, elbows, ankles and tarsus) in patients with early rheumatoid arthritis, and the relationship of the progression of large joint damage with joint damage in hands and feet, with physical disability, and with

  13. Use of amplified Mycobacterium tuberculosis direct test (Gen-probe Inc., San Diego, CA, USA in the diagnosis of tubercular synovitis and early arthritis of knee joint

    Directory of Open Access Journals (Sweden)

    Vinay Kumar Aggarwal

    2012-01-01

    Conclusion: AMTDT or Genprobe is a rapid diagnostic test for early diagnosis of tubercular arthritis, but has low sensitivity in knee joint tuberculosis. Nuclear amplification tests are still far from being a single promising alternative to conventional tests in cases of joint tuberculosis. Routine use of arthroscopic biopsies in all suspected cases is helpful in the early diagnosis of knee joint tuberculosis.

  14. Rheumatoid arthritis (image)

    Science.gov (United States)

    Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks itself. The pattern of joints ... other joints and is worse in the morning. Rheumatoid arthritis is also a systemic disease, involving other body ...

  15. Treatment of wrist joint dislocation by movable external fixator and Anchor screws%可活动外固定支架结合Anchor钉治疗腕关节脱位

    Institute of Scientific and Technical Information of China (English)

    尹自飞; 韩培; 柴益民; 蒋垚

    2012-01-01

    目的 探讨应用可活动外固定支架结合Anchor钉治疗腕关节脱位的可行性及治疗效果.方法 对16例腕关节脱位患者进行腕关节可活动外固定支架固定,同时切开复位,加压空心钉固定骨折,Anchor钉修复腕骨间韧带和桡腕韧带,克氏针临时固定腕骨.结果 随访3~6个月,16例患者均基本恢复腕关节功能,未出现再脱位、舟骨月骨坏死等.采用Cooney评价标准:优7例,良7例,可2例.结论 可活动外固定支架结合Anchor钉治疗腕关节脱位可有效固定腕关节,韧带修复可靠,利于破损韧带愈合及促进早期逐步功能锻炼,疗效满意.%Objective To discuss feasibility and clinical result of wrist joint dislocation by movable external fixator and Anchor screw. Methods 16 cases of wrist joint dislocations were treated with movable external fixators, open reduction , and cannulated screws fixation of fracture. Anchor screws were used to repaire intercarpal and radiocarpal ligaments and Kirschner wire fixing fracture temperately. Results All cases were followed up for 3 ~ 6 months. 16 patients recoveried wrist joint functions basically, and no dislocations and osteonecrosis were found. Based on Cooney's clinical scoring system,the scores of our series were 7 excellent ,7 good and 2 fair. Conclusions Treatment of wrist joint dislocations by movable external fixator and Anchor screw can fix wrist joint effectively, repairing ligaments reliably and allow function movements early.

  16. Temporomandibular Joint Septic Arthritis and Mandibular Osteomyelitis Arising From an Odontogenic Infection: A Case Report and Review of the Literature.

    Science.gov (United States)

    Gams, Kevin; Freeman, Phillip

    2016-04-01

    Septic arthritis of the temporomandibular joint (TMJ) has been infrequently reported in the literature. Some investigators believe that this condition is under-reported because it is underdiagnosed. Misdiagnosis or late diagnosis of this condition can lead to serious morbidity, including fistula formation, intracranial abscess, fibrous or bony ankylosis, temporal bone or condylar osteomyelitis, growth alteration, and several others. This report describes a case of septic TMJ arthritis arising from direct spread of an odontogenic infection with subsequent development of mandibular osteomyelitis. The purpose of this case report is to 1) increase awareness of an underdiagnosed condition, 2) establish the seriousness of this infection, 3) for the first time report on a case of TMJ septic arthritis caused by Bacteroides infection, and 4) provide a review of the relevant literature.

  17. Surgical treatment for septic arthritis of the knee joint in elderly patients: a 10-year retrospective clinical study.

    Science.gov (United States)

    Chen, Chao-Ming; Lin, Hsi-Hsien; Hung, Shih-Chieh; Huang, Tung-Fu; Chen, Wei-Ming; Liu, Chien-Lin; Chen, Tain-Hsiung

    2013-04-01

    Septic arthritis is the most rapidly destructive joint disease, but its early diagnosis remains challenging; delayed or inadequate treatment, even by expert physicians, can lead to irreversible joint destruction. Between 25% and 50% of patients develop irreversible loss of joint function, which is especially concerning in elderly patients. To understand the factors influencing the outcome of septic arthritis, the authors reviewed patients aged older than 50 years who had undergone debridement surgery for primary septic arthritis at their institution between 1998 and 2008. Ninety-two patients (92 knees) were enrolled in the study; 14 did not meet inclusion criteria and were excluded from the final analysis. Of the 78 included patients, 7 underwent arthrodesis, 22 underwent total knee arthroplasty, 19 were indicated for total knee arthroplasty for severe knee joint osteoarthritis but did not undergo surgery by the end of this study, and the remaining 30 had no or mild symptoms of osteoarthrosis and did not receive any surgical procedure. Staphylococcus aureus was the most common pathogenic agent (38%), followed by mixed bacterial infection (10%). Several factors negatively influenced the final clinical outcome, including delayed treatment, advanced macroscopic staging made during debridement surgery, performing multiple debridement surgeries, and a larger Lysholm score difference pre- and posttreatment. More antibiotics administered, longer duration of antibiotic treatment, and more pathogenic agents present were also significantly correlated with poor outcome. These findings shed new light on the management of septic arthritis. Accurate diagnoses and effective treatments are important for the clinical outcome of knee joint bacterial infection in elderly patients.

  18. Treatment of distal radioulnar joint dislocation and arthritis by Sauve-Kapandji procedure%Sauvé-Kapandji手术治疗桡尺远侧关节脱位和关节炎

    Institute of Scientific and Technical Information of China (English)

    陈振兵; 翁雨雄; 盛斌; 沈其孝; 黄启顺; 王发斌

    2008-01-01

    目的 评价Sauve-Kapandji手术治疗桡尺远侧关节脱位和关节炎的临床疗效.方法 采用Sauve-Kapandji手术治疗桡尺远侧关节脱位和关节炎12例.随访内容包括手术前后腕关节疼痛程度、腕关节活动度、握力以及术后患侧X线片情况.X线片检查观察桡尺远侧关节愈合及测量尺桡骨间距.Mayo腕关节评分法评价手术前、后腕关节功能恢复程度,DASH问卷调查表行手术前、后腕关节功能自我评价.结果 术后随访9~32个月,平均16个月.术前腕关节疼痛值在负重后为[(39.0±17.0),(x)±s,下同],术后疼痛值为(23.0±13.0).尺桡偏活动度术前为(26.0±11.0)°,术后为(41.0±12.0)°;旋前、旋后活动度术前为(84.0±21.0)°,术后为(139.0±33.0)°.握力术前为(12.8±3.6)kg,术后为(24.0±7.4)kg.Mayo评分结果术前为(43.0±13.0),术后为(73.0±16.0),优3例,良4例,中3例,差2例.DASH值术前为(57.0±14.0),术后为(31.0±10.0).X线片检查12例桡尺远侧关节及尺骨移植处全部愈合.结论 Sauve-Kapandji手术治疗桡尺远侧关节脱位和关节炎,疼痛明显减轻,旋转活动度和握力增加,功能明显改善.%Objective To evaluate the clinical effectiveness of Sauve-Kapandji technique for the treatment of distal radioulnar joint dislocation and arthritis. Methods Twelve cases of distal radioulnar joint dislocation and arthritis were treated by Sauve-Kapandji technique. All cases were followed up for 9-32 months, with an average of 16 months. Pre-and postoperative wrist pain degree, wrist range of motion, grip strength and X-rays of wrist were evaluated. According to X-rays, the distance between radius and ulna and radiological union were observed. Function of the wrist was evaluated by Mayo scores. Self-evaluations of postoperative wrist function were evaluated by DASH questionnaire. Results Wrist pain score was 39±17 preoperatively and 23±13 postoperatively. The preoperative range of motion of ulnar and radial

  19. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints

    DEFF Research Database (Denmark)

    Møller Døhn, Uffe; Ejbjerg, B.; Court-Payen, M.;

    2006-01-01

    The objective of the study was, with multidetector computed tomography (CT) as the reference method, to determine whether bone erosions in rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints detected with magnetic resonance imaging (MRI) and ultrasonography (US), but not with radiography...

  20. Prevalence of Severe Joint Pain Among Adults with Doctor-Diagnosed Arthritis - United States, 2002-2014.

    Science.gov (United States)

    Barbour, Kamil E; Boring, Michael; Helmick, Charles G; Murphy, Louise B; Qin, Jin

    2016-10-07

    In the United States, arthritis is a leading cause of disability (1,2); arthritis affected an estimated 52.5 million (22.7%) adults in 2010-2012 and has been projected to affect 78.4 million adults by 2040 (3). Severe joint pain (SJP) can limit function and seriously compromise quality of life (4,5). To determine the prevalence of SJP among adults with doctor-diagnosed arthritis, and the trend in SJP from 2002 to 2014, CDC analyzed data from the National Health Interview Survey. In 2014, approximately one fourth of adults with arthritis had SJP (27.2%). Within selected groups, the age-standardized prevalence of SJP was higher among women (29.2%), non-Hispanic blacks (42.3%), Hispanics (35.8%), and persons with a disability (45.6%), and those who were unable to work (51.9%); prevalence also was higher among those who had fair or poor health (49.1%), obesity (31.7%), heart disease (34.1%), diabetes (40.9%), or serious psychological distress (56.3%). From 2002 to 2014, the age-standardized prevalence of SJP among adults with arthritis did not change (p = 0.14); however, the number of adults with SJP was significantly higher in 2014 (14.6 million) than in 2002 (10.5 million). A strategy to improve pain management (e.g., the 2016 National Pain Strategy*) has been developed, and more widespread dissemination of evidence-based interventions that reduce joint pain in adults with arthritis might reduce the prevalence of SJP.

  1. [18F]fluorodeoxyglucose uptake as a predictor of large joint destruction in patients with rheumatoid arthritis.

    Science.gov (United States)

    Yonemoto, Yukio; Okamura, Koichi; Takeuchi, Kimihiko; Kaneko, Tetsuya; Kobayashi, Tsutomu; Okura, Chisa; Tsushima, Yoshito; Takagishi, Kenji

    2016-01-01

    The present retrospective study investigated the relationship between [(18)F]fluorodeoxyglucose-positron emission tomography (FDG-PET) findings and subsequent progression of joint destruction on plain X-ray. Nineteen rheumatoid arthritis (RA) patients (59 joints) who underwent FDG-PET and whose joints could be evaluated on plain X-ray 5 years later were included in this retrospective investigation. The relationship between the standardized uptake value (SUV) on FDG-PET and Larsen grade progression on plain X-ray was investigated for each joint. Factors related to progression of joint destruction were also investigated. Joints with advanced joint destruction (Larsen grades IV and V) on X-ray imaging at the time of FDG-PET were excluded. On initial plain X-ray images taken at the time of FDG-PET, a significant correlation was observed between the initial SUV of each joint and the progression of joint destruction 5 years later (R = 0.47, P < 0.01). Significant correlations between the SUV and progression of joint destruction were observed in both load-bearing (R = 0.52, P < 0.01) and non-load-bearing joints (R = 0.52, P < 0.01). On logistic regression analysis, higher SUV and lower prednisolone dose were associated with greater risk of progressive joint destruction (P < 0.05). On receiver operating characteristics curve analysis, the optimum threshold for identifying preceding joint destruction was an SUVmean of 1.33. In RA joints, FDG uptake was seen mostly by inflammatory cells; therefore, FDG uptake reflected joint inflammation. Additionally, the activity seen on FDG-PET might be associated with future radiographic changes in RA patients.

  2. Easing Arthritis: Research offers new hope for people with common joint disease.

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Easing Arthritis: Research offers new hope for people with common ... likely help with that. Need more information on Arthritis? From MedlinePlus.gov : For a slideshow with sound ...

  3. The diagnostic accuracy of unenhanced MRI in the assessment of joint abnormalities in juvenile idiopathic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Hemke, Robert [University of Amsterdam, Department of Radiology (G1-235), Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children' s Hospital AMC, Amsterdam (Netherlands); Kuijpers, Taco W.; Veenendaal, Mira van [University of Amsterdam, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children' s Hospital AMC, Amsterdam (Netherlands); Berg, J.M. van den; Rossum, Marion A.J. van [University of Amsterdam, Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children' s Hospital AMC, Amsterdam (Netherlands); Reade, Department of Pediatric Rheumatology, Amsterdam (Netherlands); Dolman, Koert M. [Reade, Department of Pediatric Rheumatology, Amsterdam (Netherlands); St. Lucas Andreas Hospital, Department of Pediatric Rheumatology, Amsterdam (Netherlands); Maas, Mario [University of Amsterdam, Department of Radiology (G1-235), Academic Medical Center, Amsterdam (Netherlands)

    2013-07-15

    To assess the diagnostic accuracy and reliability of MRI without contrast enhancement in the evaluation of JIA knee joint abnormalities. JIA patients with clinically active knee involvement were prospectively studied using an 1-T open-bore magnet. MRI features were independently evaluated by two readers using the JAMRIS system. The first reading included unenhanced images, whereas complete image sets were available for the second reading. Imaging findings from 73 patients were analysed. Agreement between Gd-enhanced (+Gd) and Gd-unenhanced (-Gd) MRI scores of bone marrow changes, cartilage lesions and bone erosions was good concerning sensitivity, specificity, negative predictive value and positive predictive value. Inter-observer agreement was good for both -Gd and +Gd scores (ICC = 0.91-1.00, 0.93-1.00, respectively). Regarding the assessment of synovial hypertrophy, specificity of -Gd was high (0.97), but the sensitivity of unenhanced MRI was only 0.62. Inter-reader agreement for +Gd MRI was ICC = 0.94; however, omitting post-Gd acquisitions increased inter-reader variation (ICC = 0.86). If Gd-enhanced MRI is the reference standard, omitting Gd contrast medium is irrelevant for the assessment of bone marrow changes, cartilage lesions and bone erosions as joint abnormalities in JIA. Omitting intravenous Gd in the MRI assessment of joints in JIA is inadvisable, because it decreases the reliability of detecting synovial disease. circle Magnetic resonance imaging is increasingly used to assess juvenile idiopathic arthritis. circle Synovial hypertrophy, a marker of JIA activity, is well shown by MRI. (orig.)

  4. Studies on YKL-40 in knee joints of patients with rheumatoid arthritis and osteoarthritis. Involvement of YKL-40 in the joint pathology

    DEFF Research Database (Denmark)

    Volck, B; Johansen, J S; Stoltenberg, M

    2001-01-01

    OBJECTIVE: The presence of YKL-40 (human cartilage glycoprotein 39) in synovium, cartilage and synovial fluid (SF) from knee joints of patients with rheumatoid arthritis and osteoarthritis (OA) were related to histopathological changes in synovium and cartilage and to serum YKL-40 and other......, which increased again at clinical relapse. CONCLUSIONS: YKL-40 in SF is derived from cells in the inflamed synovium, chondrocytes and SF neutrophils. Joint derived YKL-40 influences serum YKL-40. YKL-40 may be involved in the pathophysiology of the arthritic processes and reflect local disease activity....

  5. Scapholunate advanced collapse wrist salvage.

    Science.gov (United States)

    Ashmead, D; Watson, H K; Damon, C; Herber, S; Paly, W

    1994-09-01

    Patients with scapholunate advanced collapse (SLAC) wrist do not have to undergo total wrist arthrodesis; the SLAC pattern spares the radiolunate articulation, providing a basis for salvage. We report the results of 100 cases in which a technique comprised of scaphoid excision and limited wrist arthrodesis was used. The average followup period of 44 months revealed excellent functional status and a high rate of patient satisfaction. The majority of employed patients were able to return to their original jobs, and many chose to resume wrist-related recreational activities. Pain relief was good to excellent in most cases. Extension/flexion averaged 72 degrees (53% of a normal opposite wrist), radioulnar deviation 37 degrees (59%), and grip strength 80% of the opposite side. X-ray films revealed only two instances of radiolunate destruction, both in conjunction with ulnar translation of the carpus. The other 98 patients demonstrated a well-preserved radiolunate joint regardless of followup interval. Complications were few. Nonunion occurred in three cases. A dorsal impingement of the capitate and radius (12%) was felt to be technique-related and avoidable by careful capitolunate alignment.

  6. Reactive arthritis in relation to internal derangements of the temporomandibular joint: a case control study.

    Science.gov (United States)

    Lund, Bodil; Holmlund, Anders; Wretlind, Bengt; Jalal, Shah; Rosén, Annika

    2015-09-01

    The aim of this study was to find out if reactive arthritis was involved in the aetiology of chronic closed lock of the temporomandibular joint (TMJ) by looking for bacterial antigens in the synovial membrane of the TMJ, and by studying the antibody serology and carriage of human leucocyte antigen (HLA) B27 in patients with chronic closed lock. Patients with reciprocal clicking and healthy subjects acted as controls. We studied a total of 43 consecutive patients, 15 with chronic closed lock, 13 with reciprocal clicking, and 15 healthy controls with no internal derangements of the TMJ. Venous blood samples were collected from all subjects for measurement of concentrations of HLA tissue antigen and serology against Chlamydia trachomatis, Yersinia enterocolitica, Salmonella spp., Campylobacter jejuni, and Mycoplasma pneumoniae. Samples of synovial tissue from patients with closed lock and reciprocal clicking were obtained during discectomy and divided into two pieces, the first of which was tested by strand displacement amplification for the presence of C trachomatis, and the second of which was analysed for the presence of species-specific bacterial DNA using 16s rRNA pan-polymerase chain reaction (PCR). There were no significant differences between the groups in the incidence of antibodies against M pneumoniae, Salmonella spp. or Y enterocolitica. No patient had antibodies towards C trachomatis or C jejuni. We found no bacterial DNA in the synovial fluid from any patient. The HLA B27 antigen was present in 2/15 subjects in both the closed lock and control groups, and none in the reciprocal clicking group. In conclusion, reactive arthritis does not seem to be the mechanism of internal derangement of the TMJ.

  7. Comparison of Quantitative Assessment of BLADE and Isotropic Three-Dimensional Fast Spin Echo Cube (3D T2 SPACE Sequences with Conventional Protocols of wrist Joint at 3 Tesla Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Naghibi

    2016-09-01

    Full Text Available Background Magnetic resonance imaging (MRI of the wrist joint is a useful method in the diagnosis of triangular fibrocartilage complex (TFCC, ligaments and tendons, peripheral nerves, cartilage and carpal tunnel syndrome. However, the evaluation of these small anatomical structures is a topic of investigation. In some instances, the diagnostic indices of MRI in tears and other lesions of cartilage and ligamentous structures are relatively low, so the protocols should be optimized. Objectives In this study, we aim to compare new MRI protocols of 3D T2SPACE, PD BLADE and T2 BLADE with the conventional protocols, including T2 FSE, PD FSE, and T1 FSE in case of signal intensity. Patients and Methods Twenty patients with a history of wrist trauma or suspected wrist lesions were referred by orthopedic hand surgeons and enrolled into the study. All the protocols were carried out on all patients and the images were assessed quantitatively by measurement of signal to noise ratio (SNR and contrast to noise ratio (CNR. Then, these parameters were compared between different protocols. SPSS ver.18 was used for the statistical analyses. Results SNR of the cartilage, TFCC on 3D T2SPACE and T1 FSE was better than other sequences (P < 0.001. SNR of the bone on PD BLADE was significantly higher (P < 0.001 than that of conventional protocols. PD BLADE images showed significantly higher bone- cartilage CNR and bone- TFCC CNR (P < 0.001 to P < 0.001. CNR of cartilage-TFCC on T1 FSE was better than other sequences, but no significant statistical differences were seen. Conclusion High-resolution MR images of the wrist using 3D T2SPACE, PD BLADE and T2 BLADE were superior to those using conventional sequences quantitatively. High-SNR and CNR MR imaging with SPACE and BLADE would be a promising method to diagnose wrist lesions.

  8. Wrist posture affects hand and forearm muscle stress during tapping.

    Science.gov (United States)

    Qin, Jin; Chen, Hua; Dennerlein, Jack T

    2013-11-01

    Non-neutral wrist posture is a risk factor of the musculoskeletal disorders among computer users. This study aimed to assess internal loads on hand and forearm musculature while tapping in different wrist postures. Ten healthy subjects tapped on a key switch using their index finger in four wrist postures: straight, ulnar deviated, flexed and extended. Torque at the finger and wrist joints were calculated from measured joint postures and fingertip force. Muscle stresses of the six finger muscles and four wrist muscles that balanced the calculated joint torques were estimated using a musculoskeletal model and optimization algorithm minimizing the squared sum of muscle stress. Non-neutral wrist postures resulted in greater muscle stresses than the neutral (straight) wrist posture, and the stress in the extensor muscles were greater than the flexors in all conditions. Wrist extensors stress remained higher than 4.5 N/cm² and wrist flexor stress remained below 0.5 N/cm² during tapping. The sustained high motor unit recruitment of extensors suggests a greater risk than other muscles especially in flexed wrist posture. This study demonstrated from the perspective of internal tissue loading the importance of maintaining neutral wrist posture during keying activities.

  9. Ultrasound colour Doppler measurements in a single joint as measure of disease activity in patients with rheumatoid arthritis--assessment of concurrent validity

    DEFF Research Database (Denmark)

    Ellegaard, K; Torp-Pedersen, S; Terslev, L;

    2009-01-01

    OBJECTIVE: Colour Doppler ultrasound (CDU) displays blood flow in the tissues and is able to detect hyperaemia. Because hyperaemia is part of the inflammatory response, the amount of CDU activity in the inflamed synovium may be used to quantify the inflammatory activity in RA. It has never been...... investigated if the amount of CDU activity in a single joint can be used to quantify disease activity in RA. METHODS: A total of 109 patients with RA and affection of the wrist joint underwent a standardized CDU examination assessing three positions in their most affected wrist at start up in biological...... treatment. On the same day the following measures of disease activity were collected: assessment of the number of tender and swollen joints, CRP, ESR and 28-joint disease activity score (DAS28). The amount of CDU activity was quantified by measuring the percentage of colour in the synovium--the colour...

  10. Posttraumatic Arthritis

    OpenAIRE

    Pickering, Robert D.

    1984-01-01

    Posttraumatic arthritis (i.e., degenerative joint disease secondary to injury) is a particular problem in young, active patients. It limits the activities of these vigorous individuals, and the compromised joint must be endured for a long time. The knee is used as an example of a joint commonly involved in this process. Conditions predisposing patients to posttraumatic arthritis are discussed, as are some treatment modalities, including rest, ice therapy, anti-inflammatory medications, physio...

  11. An unusual case of gout in the wrist: the importance of monitoring medication dosage and interaction. A case report

    Directory of Open Access Journals (Sweden)

    Stern Paula J

    2007-10-01

    Full Text Available Abstract Background Gouty arthritis of the wrist is uncommon although gout itself is the most common inflammatory arthritis in older patients. Some known risk factors for the development of gout include trauma, alcohol use, obesity, hyperuricaemia, hypertension and diabetes mellitus. As well, certain medications have been shown to promote the development of gout. These include thiazide diuretics, low dose salicylates and cyclosporine. We present a case of gouty wrist pain possibly precipitated by a medication dosage increase as well as medication interactions. Case presentation A 77 year old male presented with right wrist pain. Redness and swelling was present at the dorsal aspect of his wrist and range of motion was full with pain at end range upon examination. One week prior, his anti-hypertensive medication dosage had been increased. The patient's situation continued to worsen. Radiographic examination revealed changes consistent with gouty arthritis. Conclusion It is important for clinicians treating joint conditions to be aware of patients' comorbidities, medication usage and changes in dosages. Education of patients with gout is of prime importance. Clinicians should educate patients that gout may occur at any joint in the body not only the lower limb. Patients should be aware of the signs and symptoms of an acute gouty attack and be made aware that changes in certain medication dosages may precipitate an attack. Awareness of radiographic changes associated with gout is still of importance although these changes are not seen as frequently as they have been in the past due to better control of the disease.

  12. Arthroscopic Resection Arthroplasty of the Radial Column for SLAC Wrist.

    Science.gov (United States)

    Cobb, Tyson K; Walden, Anna L; Wilt, Jessica M

    2014-05-01

    Background Symptomatic advanced scapholunate advanced collapse (SLAC) wrists are typically treated with extensive open procedures, including but not limited to scaphoidectomy plus four-corner fusion (4CF) and proximal row carpectomy (PRC). Although a minimally invasive arthroscopic option would be desirable, no convincing reports exist in the literature. The purpose of this paper is to describe a new surgical technique and outcomes on 14 patients who underwent arthroscopic resection arthroplasty of the radial column (ARARC) for arthroscopic stage II through stage IIIB SLAC wrists and to describe an arthroscopic staging classification of the radiocarpal joint for patients with SLAC wrist. Patients and Methods Data were collected prospectively on 17 patients presenting with radiographic stage I through III SLAC wrist who underwent ARARC in lieu of scaphoidectomy and 4CF or PRC. Fourteen patients (12 men and 2 women) subject to 1-year follow-up were included. The average age was 57 years (range 41 to 78). The mean follow-up was 24 months (range 12 to 61). Arthroscopic resection arthroplasty of the radial column is described for varying stages of arthritic changes of the radioscaphoid joint. Midcarpal resection was not performed. Results The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 66 preoperatively and 28 at final follow-up. The mean satisfaction (0 = not satisfied, 5 = completely satisfied) at final follow-up was 4.5 (range 3 to 5). The pain level (on 0-10 scale) improved from 6.6 to 1.3. The total arc of motion changed from 124° preoperatively to 142° postoperatively following an ARARC. Grip was 16 kg preoperatively and 18 kg postoperatively. Radiographic stages typically underestimated arthroscopic staging. Although four of our patients appeared to be radiographic stage I, all were found to have arthritis involving some or all of the radioscaphoid articulation at the time of arthroscopy. Clinical Relevance Pain relief

  13. Dynamic magnetic resonance imaging of the metacarpophalangeal joints in rheumatoid arthritis, early unclassified polyarthritis, and healthy controls

    DEFF Research Database (Denmark)

    Klarlund, Mette; Østergaard, Mikkel; Rostrup, Egill;

    2000-01-01

    AND METHODS: We examined 42 RA and 23 early unclassified polyarthritis patients, and 12 healthy controls in a cross-sectional study. Dynamic MRI (repeated FLASH-MR images after injection of a contrast agent) was performed through the 2nd to the 5th MCP joint. Two methods for identification of the enhancing......OBJECTIVE: To introduce dynamic magnetic resonance imaging (MRI) as an indicator of inflammatory activity in the metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA) or early unclassified polyarthritis, and to compare the results with a healthy control group. MATERIALS...

  14. Temporomandibular joint alterations and their orofacial complications in patients with juvenile idiopathic arthritis.

    Science.gov (United States)

    Carvalho, Renata Teixeira de; Braga, Flávia Silva Farah Ferreira; Brito, Fernanda; Capelli Junior, Jonas; Figueredo, Carlos Marcelo; Sztajnbok, Flávio Roberto

    2012-12-01

    Patients with juvenile idiopathic arthritis (JIA) can have alterations in bone metabolism and skeletal growth, as well as damage to the temporomandibular joint (TMJ), which can generate extra and/or intraoral alterations, resulting in craniofacial disorders. Our goal is to carry out a review of the literature on orofacial alterations in patients with JIA. Among the orofacial disorders in patients with JIA, alterations in mandibular growth, caused by dysfunctions in the TMJ region, seem highly prevalent in these patients. The most often found alterations are: retrognathia, micrognathia, anterior open bite, dental crowding, facial asymmetry and mouth opening limitation. Thus, the rheumatologist becomes a key agent in the early detection of these disorders, helping with patient referral to a dentist. The diagnosis, in turn, should be performed by the orthodontist, using clinical examination and imaging methods, allowing early treatment and a favorable prognosis. TMJ disorders should be treated by a multidisciplinary team, including pharmacological treatment for pain control and dental care through functional appliance and/or orthodontic therapy, physical therapy and sometimes, speech therapy. We conclude that among the orofacial disorders in patients with JIA, alterations in mandibular growth generated by dysfunctions in the TMJ region seem highly prevalent. Such dysfunctions can cause mainly open bite, mandibular retrusion, micrognathia, dental crowding and facial asymmetry. The rheumatologist can detect these alterations at an early stage, with immediate patient referral to a team that should preferably be a multidisciplinary one, consisting of an orthodontist, physical therapist and speech therapist, to reduce future occlusal and mandibular growth complications.

  15. Temporomandibular joint involvement in juvenile idiopathic arthritis: clinical predictors of magnetic resonance imaging signs

    Energy Technology Data Exchange (ETDEWEB)

    Argyropoulou, Maria I.; Margariti, Persefoni N.; Astrakas, Loukas; Kosta, Paraskevi [Medical School University of Ioannina, Department of Radiology, Ioannina (Greece); Karali, Aikaterini; Alfandaki, Sapfo; Siamopoulou, Antigoni [University of Ioannina, Department of Child Health, Medical School, Ioannina (Greece)

    2009-03-15

    The aim of the study was to define clinical predictors of magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA). Forty-six patients, aged 2.08-36.7 years, with JIA (oligoartitular 18, polyarticular 17, systemic type 11) were examined with standard plain and contrast-enhanced sequences. Of 88 TMJs examined, an abnormal condyle was observed in 32%, flattened articular eminence in 27%, flattened articular disk in 17%, intra-articular fluid in 10%, enhancing pannus in 45% and restricted condylar motion in 9%. Logistic regression analysis revealed that for abnormal condyle and flattened articular eminence, independent predictors were type of JIA (P < 0.015), age at onset (P < 0.038), and duration of disease activity (P < 0.001). Plots of the logistic regression models showed that TMJ involvement approached certainty for systemic sooner than for the other JIA types. Pannus was present with probability >0.5 when the disease started before 4 years of age. In conclusion, the systemic type of JIA, young age at onset and long duration of activity are risk factors for TMJ damage. MRI of the TMJ should be performed in patients who are less than 4 years of age at the onset of JIA, and in those with the systemic type, whatever the age of onset. (orig.)

  16. Temporomandibular joint involvement in juvenile idiopathic arthritis: treatment with an orthodontic appliance

    Directory of Open Access Journals (Sweden)

    M. Gattinara

    2011-09-01

    Full Text Available Introduction and purpose: About 65% of children suffering from juvenile idiopathic arthritis (JIA shows a more or less marked involvement of temporo-mandibular joint (TMJ with altered mandibular growth, resorption of the condyles, occlusary instability, reduced chewing ability and facial dysmorphia. The purpose of our study is to prevent and to treat the progressive evolution of JIA on craniofacial growth and morphology with a functional appliance; surgery should be considered only in so far as the adequacy of TMJ movement is concemed. Methods: From 1992 until now 72 children with proved JIA and TMJ involvement have been treated (50 females, 22 males, aged 6 to 16 years old. TMJ involvement was bilateral in 61% and unilateral in 39% of patients. A diagnostic workup was carried out involving tomograms of TMJ and cephalometric radiograph and analysis. The authors used a bimaxillary activator in the attempt to modify the unfavourable growth pattern and provide a gradual ante-rotation of the jaw. Results: Almost all JIA patients showed satisfactory long term results, easing of pain, reduced skeletal discrepancy, increased function and good facial profile. Conclusions: The long term results of this study indicate that orthopaedic therapy might control the vicious circle of the malocclusion in children with JIA, preventing exacerbation of mandibular clockwise rotation. Surgical intervention for the improvement of TMJ function should be considered only if a severe restricted state is imminent.

  17. Reduced articular cartilage thickness in joints without a history of active arthritis in children with juvenile idiopathic arthritis

    DEFF Research Database (Denmark)

    Pradsgaard, Dan Østergaard; Spannow, Anne Helene; Heuck, Carsten;

    Background: The functional disability experienced in juvenile idiopathic arthritis is primarily caused by degeneration of the osteocartilaginous structures due to the inflammatory process in the synovium. It is therefore essential for evaluating the therapeutic efficacy to closely monitor...... the structural damage during the disease course. During the past decade musculoskeletal ultrasound (US) has become an established diagnostic method in adult rheumatology and within recent years an increased attention for utilizing US in pediatric rheumatology has emerged. Previously we have found differences...

  18. Application of the Blobo bluetooth ball in wrist rehabilitation training.

    Science.gov (United States)

    Hsieh, Wei-Min; Hwang, Yuh-Shyan; Chen, Shih-Ching; Tan, Sun-Yen; Chen, Chih-Chen; Chen, Yu-Luen

    2016-01-01

    [Purpose] The introduction of emerging technologies such as the wireless Blobo bluetooth ball with multimedia features can enhance wrist physical therapy training, making it more fun and enhancing its effects. [Methods] Wrist injuries caused by fatigue at work, improper exercise, and other conditions are very common. Therefore, the reconstruction of wrist joint function is an important issue. The efficacy of a newly developed integrated wrist joint rehabilitation game using a Blobo bluetooth ball with C# software installed was tested in wrist rehabilitation (Flexion, Extension, Ulnar Deviation, Radial Deviation). [Results] Eight subjects with normal wrist function participated in a test of the system's stability and repeatability. After performing the Blobo bluetooth ball wrist physical therapy training, eight patients with wrist dysfunction experienced approximately 10° improvements in range of motion (ROM) of flexion extension, and ulnar deviation and about 6° ROM improvement in radial deviation. The subjects showed progress in important indicators of wrist function. [Conclusion] This study used the Blobo bluetooth ball in wrist physical therapy training and the preliminary results were encouraging. In the future, more diverse wrist or limb rehabilitation games should be developed to meet the needs of physical therapy training.

  19. SHOULD DISEASE-MODIFYING THERAPY BE STOPPED IN PATIENTS WITH RHEUMATOID ARTHRITIS BEFORE ENDOPROSTHETIC JOINT REPLACEMENT?

    Directory of Open Access Journals (Sweden)

    N. A. Savenkova

    2011-01-01

    Full Text Available Objective: to analyze disease activity, functional state, quality of life (QL, and the frequency of infectious complications in methotrexate (MT – or leflunomide (LF-treated patients with rheumatoid arthritis (RA who had undergone endoprosthetic replacement of the large joints of the lower limbs. Subjects and methods. One hundred and fourteen patients with RA who had undergone endoprosthetic replacement of the knee and hip joints were divided into 3 groups: 1 36 patients who continuously received MT or LF in the perioperative period; 2 42 patients who dis- continued MT or LF 2 and 4 weeks, respectively, prior to surgery; 3 36 patients who took no disease-modifying anti-rheumatic drugs (DMARDs within 12 months before surgery. Disease activity was estimated by the DAS28 index. QL was determined using the EQ-5D questionnaire and functional capacity was estimated by the HAQ index. Results and discussion. In all the groups, there was a preponderance of patients with moderate RA activity (more than 60%. In Groups 1 and 2, the mean dose of MT was about 10 mg weekly and that of LF was 20 mg daily. The use duration of glucocorticoids (GC and their doses were comparable in all the groups. Twelve months after surgery, DAS28 significantly reduced from 4.22±1.08 to 3.58±1.07 months in Group 1 (p = 0.01; in Group 2, the decrease was insignificant: from 4.17±1.17 to 3.80±1.15 (p > 005; in Group 3, RA activity remained as before. All the groups achieved 50% functional improvement; better results were obtained in the group of patients who continued to use DMARDs in the perioperative period (∆HAQ=-0.67. The difference in the Eq-5D index corresponded to a moderate QL improvement: ∆EQ-5D = 0.28, 0.29, and 0.31 in Groups 1, 2, and 3, respectively (p < 0.05. There were no significant group differences. Deep infection in the endoprosthetic replacement area was detected in 2.8, 2.4, and 8.3% of cases, respectively (p > 005. Conclusion. Continuous use of MT

  20. Wrist pulse (image)

    Science.gov (United States)

    To measure the pulse at the wrist, place the index and middle finger over the underside of the opposite wrist, below the base ... firmly with flat fingers until you feel the pulse in the radial artery.

  1. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis.

    LENUS (Irish Health Repository)

    Cunnington, Joanna

    2010-07-01

    Most corticosteroid injections into the joint are guided by the clinical examination (CE), but up to 70% are inaccurately placed, which may contribute to an inadequate response. The aim of this study was to investigate whether ultrasound (US) guidance improves the accuracy and clinical outcome of joint injections as compared with CE guidance in patients with inflammatory arthritis.

  2. Adaptation of an Evidence-Based Arthritis Program for Breast Cancer Survivors on Aromatase Inhibitor Therapy Who Experience Joint Pain.

    Science.gov (United States)

    Nyrop, Kirsten A; Callahan, Leigh F; Rini, Christine; Altpeter, Mary; Hackney, Betsy; Schecher, Arielle; Wilson, Anne; Muss, Hyman B

    2015-06-11

    Adding aromatase inhibitors (AIs) to adjuvant treatment of postmenopausal women with hormone-receptor-positive breast cancer significantly reduces cancer recurrence. A common side effect of AIs is noninflammatory joint pain and stiffness (arthralgia) similar to arthritis symptoms. An evidence-based walking program developed by the Arthritis Foundation - Walk With Ease (WWE) - reduces arthritis-related joint symptoms. We hypothesized that WWE may also reduce AI-associated arthralgia. However, the potential for different barriers and facilitators to physical activity for these 2 patient populations suggested a need to adapt WWE before testing it with breast cancer survivors. We conducted qualitative research with 46 breast cancer survivors to explore program modification and inform the development of materials for an adapted program (Walk With Ease-Breast Cancer). Our process parallels the National Cancer Institute's Research-Tested Intervention Programs (RTIPs) guidelines for adapting evidence-based programs for cancer populations. Findings resulted in a customized 8-page brochure to supplement existing WWE materials.

  3. Frequency and spectrum of abnormalities in the bone marrow of the wrist: MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Alam, F.; Schweitzer, M.E. (Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology); Li Xiaoxian (Dept. of Radiology, Tangshan Gongren Hospital, Tangshan (China)); Malat, J. (Department of Radiology, Naples Radiologists, Naples (Italy)); Hussain, S.M. (Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology Rijksuniversiteit Leiden (Netherlands). Dept. of Diagnostic Radiology)

    1999-06-01

    Objective. To describe the frequency of marrow abnormalities on wrist MR imaging and the MR findings of these various abnormalities.Design and patients. Five hundred and nineteen patients were studied at 1.5 T. Two observers recorded the presence and location of avascular necrosis, occult fractures and arthritic edema [focal osteoarthritis, ulnolunate abutment, rheumatoid arthritis, septic arthritis, gouty arthritis and scapholunate advanced collapse (SLAC)].Results and conclusion. One hundred and eighty-seven (36%) patients demonstrated marrow abnormalities in the wrist, of which 101 were diagnosed as arthritis [64 (34%) as focal osteoarthritis, 17 (9%) as ulnolunate abutment, 15 (8%) as rheumatoid arthritis, 2 as septic arthritis, 2 as SLAC, and 1 as gouty arthritis]. Seventy-two patients had occult fractures and in 27 patients avascular necrosis was seen. MR imaging can reveal various abnormalities in bone marrow of the wrist when findings on radiography are normal or equivocal. (orig.) With 17 figs., 13 refs.

  4. 高频超声诊断膝关节炎%High-frequency ultrasound in diagnosis of knee joint arthritis

    Institute of Scientific and Technical Information of China (English)

    周元媛; 张瑞芳; 秦石成

    2011-01-01

    目的 探讨高频超声对膝关节炎的临床价值. 方法 对以膝关节肿胀、疼痛为主诉就诊的34例患者的68个膝关节进行高频超声检查,回顾性分析其超声声像图表现. 结果 关节腔积液最多见,29例患者58个关节均有不同程度积液;滑膜增厚21例42个关节;关节软骨损害11例22个关节;关节游离体2例4个关节;骨质破坏15例30个关节;腘窝囊肿6例6个关节.类风湿关节炎与骨关节炎在超声表现上有一定的重叠性. 结论 高频超声对膝关节病变,尤其是滑膜病变具有一定诊断价值.%Objective To investigate the value of high-frequency ultrasound in diagnosis of knee joints arthritis. Methods Sixty-eight knee joints of 34 patients complaining of arthrocele and pain were examined with high-frequency ultrasound,then the images were analyzed retrospectively. Results Intra-articular fluid was found in 29 patients (58 joints), synovitis of joints was found in 21 patients (42 joints), articular cartilage damage was found in 11 patients (22 joints), joint corpus liberum were found in 2 patients (4 joints), bone erosions were found in 15 patients (30 joints), and Baker cyst was found in 6 patients (6 joints) with high-frequency ultrasound. There were some similar ultrasonic manifestations between rheumatoid arthritis and osteoarthritis. Conclusion High-frequency ultrasound is valuable in examining the knee joint damages,especially for detection of membrana synovialis.

  5. Reconstructing the rheumatoid wrist: a utility analysis comparing total wrist fusion and total wrist arthroplasty from the perspectives of rheumatologists and hand surgeons.

    Science.gov (United States)

    Cavaliere, Christi M; Oppenheimer, Adam J; Chung, Kevin C

    2010-03-01

    Rheumatologists and hand surgeons have historically demonstrated strikingly divergent attitudes toward the benefits of surgical intervention, either total wrist fusion or total wrist arthroplasty, for the rheumatoid wrist. A utility analysis was conducted to compare a national random sample of hand surgeons and rheumatologists regarding their opinions about surgical management of severe rheumatoid wrist disease. A web-based trade-off utility survey was developed, and participants were presented with survey scenarios comparing well-controlled rheumatoid arthritis with operative and non-operative management. Utility values were calculated for each scenario, and a decision analytic model was constructed. Utility values for rheumatologists and hand surgeons did not differ significantly for any scenario. Total wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup. This decision analytic model demonstrates similar opinions between two subspecialties that have historically demonstrated divergent attitudes towards rheumatoid hand surgery.

  6. JUVENILE IDIOPATHIC ARTHRITIS – A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Paresh H

    2012-11-01

    Full Text Available ABSTRACT: The prevalence of Juvenile idiopathic arthritis (JIA is 0.86 per 1000 children. Subcutaneous nodules have been reported in 5% to 10% of children with JIA. Approximately 90% of patients with RA and subc utaneous nodules test positive for rheumatoid factor (RF, and approximately 40% o f all RF-seropositive patients with RA have subcutaneous nodules, whereas only 6% in volvement is seen in seronegative cases. We hereby report a case of atypical Juvenile idiopathic arthritis (JIA in a 6 year old, female child with joint pain & myalgia along with subcutaneous nodules over the dorsum of feet, hands and elbows. Joint pain initial ly involving the left ankle, slowly progressed to involve the knee, shoulder, wrist, metacar pophalangeal and interphalangeal joints over a period of one year. Joint involvement was not symmetric. RF was Negative. Fundoscopy examination was normal. Histopathological examinat ion revealed a central zone of Fibrinoid necrosis surrounded by epithelioid h istiocytes and occasional lymphocytes. Differential diagnosis of Rheumatoid Nodule (R N or Subcutaneous Granuloma Annulare (SGA or Necrobiosis Lipoidica Diabeticorum was made. In light of clinicopathological findings, both SGA and NLD were ruled out a nd the diagnosis of Juvenile idiopathic arthritis presenting as RF-negative polyarthritis was made.

  7. Detection of rheumatoid arthritis bone erosions by two different dedicated extremity MRI units and conventional radiography

    DEFF Research Database (Denmark)

    Duer-Jensen, A.; Vestergaard, A.; Dohn, U.M.;

    2008-01-01

    was particularly more sensitive than CR for metacarpal heads and carpal bones. MagneVu MRI and CR detected 100% and 89%, respectively, of large erosions (Outcome Measures in Rheumatoid Arthritis Clinical Trials-Rheumatoid Arthritis MRI Scoring System (OMERACT-RAMRIS) score >1 on Artoscan) in MCP joints and 69......% and 15.8% of large erosions in wrists. Conclusions: Both E-MRI units detected more erosions than CR, in particular due to a higher sensitivity in metacarpal heads and carpal bones. The MagneVu unit detected fewer erosions than the Artoscan unit due to a lower average image quality and a smaller...

  8. [Rheumatoid arthritis: diagnostics and therapy 2012].

    Science.gov (United States)

    Lorenz, H-M

    2012-07-01

    Rheumatoid Arthritis (RA) should be suspected if patients do not only complain of joint pain, but suffer from joint swelling, sensation of heat, hyperemia and warmth around the joints. An arthritic joint pain should be most prominent at night time or early in the morning and cause morning stiffness (> 30 min) of the joint, exercise will improve the symptoms. Diagnosis of RA will be even more likely if wrists, MCP- or PIP joints are affected. Serologic procedures will test for rheumatoid factor or anti-citrullinated antibodies (CCP Ab). One needs to keep in mind that positive results for rheumatoid factor or CCP Ab alone never proves the diagnosis of RA. After diagnosis therapy should be started immediately, recruiting physiotherapy, pain medication, corticosteroids and disease-modifying anti-rheumatic drugs (DMARDs), primarily methotrexate. At the latest after failure of two DMARDs biologics like TNF-α-blockers, an Interleukin-6-Receptor-antibody, a B-cell-specific antibody or a rather T-cell-specific biologic will be initiated. Aim of therapy is freedom of symptoms of an ongoing arthritis, low dosage of immunosuppressants (especially corticosteroids maximally 5 mg/day), stop of radiological progression and prevention of long term consequences of inflammation like myocardial infarction, stroke or lymphoma.

  9. Four-corner fusion and scaphoid excision using headless compression screws for SLAC and SNAC wrist deformities.

    Science.gov (United States)

    Richards, Allison Alexander; Afifi, Ahmed M; Moneim, Moheb S

    2011-06-01

    Scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist deformities are the most common causes of traumatic arthritis of the wrist. Four-corner fusion and scaphoid excision has proven to be an effective procedure for relieving pain and preserving range of motion in the wrist joint. Several methods for providing fixation of the midcarpal joint during fusion have been used, including K-wires, staples, and the Spider plate. K-wire fixation has proven effective, but requires a period of cast immobilization to protect the fusion mass. The Spider plate was promising, but has not been without complications. The development and improvements in cannulated headless compression screws has resulted in increased indications for their use, including fixation for 4-corner fusion. We review the technique and tips developed by the senior author over the last several years using headless compression screws for fixation of the midcarpal joint. Acutrak 2 Standard implants were used. This technique has allowed for early range of motion with reliable fusion rates.

  10. 手术治疗腕关节骨折脱位并发腕管综合征的临床效果%Clinical effect of surgery treating wrist joint fracture dislocation associat-ed with carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    吴滨滨; 李旭; 刘伟波

    2015-01-01

    Objective To investigate the clinical effect of the surgery treating wrist joint fracture dislocation associated with carpal tunnel syndrome. Methods Ninety patients with wrist joint fracture dislocation associated with carpal tunnel syndrome treated in our hospital from October 2011 to October 2014 were selected and divided into control group and study group.Control group was given non-surgical treatment and study group was given surgical treatment.The clinical efficacy between two groups was compared. Results After treatment,the excellent and good rate of control group was 62.5%and that of the study group was 82.0%,and there was a statistical difference between two groups (P<0.05).The study group was significantly better than the control group in the wrist joint mobility situation and median nerve recovery sit-uation,and there was a statistical difference (P<0.05). Conclusion Surgery treating wrist joint fracture dislocation asso-ciated with carpal tunnel syndrome has remarkable clinical effect and enables good postoperative recovery for patients, and surgical treatment is recommended to treat wrist joint fracture dislocation associated with carpal tunnel syndrome.%目的:探讨手术治疗腕关节骨折脱位并发腕管综合征的临床效果。方法选取本院2011年10月~2014年10月收治的腕关节骨折脱位并发腕管综合征患者90例,分为对照组与研究组,其中对照组采用非手术治疗,研究组采用手术方法治疗,比较两组患者的临床效果。结果治疗后,对照组的优良率为62.5%,研究组为82.0%,两组比较,差异有统计学意义(P<0.05);研究组患者的腕关节活动情况与正中神经恢复情况明显优于对照组,差异有统计学意义(P<0.05)。结论手术治疗腕关节骨折脱位并发腕管综合征的临床效果显著,患者术后恢复情况较好,建议采用手术治疗腕关节骨折脱位并发腕管综合征。

  11. Surgical treatment for traumatic instability of wrist joint%创伤性腕关节不稳定应用手术治疗的疗效分析

    Institute of Scientific and Technical Information of China (English)

    纪建国; 王旭廷; 董洪光

    2016-01-01

    Objective To investigate the clinical effect of surgical treatment for patients with traumatic instability of wrist joint.Methods 80 patients with traumatic instability of wrist joint admitted into our hospital from January,2013 to November,2014 were randomly divided into a control group and an experimental group.The control group were treated with manipulative reduction and plaster fixation and the experimental group with surgery.The scores of Jiranek and Gartland-Werley before and after the treatment,the overall therapeutic effect,and the stability of wrist joint were compared between these two groups.Results The Jiranek score were significantly higher and Gartland-Werley score was obviously lower in the experimental group than in the control group [(169.24 ± 25.28) vs.(136.04 ± 18.25) and (3.76 ±-2.03) vs.(10.36 ± 3.95)],with statistical differences (t=6.734,9.399,P<0.01).The overall treatment effect was much better in the experimental group than in the control group,with a statistical difference (Z =-2.979,P<0.01).6 and 12 months after discharging,the stability rates of wrist joint were 95% and 80% in the experimental group and were 65% and 30% in the control group,with statistical differences (x 2=11.250,2.202,P<0.01).Conclusions Surgical treatment for patients with traumatic instability of wrist joint has a significant effect and is of reference.%目的 探讨应用手术治疗对创伤性腕关节不稳定患者的疗效.方法 收集本院2013年1月至2014年1 1月入院的80例创伤性腕关节不稳定患者随机分为两组.对照组患者给予手法复位石膏固定治疗,实验组患者则给予手术治疗,比较两组患者治疗前后Jiranek与Gartland-Werley评分、整体治疗效果与腕关节稳定情况.结果 实验组治疗后患者Jiranek评分(169.24±25.28)分,显著高于对照组的(136.04±18.25)分,Gartland-Werley评分为(3.76±2.03)分,显著低于对照组的(10.36±3.95)分,差异有统计学意义(t=6

  12. Does addition of low-level laser therapy (LLLT) in conservative care of knee arthritis successfully postpone the need for joint replacement?

    Science.gov (United States)

    Ip, David

    2015-12-01

    The current study evaluates whether the addition of low-level laser therapy into standard conventional physical therapy in elderly with bilateral symptomatic tri-compartmental knee arthritis can successfully postpone the need for joint replacement surgery. A prospective randomized cohort study of 100 consecutive unselected elderly patients with bilateral symptomatic knee arthritis with each knee randomized to receive either treatment protocol A consisting of conventional physical therapy or protocol B which is the same as protocol A with added low-level laser therapy. The mean follow-up was 6 years. Treatment failure was defined as breakthrough pain which necessitated joint replacement surgery. After a follow-up of 6 years, patients clearly benefited from treatment with protocol B as only one knee needed joint replacement surgery, while nine patients treated with protocol A needed surgery (p knee arthritis.

  13. MRI findings of treated bacterial septic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Bierry, Guillaume; Huang, Ambrose J.; Chang, Connie Y.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital and Harvard Medical School, Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States)

    2012-12-15

    The purpose of this study was to report the MRI findings that can be encountered in successfully treated bacterial septic arthritis. The study included 12 patients (8 male and 4 female; mean age 38 years, range 9-85) with 13 proven cases of bacterial septic arthritis. The joints involved were hip (n = 3), knee (n = 3), shoulder (n = 2), sacroiliac (n = 2), ankle (n = 1), wrist (n = 1), and elbow (n = 1). MRI examinations following surgical debridement and at initiation of antibiotic therapy and after successful treatment were compared for changes in effusion, synovium, bone, and periarticular soft tissues. Imaging findings were correlated with microbiological and clinical findings. Joint effusions were present in all joints at baseline and regressed significantly at follow-up MRI (p = 0.001). Abscesses were present in 5 cases (38 %), and their sizes decreased significantly at follow-up (p = 0.001). Synovial enhancement and thickening were observed in all joints at both baseline and follow-up MRI. Myositis/cellulitis was present in 10 cases (77 %) at baseline and in 8 cases (62 %) at follow-up MRI. Bone marrow edema was present in 10 joints (77 %) at baseline and persisted in 8 joints (62 %). Bone erosions were found in 8 joints (62 %) and persisted at follow-up MRI in all cases. The sizes of joint effusions and abscesses appear to be the factors with the most potential for monitoring therapy for septic arthritis, since both decreased significantly following successful treatment. Synovial thickening and enhancement, periarticular myositis/cellulitis, and bone marrow edema can persist even after resolution of the infection. (orig.)

  14. Arthritis: Frequently Asked Questions

    Science.gov (United States)

    ... of arthritis, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), and ankylosing spondylitis. Modifiable risk ... involve the following: Medications. Nonpharmacologic therapies. Physical or occupational therapy. Splints or joint assistive aids. Patient education and ...

  15. Imaging in Psoriatic Arthritis

    DEFF Research Database (Denmark)

    Poggenborg, René Panduro; Østergaard, Mikkel; Terslev, Lene

    2015-01-01

    Psoriatic arthritis (PsA) is an inflammatory joint disease characterized by arthritis and often enthesitis in patients with psoriasis, presenting a wide range of manifestations in various patterns. Imaging procedures are primarily conventional radiography, ultrasonography (US), and magnetic...

  16. Joint Replacement (Finger and Wrist Joints)

    Science.gov (United States)

    ... Gardening Safety Turkey Carving Removing a Ring Español Artritis de la base del pulgar Dedo en gatillo ... Gardening Safety Turkey Carving Removing a Ring Español Artritis de la base del pulgar Dedo en gatillo ...

  17. Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?

    Energy Technology Data Exchange (ETDEWEB)

    Schallert, Erica K.; Kan, J.H.; Monsalve, Johanna; Zhang, Wei; Bisset, George S. [Texas Children' s Hospital, Department of Pediatric Radiology, Houston, TX (United States); Rosenfeld, Scott [Texas Children' s Hospital, Department of Pediatric Orthopedic Surgery, Houston, TX (United States)

    2015-08-15

    Joint effusions identified by MRI may accompany osteomyelitis and determining whether the joint effusion is septic or reactive has important implications on patient care. Determine the incidence of epiphyseal marrow edema, joint effusions, perisynovial edema and epiphyseal non-enhancement in the setting of pediatric metaphyseal osteomyelitis and whether this may be used to predict coexisting septic arthritis. Following IRB approval, we retrospectively evaluated children who underwent MRI and orthopedic surgical consultation for suspected musculoskeletal infection between January 2011 and September 2013. Criteria for inclusion in the study were microbiologically/pathologically proven infection, MRI prior to surgical intervention, long bone involvement and age 0-18 years. MRI exams were independently reviewed by two faculty pediatric radiologists to confirm the presence of appendicular metaphyseal osteomyelitis, to evaluate extent of edema, to determine subjective presence of a joint effusion and to assess perisynovial edema and epiphyseal non-enhancement. Any discrepant readings were reviewed in consensus. Charts and operative notes were reviewed to confirm the diagnosis of osteomyelitis and septic arthritis. One hundred and three joints with metaphyseal osteomyelitis were identified (mean age: 7.1 years; M:F 1.3:1), of whom 53% (55/103) had joint effusions, and of those, 75% (41/55) had surgically confirmed septic arthritis. The incidence of coexisting septic arthritis was 40% in the setting of epiphyseal edema, 74% in epiphyseal edema and effusion, 75% with perisynovial edema, 76% with epiphyseal non-enhancement and 77% when all four variables were present. Of these, the only statistically significant variable, however, was the presence of a joint effusion with a P-value of <0.0001 via Fisher exact test. Statistical significance for coexisting septic arthritis was also encountered when cases were subdivided into intra-articular vs. extra-articular metaphyses (P

  18. Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrast-enhanced (Gd-DTPA) magnetic resnance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Jevtic, V. [Inst. of Radiology, Univ. Medical Centre, Ljubljana (Slovenia); Watt, I. [Dept. of Clinical Radiology, Bristol Royal Infirmary (United Kingdom); Rozman, B. [Dept. of Rheumatology, Univ. Medical Centre, Ljubljana (Slovenia); Kos-Golja, M. [Dept. of Rheumatology, Univ. Medical Centre, Ljubljana (Slovenia); Demsar, F. [Inst. Jozef Stefan, Ljubljana (Slovenia); Jarh, O. [Inst. Jozef Stefan, Ljubljana (Slovenia)

    1995-07-01

    A series of patients with clinically early inflammatory joint disease due to rheumatoid arthritis, psoriatic arthritis and Reiter`s syndrome were examined by plain film radiography and magnetic resonance imaging (MRI). The spin echo T1-weighted precontrast, T2-weighted, and, especially, T1-weighted postcontrast images demonstrated distinct differences in the distribution of inflamatory changes, both within and adjacent to involved small hand joints. Two major subtypes of inflammatory arthritis were shown, thus providing a specific differential diagnosis between rheumatoid arthritis and some patients with seronegative spondyloarthritis. In particular, all the patients with Reiter`s syndrome who were studied, and half of those with psoriatic arthritis, had a distinctive pattern of extra-articular desease involvement. The need for a new classification of clinical subsets in psoriatic arthritis has been recently suggested. The present findings suggest that magnetic resonance imaging could be useful in such a reclassification of seronegative spondyloarthritis, as well as offering considerable potential for a reappraisal of pathogenesis and therapy. In this series, it was also noted that juxta-articular osteoporosis on plain film did not correlate with bone marrow oedema on MRI. Hence the aetiology of this common radiographic finding also merits further consideration. (orig.)

  19. Bone scan and joint scan of hands and feet in rheumatoid arthritis; Scintigraphie osseuse et articulaire des mains et des pieds dans la polyarthrite rhumatoide

    Energy Technology Data Exchange (ETDEWEB)

    Carpentier, N.; Verbeke, S.; Perdrisot, R.; Grilo, R.M.; Quenesson, E.; Bonnet, C.; Vergne, P.; Treves, R.; Bertin, P.; Boutros-Toni, F. [Centre Hospitalier Universitaire Dupuytren, Faculte de Medecine, 87 - Limoges (France)

    2000-09-01

    The aim of this study was to determine the ability of joint scan and bone scan of hands and feet, in patients with rheumatoid arthritis, to localize the altered joints. The sensitivity, the specificity, the positive predictive value (PPV) and the negative predictive value (NPV) of joint scan were determined in comparison with clinical joint assessment. Fifteen patients (780 joints) were clinically examined (pain and synovitis); during the same day, a bone scan and a joint scan were realized by oxidronate {sup 99m}Tc intravenous injection. Patients were scanned 5 minutes (tissual time, T{sub t}) and 3 hours 1/4 (bone time, T{sub 0}) after the administration. The uptake of the bi-phosphonate was evaluated with a qualitative method using a grey scale. The uptake of {sup 99m}Tc oxidronate was quantitated using an extra-articular region of interest. The sensitivity, specificity, PPV and NPV of the scan at Tt were 46%, 96%, 85% et 78%. The same parameters were 75%, 66%, 53% and 84% for the scan realized at T{sub 0}. The joint scan has showed 22% of false positive. These false positives could be a consequence of an earlier detection of joint alterations by scan. The joint scan should forecast the evolution of joints in patients with rheumatoid arthritis. (author)

  20. Hyperstaticity for ergonomie design of a wrist exoskeleton.

    Science.gov (United States)

    Esmaeili, Mohammad; Jarrassé, Nathanaël; Dailey, Wayne; Burdet, Etienne; Campolo, Domenico

    2013-06-01

    Increasing the level of transparency in rehabilitation devices has been one of the main goals in robot-aided neurorehabilitation for the past two decades. This issue is particularly important to robotic structures that mimic the human counterpart's morphology and attach directly to the limb. Problems arise for complex joints such as the human wrist, which cannot be accurately matched with a traditional mechanical joint. In such cases, mechanical differences between human and robotic joint cause hyperstaticity (i.e. overconstraint) which, coupled with kinematic misalignments, leads to uncontrolled force/torque at the joint. This paper focuses on the prono-supination (PS) degree of freedom of the forearm. The overall force and torque in the wrist PS rotation is quantified by means of a wrist robot. A practical solution to avoid hyperstaticity and reduce the level of undesired force/torque in the wrist is presented, which is shown to reduce 75% of the force and 68% of the torque.

  1. Tuberculous Tenosynovitis Presenting as Ganglion of Wrist

    Directory of Open Access Journals (Sweden)

    Shahaji Chavan

    2012-01-01

    Full Text Available Tuberculosis (TB is still endemic in many developed countries. Involvement of the hand and wrist at presentation is extremely rare, and the diagnosis is often missed. A 57 years old male presented with swelling over the left wrist since 3 years Three swellings over dorsal aspect of the left wrist Soft in consistency Non tender Non compressible Mobile at right angles to the plane of the wrist joint. ESR: 45 mm in 1 hr and rest blood investigations were normal. Ultrsonography showed giant cell tumor of Extensor Digitorum sheath. X-ray: soft tissue swelling and MRI was suggestive of extensor tendon sheath extraskeletal synovial Koch’s, or giant cell tumor of tendon sheath. Excision of swelling was planned and intraoperatively, rice bodies were seen inside it. Histopathological examination showed caseous necrosis with granuloma formation. Patient was put on DOT1 therapy. Tuberculous tenosynovitis was first described by Acrel in 1777. Rice bodies occurring in joints affected by tuberculosis were first described in 1895 by Reise. Rice bodies will be diagnosed on plain radiographs when mineralization occurs. More than 50% of cases recur within 1 year of treatment. The currently recommended 6-month course is often adequate with extensive curettage lavage and synovectomy should be performed. Surgery is essential, but the extent of surgical debridement is still debatable. The surgeon has to be aware of the significance of loose bodies when performing routine excision of innocuous looking wrist ganglia.

  2. Education in wrist arthroscopy

    NARCIS (Netherlands)

    Obdeijn, M.C.

    2014-01-01

    The subject of this thesis is an initiative for improving the education of residents in surgical skills and knowledge by using the current technical possibilities. The choice of wrist arthroscopy was driven by the fact that novel techniques have recently been developed within hand and wrist surgery

  3. Lack of effect of doxycycline on disease activity and joint damage in patients with rheumatoid arthritis. A double blind, placebo controlled trial

    NARCIS (Netherlands)

    Laan, W. van der; Molenaar, E.; Ronday, K.; Verheijen, J.; Breedveld, F.; Greenwald, R.; Dijkmans, B.; Tekoppele, J.

    2001-01-01

    Objective. To investigate the effects of doxycycline on disease activity and joint destruction in patients with rheumatoid arthritis (RA). Methods. A 36 week double blind, placebo controlled crossover trial was conducted. Patients (n = 66) received 50 mg doxycycline or placebo twice a day during 12,

  4. Is Swollen to Tender Joint Count Ratio aNew and Useful Clinical Marker for BiologicDrug Response in Rheumatoid Arthritis?

    DEFF Research Database (Denmark)

    Kristensen, Lars Erik; Bliddal, Henning; Christensen, Robin;

    2014-01-01

    OBJECTIVE: To study the impact of swollen to tender joint count ratio (STR) and other baseline characteristics on treatment response to a first course of anti-tumor necrosis factor (anti-TNF) therapy in rheumatoid arthritis (RA) patients. METHODS: Patients with RA initiating their first course...

  5. A systematic literature review analysis of ultrasound joint count and scoring systems to assess synovitis in rheumatoid arthritis according to the OMERACT filter

    DEFF Research Database (Denmark)

    Mandl, Peter; Naredo, Esperanza; Wakefield, Richard J

    2011-01-01

    The OMERACT Ultrasound Task Force is currently developing a global synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and t...

  6. Effect of a high-intensity weight-bearing exercise program on radiologic damage progression of the large joints in subgroups of patients with rheumatoid arthritis.

    NARCIS (Netherlands)

    Munneke, M.; Jong, Z. de; Zwinderman, A.H.; Ronday, H.K.; Schaardenburg, D. van; Dijkmans, B.A.C.; Kroon, H.M.; Vliet Vlieland, T.P.M.; Hazes, J.M.W.

    2005-01-01

    OBJECTIVE: To investigate whether a high-intensity exercise program accelerates the rate of radiologic damage of the large joints in predefined subgroups of patients with rheumatoid arthritis. METHODS: The data of 277 participants in a 2-year randomized controlled trial, comparing the effects of hig

  7. Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group

    DEFF Research Database (Denmark)

    Klarlund, Mette; Østergaard, Mikkel; Jensen, K E;

    2000-01-01

    OBJECTIVES: To evaluate synovial membrane hypertrophy, tenosynovitis, and erosion development of the 2nd to 5th metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints by magnetic resonance imaging in a group of patients with rheumatoid arthritis (RA) or suspected RA followed up for one...

  8. Disability and health-related quality of life among patients with rheumatoid arthritis: association with radiographic joint damage, disease activity, pain, and depressive symptoms

    NARCIS (Netherlands)

    I. Rupp; H.C. Boshuizen; H.J. Dinant; C.E. Jacobi; G.A.M. van den Bos

    2006-01-01

    Objective: To study the associations between disability and health-related quality of life ( HRQoL), respectively, and radiographic joint damage, disease activity, pain, and depressive symptoms among patients with rheumatoid arthritis ( RA). Methods: Data were collected through questionnaires and cl

  9. Otitis interna, media, and externa with destruction of the left tympanic bulla and subluxation and septic arthritis of the left temporomandibular joint in an alpaca (Vicugna pacos).

    Science.gov (United States)

    Galvan, Noe; Middleton, John R; Cook, Cristi; Britt, Lisa G; Kuroki, Keiichi

    2013-03-01

    A 1.5-year-old, 37.7 kg, female alpaca was evaluated for a 2-week history of weight loss, left ear droop, and deviation of the rostral mandible to the right. Antemortem radiography and postmortem examination revealed otitis interna, media, and externa, destruction of the left tympanic bulla, and subluxation and septic arthritis of the left temporomandibular joint.

  10. Studies on ageing and the severity of radiographic joint damage in rheumatoid arthritis

    NARCIS (Netherlands)

    Mangnus, Lukas; van Steenbergen, Hanna W.; Lindqvist, Elisabet; Brouwer, Elisabeth; Reijnierse, Monique; Huizinga, Tom W. J.; Gregersen, Peter K.; Berglin, Ewa; Rantapaa-Dahlqvist, Solbritt; van der Heijde, Desiree; van der Helm-van Mil, Annette H. M.

    2015-01-01

    Introduction: The western population is ageing. It is unknown whether age at diagnosis affects the severity of Rheumatoid Arthritis (RA), we therefore performed the present study. Method: 1,875 RA-patients (7,219 radiographs) included in five European and North-American cohorts (Leiden-EAC, Wichita,

  11. Prostaglandin D2 regulates joint inflammation and destruction in murine collagen-induced arthritis.

    NARCIS (Netherlands)

    Maicas Blasco, N.; Ibanez, L.; Alcaraz, M.J.; Ubeda, A.; Ferrandiz, M.L.

    2012-01-01

    OBJECTIVE: Prostaglandin D2 (PGD2) may exert proinflammatory or antiinflammatory effects in different biologic systems. Although this prostanoid and the enzymes responsible for its synthesis are up-regulated by interleukin-1beta (IL-1beta) in human chondrocytes in vitro, the role of PGD2 in arthriti

  12. Case report of post-irradiation necrosis on the knee joint in rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Ohno, Osamu; Ishikawa, Hitoshi; Hirohata, Kazushi (Kobe Univ. (Japan). School of Medicine)

    1982-08-01

    In the treatment of rheumatoid arthritis, the patient with post-irradiation necrosis received several operations for the management of arthritic edema. However, the prognosis was unfavourable. This result raised many problems and suggested the importance of preoperative accurate grasp of the pathologic state of a patient.

  13. Pneumococcal polyarticular septic arthritis after a single infusion of infliximab in a rheumatoid arthritis patient: a case report

    Directory of Open Access Journals (Sweden)

    Hayashi Masatoshi

    2012-03-01

    Full Text Available Abstract Introduction We present a case of Streptococcus pneumoniae polyarticular septic arthritis in a patient with rheumatoid arthritis receiving a single infusion of infliximab. Case presentation A 38-year-old Japanese man with a 5-year history of seronegative rheumatoid arthritis had previously received sulphasalazine and methotrexate therapies and was on regular low-dose prednisolone therapy. Despite these treatments, his disease activity remained high and infliximab was introduced in addition to methotrexate, prednisolone, and folic acid. However, he was admitted to hospital with a fever of 40.6°C, chills, and polyarthralgia eight days after the first infusion of infliximab. His joints were swollen, painful, and warm. Laboratory data showed marked acute inflammation. He was diagnosed with bacterial septic polyarthritis, and emergency surgical joint lavage and drainage was performed at the knees along with needle aspiration and lavage of the ankles and right wrist. He was then given intravenous antibiotic therapy for 31 days. He made a good recovery and was discharged on day 37. Conclusions We believe this is the first reported case of severe pneumococcal septic arthritis requiring hospitalization in a patient treated with infliximab. S. pneumonia is now a well-recognized but uncommon cause of polyarticular septic arthritis that can lead to cessation of therapy, as in our patient's case.

  14. Wrist and forearm postures and motions during typing.

    Science.gov (United States)

    Serina, E R; Tal, R; Rempel, D

    1999-07-01

    Awkward upper extremity postures and repetitive wrist motions have been identified by some studies as risk factors for upper extremity musculoskeletal disorders during keyboard work. However, accurate body postures and joint motions of typists typing on standardized workstations are not known. A laboratory study was conducted to continuously measure wrist and forearm postures and motions of 25 subjects while they typed for 10-15 min at a standard computer workstation adjusted to the subjects' anthropometry. Electrogoniometers continuously recorded wrist and forearm angles. Joint angular velocities and accelerations were calculated from the postural data. The results indicate that wrist and forearm postures during typing were sustained at non-neutral angles; mean wrist extension angle was 23.4 +/- 10.9 degrees on the left and 19.9 +/- 8.6 degrees on the right. Mean ulnar deviation was 14.7 +/- 10.1 degrees on the left and 18.6 +/- 5.8 degrees on the right. More than 73% of subjects typed with the left or right wrist in greater than 15 degrees extension and more than 20% typed with the left or right wrist in greater than 20 degrees ulnar deviation. Joint angles and motions while typing on an adjusted computer workstation were not predictable based on anthropometry or typing speed and varied widely between subjects. Wrist motions are rapid and are similar in magnitude to wrist motions of industrial workers performing jobs having a high risk for developing cumulative trauma disorders. The magnitude of the dynamic components suggests that wrist joint motions may need to be evaluated as a risk factor for musculoskeletal disorders during typing.

  15. Spinal GABA-B receptor modulates neutrophil recruitment to the knee joint in zymosan-induced arthritis.

    Science.gov (United States)

    Bassi, Gabriel S; do C Malvar, David; Cunha, Thiago M; Cunha, Fernando Q; Kanashiro, Alexandre

    2016-08-01

    Recent studies have demonstrated that the central nervous system controls inflammatory responses by activating complex efferent neuroimmune pathways. The present study was designed to evaluate the role that central gamma-aminobutyric acid type B (GABA-B) receptor plays in neutrophil migration in a murine model of zymosan-induced arthritis by using different pharmacological tools. We observed that intrathecal administration of baclofen, a selective GABA-B agonist, exacerbated the inflammatory response in the knee after zymosan administration characterized by an increase in the neutrophil recruitment and knee joint edema, whereas saclofen, a GABA-B antagonist, exerted the opposite effect. Intrathecal pretreatment of the animals with SB203580 (an inhibitor of p38 mitogen-activated protein kinase) blocked the pro-inflammatory effect of baclofen. On the other hand, systemic administration of guanethidine, a sympatholytic drug that inhibits catecholamine release, and nadolol, a beta-adrenergic receptor antagonist, reversed the effect of saclofen. Moreover, saclofen suppressed the release of the pro-inflammatory cytokines into the knee joint (ELISA) and pain-related behaviors (open field test). Since the anti-inflammatory effect of saclofen depends on the sympathetic nervous system integrity, we observed that isoproterenol, a beta-adrenergic receptor agonist, mimics the central GABA-B blockade decreasing knee joint neutrophil recruitment. Together, these results demonstrate that the pharmacological manipulation of spinal GABAergic transmission aids control of neutrophil migration to the inflamed joint by modulating the activation of the knee joint-innervating sympathetic terminal fibers through a mechanism dependent on peripheral beta-adrenergic receptors and central components, such as p38 MAPK.

  16. Analysis of Accumulating Clonotypes of T Cell in Joints of a Spontaneous Murine Model of Rheumatoid Arthritis

    Institute of Scientific and Technical Information of China (English)

    WenmingZhao; LipingZhang; YukageKobari; YoshikataMisaki; KazuhikoYamamoto

    2004-01-01

    SKG mouse, as a model of spontaneous rheumatoid arthritis (RA) bred recent years, is similar to the patients with RA. We analyzed the clonotypes of T cell infiltrating into joints of SKG mice in initial stage and late stage of RA by using reverse transcriptase-polymerase chain reaction (RT-PCR) and subsequent single-strand conformation polymorphism (SSCP). The results indicated that the percentages of clonotypes TCR Vβ2 and Vβ8.2 of T cell clonotypes increased obviously to 72.3% and 60.2%, respectively. Mice number with identical TCR Vβ2 and Vβ8.2 clonotypes also clearly increased in late stage of disease to 100% and 75%, respectively. These results mean that T cells with TCR Vβ2 and Vβ8.2 clonotypes probably play an important role in RA progression of SKG mouse. Sequencing of the extracted DNA verified that common bands on SSCP gel were derived from the same T cell clones among samples from different joints. The results we obtained implied that RT-PCR/SSCP method was a sensitive and credible method for analyzing T cell clonotypes. When the T cells of SKG mouse were adoptively transferred to a nude mouse, it was verified that the T cells infiltrating into joints were related to morbid formation of RA. Cellular & Molecular Immunology.

  17. Analysis of Accumulating Clonotypes of T Cell in Joints of a Spontaneous Murine Model of Rheumatoid Arthritis

    Institute of Scientific and Technical Information of China (English)

    Wenming Zhao; Liping Zhang; Yukage Kobari; Yoshikata Misaki; Kazuhiko Yamamoto

    2004-01-01

    SKG mouse, as a model of spontaneous rheumatoid arthritis (RA) bred recent years, is similar to the patients with RA. We analyzed the clonotypes of T cell infiltrating into joints of SKG mice in initial stage and late stage of RA by using reverse transcriptase-polymerase chain reaction (RT-PCR) and subsequent single-strand conformation polymorphism (SSCP). The results indicated that the percentages of clonotypes TCR Vβ2 and Vβ8.2 of T cell cionotypes increased obviously to 72.3% and 60.2%, respectively. Mice number with identical TCR Vβ2 and Vβ8.2 clonotypes also clearly increased in late stage of disease to 100% and 75%, respectively.These results mean that T cells with TCR Vβ2 and Vβ8.2 clonotypes probably play an important role in RA progression of SKG mouse. Sequencing of the extracted DNA verified that common bands on SSCP gel were derived from the same T cell clones among samples from different joints. The results we obtained implied that RT-PCR/SSCP method was a sensitive and credible method for analyzing T cell clonotypes. When the T cells of SKG mouse were adoptively transferred to a nude mouse, it was verified that the T cells infiltrating into joints were related to morbid formation of RA.

  18. Orthopedic symptoms in pustular bacterid (pustulosis palmaris et plantaris): Tietze's syndrome and arthritis of manubriosternal joint due to focal infection.

    Science.gov (United States)

    Ishibashi, A; Nishiyama, Y; Endo, M; Kawaji, W; Kato, T

    1977-04-01

    Painful orthopedic symptoms in the sternal area, such as arthritis of the manubriosternal and sternoclavicular joint or Tietze's syndrome, were found in 14 of 132 cases of pustulosis palmaris et plantaris. The majority of the pustulosis palmaris et plantaris patients with orthopedic symptoms had skin eruptions not only on the palms and soles, but also on the backs of the hands and feet, the arms, the legs and the trunk. Such cases were usually accompanied by elevation of the erythrocyte sedimentation rate, leucocytosis, changes in serum globulin, and also pyrexia at the time of exacerbation. The skin and orthopedic symptoms often worsened after acute exacerbation of the focal infection, and occasionally responded to tonsillectomy or chemotherapy with antibiotics, which is suggestive of the probable cause of the bacterid.

  19. The knee joint in early juvenile idiopathic arthritis: An ROC study for evaluating the diagnostic accuracy of contrast-enhanced MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Uhl, M.; Krauss, M.; Kern, S.; Herget, G.; Hauer, M.P.; Altehoefer, C.; Langer, M. [Univ. Hospital, Freiburg (Germany). Dept. of Diagnostic Radiology; Darge, K. [Heidelberg Univ. Hospital (Germany). Radiological Clinic; Berner, R. [Children' s Hospital, Freiburg (Germany). Dept. of General Pediatrics

    2000-01-01

    Diagnosis of juvenile idiopathic arthritis (JIA) remains difficult due to unspecific clinical and laboratory findings, especially in early stages of the disease. The purpose of our study was to determine the sensitivity and specificity of MR imaging in diagnosing JIA of the knee joints. Forty children (3 - 17 years old) clinically diagnosed with JIA (follow-up >1 year) of a knee joint and a control group of 40 children with painful knee joints (MR diagnosis: bone bruise of the knee (n=7), normal knee joint (n=12), osteomyelitis (n=6), septic arthritis (n=2), bone tumor (n=7) and miscellaneous bone lesions (n=6)) were examined using a 1.5 T MR unit. T1-weighted spin-echo (SE), T2-weighted fast SE, contrast-enhanced Tz1-weighted SE and 2D gradient echo sequences were performed. The receiver operating characteristic (ROC) curves evaluation was conducted by 5 independent radiologists. The positive criteria for diagnosing JIA were joint effusions (n=40), contrast-enhancing synovitis (n=39), cartilage lesions (n=15), subchondral erosions and bony destruction (n=1). Sensitivity and specificity were 93.5% and 92.5%, respectively. Both cases of septic arthritis were misdiagnosed as JIA by all radiologists. Contrast-enhanced MR imaging seems to be a highly sensitive tool in establishing the diagnosis of JIA.

  20. Low-level laser therapy stimulates tissue repair and reduces the extracellular matrix degradation in rats with induced arthritis in the temporomandibular joint.

    Science.gov (United States)

    Lemos, George Azevedo; Rissi, Renato; de Souza Pires, Ivan Luiz; de Oliveira, Letícia Prado; de Aro, Andrea Aparecida; Pimentel, Edson Rosa; Palomari, Evanisi Teresa

    2016-08-01

    The objective of this study was to characterize morphological and biochemistry action of low-level laser therapy (LLLT) on induced arthritis in the temporomandibular joint (TMJ) of rats. Twenty-four male Wistar rats were randomly divided into groups with 12 animals each: (AG) group with arthritis induced in the left TMJ and (LG) group with arthritis induced in the left TMJ and treated with LLLT (830 nm, 30 mW, 3 J/cm(2)). Right TMJs in the AG group were used as noninjected control group (CG). Arthritis was induced by intra-articular injection of 50 μl Complete Freund's Adjuvant (CFA) and LLLT began 1 week after arthritis induction. Histopathological analysis was performed using sections stained with hematoxylin-eosin, Toluidine Blue, and picrosirius. Biochemical analysis was determined by the total concentration of sulfated glycosaminoglycans (GAGs) and evaluation of matrix metalloproteinases (MMP-2 and MMP-9). Statistical analysis was performed using paired and unpaired t tests, with p arthritis.

  1. SKLB023 blocks joint inflammation and cartilage destruction in arthritis models via suppression of nuclear factor-kappa B activation in macrophage.

    Directory of Open Access Journals (Sweden)

    Caifeng Xie

    Full Text Available Rheumatoid arthritis (RA is the most common arthritis and is mainly characterized by symmetric polyarticular joint disorders. Our previous study demonstrated a novel small molecule compound (Z-N-(3-Chlorophenyl-2-(4-((2,4-dioxothiazolidin-5-ylidene methyl phenoxy acet-amide (SKLB023 showed potently anti-arthritic effects in a rat arthritis model, however, the underlying mechanisms for this are largely unknown. Both NF-κB and macrophages were reported to play important roles in the pathologic processes of RA. The purposes of this study were to indicate whether NF-κB and macrophages contributed to anti-arthritic effects of SKLB023 in two experimental arthritis models. Our results showed that SKLB023 could significantly improve joint inflammation and cartilage destruction both in adjuvant induced arthritis (AIA and collagen-induced arthritis (CIA models. We further found that the binding activation of NF-κB to DNA in joint tissues and RAW264.7 macrophages were suppressed by SKLB023. SKLB023 also inhibited the NF-κB activity in peritoneal macrophages by luciferase assay. Furthermore, the number of macrophages in synovial tissues was decreased after the treatment of different doses of SKLB023. The levels of TNF-α, IL-1β, and IL-6 in plasma, and the levels of TNF-α, NO, and IL-1β in peritoneal macrophages were down-regulated by SKLB023. Finally, SKLB023 attenuated the expression of iNOS and COX-2 in vivo and suppressed the phosphorylations of components of the mitogen-activated protein kinases (MAPKs. These observations identify a novel function for SKLB023 as an inhibitor of NF-κB in macrophages of RA, highlighting that SKLB023 was a potential therapeutic strategy for RA.

  2. Abnormal PTPN11 enhancer methylation promotes rheumatoid arthritis fibroblast-like synoviocyte aggressiveness and joint inflammation

    Science.gov (United States)

    Maeshima, Keisuke; Stanford, Stephanie M.; Hammaker, Deepa; Sacchetti, Cristiano; Zeng, Li-fan; Ai, Rizi; Zhang, Vida; Boyle, David L.; Aleman Muench, German R.; Feng, Gen-Sheng; Whitaker, John W.; Zhang, Zhong-Yin; Wang, Wei; Bottini, Nunzio; Firestein, Gary S.

    2016-01-01

    The PTPN11 gene, encoding the tyrosine phosphatase SHP-2, is overexpressed in rheumatoid arthritis (RA) fibroblast-like synoviocytes (FLS) compared with osteoarthritis (OA) FLS and promotes RA FLS invasiveness. Here, we explored the molecular basis for PTPN11 overexpression in RA FLS and the role of SHP-2 in RA pathogenesis. Using computational methods, we identified a putative enhancer in PTPN11 intron 1, which contained a glucocorticoid receptor–binding (GR-binding) motif. This region displayed enhancer function in RA FLS and contained 2 hypermethylation sites in RA compared with OA FLS. RA FLS stimulation with the glucocorticoid dexamethasone induced GR binding to the enhancer and PTPN11 expression. Glucocorticoid responsiveness of PTPN11 was significantly higher in RA FLS than OA FLS and required the differentially methylated CpGs for full enhancer function. SHP-2 expression was enriched in the RA synovial lining, and heterozygous Ptpn11 deletion in radioresistant or innate immune cells attenuated K/BxN serum transfer arthritis in mice. Treatment with SHP-2 inhibitor 11a-1 reduced RA FLS migration and responsiveness to TNF and IL-1β stimulation and reduced arthritis severity in mice. Our findings demonstrate how abnormal epigenetic regulation of a pathogenic gene determines FLS behavior and demonstrate that targeting SHP-2 or the SHP-2 pathway could be a therapeutic strategy for RA. PMID:27275015

  3. Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging

    DEFF Research Database (Denmark)

    Szkudlarek, Marcin; Court-Payen, M; Strandberg, C;

    2001-01-01

    OBJECTIVE: To evaluate the effectiveness of power Doppler ultrasonography (PDUS) for assessing inflammatory activity in the metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA), using dynamic magnetic resonance imaging (MRI) as a reference method. METHODS: PDUS and dynamic...... MRI were performed on 54 MCP joints of 15 patients with active RA and on 12 MCP joints of 3 healthy controls. PDUS was performed with a LOGIQ 500 unit by means of a 7-13-MHz linear array transducer. Later the same day, MRI was performed with a 1.0T MR unit. A series of 24 coronal T1-weighted images...

  4. Concomitant septic arthritis and tophaceous gout of the knee managed with intermittent closed joint irrigation combined with negative pressure therapy: a case study and literature review.

    Science.gov (United States)

    V N, Panicker; J K, Turner; M J, Chehade

    2014-01-01

    Tophaceous gout complicated by septic arthritis presents a management dilemma which can often require multiple surgical debridements. There is little published in the literature regarding treatment of these concomitant conditions. We postulate that biofilm may play a role increasing the difficulty of sterilising a tophaceous joint. The use of topical negative pressure therapy that targets biofilm has been well established for a range of wounds. A new device that incorporates both intermittent negative pressure therapy and wound irrigation was introduced in 2012. This case report describes the use of this topical negative device with the instillation option in the management of severe septic arthritis with concomitant gout and suggests directions for further research.

  5. Activity of identified wrist-related pallidal neurons during step and ramp wrist movements in the monkey.

    Science.gov (United States)

    Hamada, I; DeLong, M R; Mano, N

    1990-12-01

    1. The activity of globus pallidus (GP) neurons (n = 1,117) was studied in two monkeys to reexamine the relation of neuronal activity to movement type (slow vs. fast) while they performed both a visually guided step and ramp wrist tracking task. To select neurons specifically related to wrist movements, we employed both a somatosensory examination of individual body parts and a statistical analysis of the strength of temporal coupling of neuronal discharges to active wrist movement. 2. Neuronal responses to somatosensory stimulation were studied in 1,000 high-frequency GP neurons, of which 686 exhibited clear responses to manipulation of body parts. Of the latter, 336 responded to passive manipulation of forelimb joints and 58 selectively to passive flexion or extension of the wrist. 3. In the external segment of GP (GPe), most neurons responding to passive wrist movement were found to be clustered in four to five adjacent, closely positioned (separated by 200 microns) tracks in single coronal planes. The clusters were irregular in shape with a maximal width of 800-1,000 microns. Separate clusters of neurons responsive to passive wrist movement were identified in planes 3 mm apart in one monkey and in planes 500 microns apart in the other. Multiple clusters of neurons were also found for neurons responsive to joints other than the wrist. These findings suggest a more discrete and complex representation of individual joints in the primate GP than previously conceived. 4. During the performance of the wrist flexion and extension task, 92 neurons showed clear and consistent changes in activity. For these neurons we measured, with a statistical method on a trial-by-trial basis, the strength of temporal coupling between the onset of active wrist movement and the onset of change in neuronal discharge rate. Fifteen neurons showed changes in activity time-locked to the onset of active wrist movement. 5. Twelve pallidal neurons were classified as "wrist-related" based on

  6. Development of Intra-Articular Drug Delivery to Alter Progression of Arthritis Following Joint Injury

    Science.gov (United States)

    2013-04-01

    assessment using modified Mankin total joint score and representative MicroCT and Safranin -O/Fast Green stained sections. Modified Mankin total joint...values and 25th-75th quartile range displayed (n=6-8 per group). (C) Representative histological pictures with MicroCT (blue) and Safranin -O/Fast Green

  7. Genetics Home Reference: juvenile idiopathic arthritis

    Science.gov (United States)

    ... Home Health Conditions juvenile idiopathic arthritis juvenile idiopathic arthritis Enable Javascript to view the expand/collapse boxes. ... PDF Open All Close All Description Juvenile idiopathic arthritis refers to a group of conditions involving joint ...

  8. MRI of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Dick, Elizabeth A. [Department of MRI, St Mary' s Hospital, Praed St, London W2 1NY (United Kingdom)], E-mail: dickelizabeth@hotmail.com; Burnett, Carole; Gedroyc, Wladyslaw M.W. [Department of MRI, St Mary' s Hospital, Praed St, London W2 1NY (United Kingdom)

    2008-08-15

    Magnetic resonance imaging of the wrist is increasingly recognised as the imaging modality of choice in wrist disorders as image resolution improves and clinicians realise its potential. Consequently the ability to confidently interpret such imaging will become more important to both general and musculoskeletal radiologists. This article reviews current optimal imaging protocols and describes common abnormalities with a particular emphasis on less well understood topics such as intercalated segment instability, the triangular fibrocartilage complex and carpal tunnel syndrome.

  9. Proximal wrist extensor tendinopathy

    OpenAIRE

    Ihm, Joseph

    2007-01-01

    Proximal wrist extensor tendinopathy, which is also known as tennis elbow, is pain at or just distal to the lateral humeral epicondyle within the proximal wrist extensor tendon. It occurs commonly in certain athletes but can also occur in people with jobs that require repetitive movements of the hand and upper limb. In most cases the tendon involved shows no signs of inflammation or tendonitis, but instead shows fibroblasts, vascular hyperplasia, and disorganized collagen. Diagnosis is often ...

  10. Arthritis and IBD

    Science.gov (United States)

    ... pain and stiffness in the lower spine and sacroiliac joints (at the bottom of the back). Interestingly, and ... addition to causing arthritis of the spine and sacroiliac joints, ankylosing spondylitis can cause inflammation of the eyes, ...

  11. MRI bone oedema scores are higher in the arthritis mutilans form of psoriatic arthritis and correlate with high radiographic scores for joint damage

    DEFF Research Database (Denmark)

    Tan, Yu M; Østergaard, Mikkel; Doyle, Anthony;

    2009-01-01

    INTRODUCTION: The aim of this study was to investigate the magnetic resonance imaging (MRI) features of bone disease in the arthritis mutilans (AM) form of psoriatic arthritis (PsA). METHODS: Twenty-eight patients with erosive PsA were enrolled (median disease duration of 14 years). Using x...

  12. Pharyngeal function in patients with rheumatoid arthritis of the cervical spine and temporomandibular joint

    Energy Technology Data Exchange (ETDEWEB)

    Ekberg, O.; Redlund-Johnell, I.; Sjoeblom, K.G.

    Pharyngeal function was studied in 31 patients with rheumatoid arthritis. Eighteen of these patients had dysphagia. Cervical spine abnormalities were present in 14. Destruction of the capitulum and/or ramus of the mandible was registered in 9. Pharyngeal dysfunction was revealed in 20. Patients with a vertical dislocation of the C1-C2 in relation to the occipital bone and patients with destruction of the capitulum and/or ramus of the mandible had an increased frequency of pharyngeal dysfunction. Pharyngeal dysfunction is thought to be due to mechanical factors and caused by derangements of muscular attachments and turning points.

  13. Phenotypic alterations of neuropeptide Y and calcitonin gene-related peptide-containing neurons innervating the rat temporomandibular joint during carrageenan-induced arthritis

    Directory of Open Access Journals (Sweden)

    J.P. Damico

    2012-10-01

    Full Text Available The aim of this study was to identify immunoreactive neuropeptide Y (NPY and calcitonin gene-related peptide (CGRP neurons in the autonomic and sensory ganglia, specifically neurons that innervate the rat temporomandibular joint (TMJ. A possible variation between the percentages of these neurons in acute and chronic phases of carrageenan-induced arthritis was examined. Retrograde neuronal tracing was combined with indirect immunofluorescence to identify NPY-immunoreactive (NPY-IR and CGRP- immunoreactive (CGRP-IR neurons that send nerve fibers to the normal and arthritic temporomandibular joint. In normal joints, NPY-IR neurons constitute 78±3%, 77±6% and 10±4% of double-labeled nucleated neuronal profile originated from the superior cervical, stellate and otic ganglia, respectively. These percentages in the autonomic ganglia were significantly decreased in acute (58±2% to superior cervical ganglion and 58±8% to stellate ganglion and chronic (60±2% to superior cervical ganglion and 59±15% to stellate ganglion phases of arthritis, while in the otic ganglion these percentages were significantly increased to 19±5% and 13±3%, respectively. In the trigeminal ganglion, CGRP-IR neurons innervating the joint significantly increased from 31±3% in normal animals to 54±2% and 49±3% in the acute and chronic phases of arthritis, respectively. It can be concluded that NPY neurons that send nerve fibers to the rat temporomandibular joint are located mainly in the superior cervical, stellate and otic ganglia. Acute and chronic phases of carrageenan-induced arthritis lead to an increase in the percentage of NPY-IR parasympathetic and CGRP-IR sensory neurons and decrease in the percentage of NPY-IR sympathetic neurons related to TMJ innervation.

  14. Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis

    Directory of Open Access Journals (Sweden)

    Manish Chug

    2014-01-01

    Conclusion: The use of uncemented prosthesis in treatment of Questionnaire Score. Range of motion joint osteoarthritis gives excellent short term results in improving hand function in terms of strength and stability and achieving pain relief.

  15. Pan-regional (cervico-thoraco-lumbo-sacral spinal epidural abscess with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis: complete resolution with non-operative management

    Directory of Open Access Journals (Sweden)

    Appukutty Manickam, MRCS

    2014-12-01

    Conclusion: Even pan-regional CTLS SEA with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis can be managed non-operatively. A complete clinical and radiological resolution can be achieved with antibiotics alone.

  16. Toll-like receptor 4 is involved in inflammatory and joint destructive pathways in collagen-induced arthritis in DBA1J mice.

    Directory of Open Access Journals (Sweden)

    Matthias Pierer

    Full Text Available In rheumatoid arthritis, a significant proportion of cytokine and chemokine synthesis is attributed to innate immune mechanisms. TLR4 is a prominent innate receptor since several endogenous ligands known to activate the innate immune system bind to it and may thereby promote joint inflammation. We generated TLR4 deficient DBA1J mice by backcrossing the TLR4 mutation present in C3H/HeJ strain onto the DBA1J strain and investigated the course of collagen-induced arthritis in TLR4 deficient mice in comparison to wild type littermates. The incidence of collagen- induced arthritis was significantly lower in TLR4 deficient compared to wild type mice (59 percent vs. 100 percent. The severity of arthritis was reduced in the TLR4 deficient mice compared to wild type littermates (mean maximum score 2,54 vs. 6,25. Mice deficient for TLR4 were virtually protected from cartilage destruction, and infiltration of inflammatory cells was reduced compared to wt mice. In parallel to the decreased clinical severity, lower anti-CCP antibody concentrations and lower IL-17 concentrations were found in the TLR4 deficient mice. The study further supports the role of TLR4 in the propagation of joint inflammation and destruction. Moreover, since deficiency in TLR4 led to decreased IL-17 and anti-CCP antibody production, the results indicate a link between TLR4 stimulation and the adaptive autoimmune response. This mechanism might be relevant in human rheumatoid arthritis, possibly in response to activating endogenous ligands in the affected joints.

  17. Pointing with the wrist: a postural model for Donders' law.

    Science.gov (United States)

    Campolo, Domenico; Widjaja, Ferdinan; Esmaeili, Mohammad; Burdet, Etienne

    2011-07-01

    The central nervous system uses stereotypical combinations of the three wrist/forearm joint angles to point in a given (2D) direction in space. In this paper, we first confirm and analyze this Donders' law for the wrist as well as the distributions of the joint angles. We find that the quadratic surfaces fitting the experimental wrist configurations during pointing tasks are characterized by a subject-specific Koenderink shape index and by a bias due to the prono-supination angle distribution. We then introduce a simple postural model using only four parameters to explain these characteristics in a pointing task. The model specifies the redundancy of the pointing task by determining the one-dimensional task-equivalent manifold (TEM), parameterized via wrist torsion. For every pointing direction, the torsion is obtained by the concurrent minimization of an extrinsic cost, which guarantees minimal angle rotations (similar to Listing's law for eye movements) and of an intrinsic cost, which penalizes wrist configurations away from comfortable postures. This allows simulating the sequence of wrist orientations to point at eight peripheral targets, from a central one, passing through intermediate points. The simulation first shows that in contrast to eye movements, which can be predicted by only considering the extrinsic cost (i.e., Listing's law), both costs are necessary to account for the wrist/forearm experimental data. Second, fitting the synthetic Donders' law from the simulated task with a quadratic surface yields similar fitting errors compared to experimental data.

  18. The Prevalence of Pisotriquetral Arthritis in the Setting of Scapholunate Advanced Collapse.

    Science.gov (United States)

    Rancy, Schneider K; Trehan, Samir K; Li, Angela E; Lee, Steve K; Potter, Hollis G; Wolfe, Scott W

    2016-11-01

    Background Previous authors have reported pisotriquetral pain and subsequent pisiform excision following partial or total wrist fusion in patients with scapholunate advanced collapse (SLAC). Prior studies have not considered the potential role of SLAC biomechanics on pisotriquetral osteoarthritis (PT OA) development preoperatively. Purpose To determine the prevalence and severity of PT OA in patients with SLAC as compared with a control population. Patients and Methods Magnetic resonance imaging (MRI) studies of 24 patients with SLAC wrist and 24 sex- and age-matched control patients were analyzed. Patients with SLAC wrist were selected from a database of all wrist MRI studies performed at our institution from 2006 to 2015, excluding those with inflammatory arthritis, chondrocalcinosis, and incomplete or atraumatic scapholunate interosseous ligament rupture. Control patients underwent MRI for nonarthritic clinical indications and were chosen in an age- and sex-matched fashion. Patients undergoing MRI for triangular fibrocartilage complex injury, extensor carpi ulnaris tendinopathy, or ulnar-sided wrist pain were excluded from the control cohort. MRI grading of arthritic change at the pisotriquetral joint was assessed by a blinded musculoskeletal radiologist according to a four-category scale, with grade 4 indicating the greatest arthritic severity. Results The prevalence of PT OA in the control cohort was found to be 37.5% compared with 41.7% in the SLAC cohort. The prevalence of greatest arthritic severity (grade 4) at the pisotriquetral joint was found to be 4.2% in the control cohort, compared with 16.7% in the SLAC cohort. Conclusion We conclude that the overall prevalence of chondral wear at the pisotriquetral joint in SLAC wrist does not differ significantly from that found in control populations. We did identify a fourfold (but not statistically significant) increased prevalence of end-stage arthritis in patients with SLAC. Given reports of

  19. Correlation between computer-aided dynamic gadolinium-enhanced MRI assessment of inflammation and semi-quantitative synovitis and bone marrow oedema scores of the wrist in patients with rheumatoid arthritis--a cohort study

    DEFF Research Database (Denmark)

    Boesen, Mikael; Kubassova, Olga; Bouert, Rasmus;

    2012-01-01

    Objective. To test the correlation between assessment of inflammation using dynamic contrast-enhanced MRI (DCE-MRI) analysed by a novel computer-aided approach and semi-quantitative scores of synovitis and bone marrow oedema (BME) using the OMERACT-RA MRI Scoring (RAMRIS) system, in the wrist of ...

  20. Anxiety and depression levels in rheumatoid arthritis patients before and after joint replacement procedure.

    Science.gov (United States)

    Pietrzak, Joanna; Kwarta, Paulina; Karbownik, Michał; Mokros, Łukasz; Zdanowicz, Paula; Miśkowiec, Dawid; Witusik, Andrzej; Antczak, Adam; Pietras, Tadeusz

    2016-10-19

    The progression of the inflammatory process in the course of rheumatoid arthiritis (RA) may cause a permanent destruction of joints, which in case of bigger ones (i.e. hip or knee) may be particularly a psychological burden for a patient.

  1. Acute suppurative arthritis of the temporomandibular joint. Report of a case.

    OpenAIRE

    Dhanrajani P; Khateery S

    1993-01-01

    The case reported illustrates a rare but interesting condition. Early treatment is the most important factor in decreasing the high morbidity associated with this infection. Aspiration is a key diagnostic tool for early diagnosis. Surgical intervention should be individually assessed and active physiotherapy is a must to resume normal function of the joint.

  2. Validity and Agreement between the 28-Joint Disease Activity Score Based on C-Reactive Protein and Erythrocyte Sedimentation Rate in Patients with Rheumatoid Arthritis

    DEFF Research Database (Denmark)

    Nielung, Louise; Christensen, Robin; Danneskiold-Samsøe, Bente;

    2015-01-01

    Objective. To validate the agreement between the 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) and the 28-joint disease activity score based on C-reactive protein (DAS28-CRP) in a group of Danish patients with rheumatoid arthritis (RA). Methods. Data from 109...... Danish RA patients initiating biologic treatment were analysed at baseline and following one year of treatment. Participants were retrospectively enrolled from a previous cohort study and were considered eligible for this project if CRP and ESR were measured at baseline and at the follow-up visit...

  3. SEPTIC ARTHRITIS OF THE HIP IN ADULTS: A RARE PRESENTATION

    OpenAIRE

    Kuppa; Yerukala; Dema; Sujith; Venkateswar Reddy

    2015-01-01

    Septic Arthritis also known as infectious arthritis, can be bacterial or fungal arthritis. The condition is an inflammation of a joint that is caused by an infection. Typically, Septic Arthritis affects one large joint in the body such as knee or hip. Generally, Septic Arthritis is present with complete absorption of the head of the ...

  4. Rheumatoid wrist deformity and risk of extensor tendon rupture evaluated by 3DCT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Ishikawa, Hajime; Abe, Asami; Murasawa, Akira; Nakazono, Kiyoshi; Horizono, Hidehiro; Ishii, Katsushi; Seki, Eiko [Niigata Rheumatic Center, Department of Rheumatology, Shibata city, Niigata (Japan)

    2010-05-15

    Extensor tendon rupture on the dorsum of the wrist is commonly seen in patients with rheumatoid arthritis (RA). It causes immediate dysfunction of the hand and surgical reconstruction is usually required. The purpose of this study was to clarify the risk of extensor tendon rupture by quantifying wrist deformity on three-dimensional computed tomography (3DCT) images. Three-dimensional CT images of 108 wrists in 102 patients with RA and 38 wrists in 38 healthy volunteers were analyzed retrospectively. All of the rheumatoid wrists had caused persistent pain for more than 6 months despite ongoing medical treatment. Extensor tendon rupture was noted in 49 wrists in 47 patients, and no rupture was noted in 59 wrists in 56 patients. The dorsal subluxation ratio (DSR) of the ulnar head and the carpal supination angle (CSA) were measured utilizing a new technique. The average DSR and CSA in the rupture group (n = 49), the non-rupture group (n = 59), and the normal wrist group (n = 38) were 37%, 19%, and 26%, and 15 , 11 , and 6 respectively. The cut-off values for extensor tendon rupture in the wrists of patients with RA were 32% (sensitivity; 70%, specificity; 75%) in the DSR, and 14 (71%, 68%) in the CSA. By utilizing 3DCT imaging of the rheumatoid wrist, these parameters can help improve our ability to predict extensor tendon rupture. (orig.)

  5. Effects of low dosage Co-60 irradiation in the course of aseptic arthritis of the knee joint of rabbits; Effekte einer niedrig dosierten Co-60-Bestrahlung auf den Verlauf einer aseptischen Arthritis am Kniegelenk des Kaninchens

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, U.; Koch, F.; Ludewig, E. [Univ. Leipzig (Germany). Veterinaermedizinische Fakultaet; Kamprad, F.; Melzer, R.; Hildebrandt, G. [Leipzig Univ. (Germany). Klinik fuer Strahlentherapie und Radioonkologie

    1998-12-01

    Purpose: Numerous clinical observations demonstrate the efficacy of low radiation doses in the treatment of painful osteoarthritis. Experimental investigations remain scarce. We investigated the effects of locally daily 5 times 1.0 Gy 60-Co irradiation on an artificially induced aseptic gonarthritis in rabbits. Material and methods: Three separate experiments (EV) were performed (10 rabbits per experiment, 5 treated/5 controls; duration: EV1: 18 days; EV2: 6 days; EV3: 29 days). An aseptic arthritis in the right knee joint of rabbits was induced by intraarticular injection of 0.5 ml papain solution (3%, 30,000 USP/mg) on day 0. The arthritic knee joint of the anesthesized animals was irradiated daily from day 1 to 5 with 5 times 1.0 Gy. The controls were sham-irradiated under the same conditions. The time course of arthritis in treated animals and sham-treated controls was evaluated by clinical, laboratory-chemical and histological criteria. The clinical investigation was performed daily, the puncture of the knee-joints was carried out several times in EV1, and at the end of experiments in EV2 and EV3. At the end of the observation period, animals were killed and the knee joints excised for histological analysis. Results: The intraarticular injection of papain caused a peracute inflammatory response in all animals. After 1 week the chronical stage was reached, and the experimental arthritis resolved slowly within several weeks. Local irradiation accelerated the decrease of inflammatory joint swelling, being significant by day 4. On day 6 the volume of synovial fluid in irradiated knee-joints was significantly smaller. The morphometric data indicated a reduction in thickness of synovial membrane, a decrease in number of synovial cell layers, and a decrease in distance between capillaries and the synovial membrane surface following irradiation of arthritic joints. Due to considerable individual variability, the morphometric data partially did not reach statistically

  6. ANALYSIS OF THE PATHOGENETIC MECHANISMS OF CHRONIC JOINT PAIN IN PATIENTS WITH RHEUMATOID ARTHRITIS AND KNEE OSTEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    E. S. Filatova

    2014-01-01

    Full Text Available Objective: to reveal neurogenic mechanisms in the pathogenesis of chronic pain syndrome in rheumatoid arthritis (RA and knee osteoarthritis (OA in order to develop individualized pharmacotherapy.Subjects and methods. One hundred and eighty-three patients with RA and 80 with knee OA were examined. By using the neuropathic pain diagnostic questionnaire (DN4, all the patients were divided into 2 groups with and without a neuropathic pain component (NPC.Results. NPC was found in 43% of the patients with RA and it was connected with involvement of the peripheral somatosensory system. In RA, NPC was common in older patients with longer disease duration, higher X-ray stage, and severe functional insufficiency. 30% of patients with knee OA also had NPC, however the signs of nervous system involvement were absent. In OA, NPC was associated with hyperalgesia, higher pain intensity, more marked joint dysfunction on the WOMAC, and anxiety.Discussion. This investigation revealed a mixed pattern of chronic pain syndrome in patients with RA and knee OA; some patients were found to have a NPC in the presence of predominantly a nociceptive component

  7. X-Ray Exam: Wrist

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old X-Ray Exam: Wrist KidsHealth > For Parents > X-Ray Exam: Wrist A A A What's in ... español Radiografía: muñeca What It Is A wrist X-ray is a safe and painless test that ...

  8. Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis--update on evaluation and treatment.

    Science.gov (United States)

    Strauch, Robert J

    2011-04-01

    Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse are common patterns of wrist arthritis. Scaphoid nonunion advanced collapse is caused by trauma, whereas SLAC wrist may also result from chronic pseudogout and can appear bilaterally without a clear history of injury. Surgical treatment for SLAC wrist includes 4-corner arthrodesis, capitolunate arthrodesis, complete wrist arthrodesis, proximal row carpectomy (PRC), denervation, and radial styloidectomy. Scaphoid nonunion advanced collapse wrist has the additional surgical option of excision of the distal ununited scaphoid fragment. Controversy persists over the relative merits of PRC versus 4-corner arthrodesis and whether PRC may be performed in the setting of capitate arthritis.

  9. Idiopathic septic arthritis of a lumbar facet joint associated with paraspinal abscess.

    Science.gov (United States)

    Kitova-John, Margarita Borislavova; Azim-Araghi, Ali; Sheikh, Faraz Tariq; Kitov, Borislav Dimitrov

    2015-08-13

    A 48-year-old woman presented with a 1-month history of severe lower back pain on a background of 24 h of mild fever and general tiredness with an associated right-sided foot drop. Five weeks after the onset and with no improvement in symptoms in spite of analgesia and physiotherapy, the patient had a lumbar spine MRI which demonstrated a collection extending from the facet joints of L5 and L6 to the iliacus muscle on the right. A CT-guided aspiration was performed with a lengthy hospital stay for intravenous antibiotic treatment. The culture and sensitivity study of the aspirate isolated Streptococcus pneumoniae.

  10. Gouty arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Barthelemy, C.R.; Nakayama, D.A.; Lightfoot, R.W. Jr.; Wortmann, R.L.; Carrera, G.F.

    1984-01-01

    A prospective analysis of 60 patients with gout was undertaken to evaluate the radiographic spectrum of gouty arthritis in patients treated in the era of hypouricemic therapy. Twenty-two of these patients were clinically tophaceous; 36 were considered to have radiographic findings diagnostic of gouty arthritis by strict radiographic criteria. Up to 24% of the patients denied symptoms in joints with radiographic changes of gout; 42% with no evidence of tophi on clinical examination had radiographic changes characteristic of gout. Radiographic assessment can be extremely helpful in the management of gout by documenting the degree and extent of bony involvement, particularly in patients with limited symptoms or without clinical tophi.

  11. Streptobacillus moniliformis septic arthritis: a clinical entity distinct from rat-bite fever?

    Directory of Open Access Journals (Sweden)

    Wong Samson SY

    2007-06-01

    Full Text Available Abstract Background Streptobacillus moniliformis is a zoonotic agent associated with rodent contacts. Although it is more commonly reported to cause rat-bite fever with reactive arthritides, it can also lead to pyogenic infection of the joints. Case presentation We present a lady with past history of osteoarthritis developing streptobacillary septic arthritides of the right knee and left wrist, and required antibiotic and arthrotomy for treatment. We also review 11 previously reported cases of streptobacillary septic arthritis to discuss the characteristics, treatment, prognosis of the infection, and illustrates the differences between streptobacillary rat-bite fever and septic arthritis. Among this patient population, most patients had potential contact with rats (91.6%. The knee is the most commonly affected joint (58.3%, and 83.3% patients having polyarticular involvement. As opposed to rat-bite fever, fever and rash was only present in 58.3% and 16.7% of patients respectively. S. moniliformis bacteremia is uncommon (8.4% and the prognosis is good. Conclusion Arthrocentesis is useful in distinguishing streptobacillary septic arthritis from reactive arthritis of rat-bite fever. The sole use of commercial media containing sodium polyanethol sulfonate may render the bacterial culture negative. A detailed history of possible exposure to rodents should be elicited from patients with arthritis in order to facilitate microbiologic diagnosis.

  12. Treatment of rheumatoid arthritis with metacarpophalangeal joint replacement%掌指关节置换术治疗类风湿关节炎

    Institute of Scientific and Technical Information of China (English)

    庄超; 王黎明; 桂鉴超; 徐燕

    2008-01-01

    目的 探讨应用掌指关节置换术治疗类风湿关节炎的方法和临床疗效.方法 2002年1月-2007年1月,对8例13指类风湿关节炎的患者,采用Swanson假体行掌指关节置换术.结果 术后伤口均Ⅰ期愈合,随访时间为9~24个月,平均15.8个月.掌指关节置换后按李庆泰等的疗效评定标准评价:优9指,良4指.结论 掌指关节置换术治疗类风湿关节炎疗效可靠,是一种较好的治疗方法.%Objective To investigate the technique and clinical outcome of treating rheumatoid arthritis with metacarpophalangeal joint replacement. Methods From January 2002 to January 2007, 13 digits in 8 patients with rheumatoid arthritis were treated by metacarpophalangeal joint replacement using Swenson prosthesis. Joint range of motion and postoperative pain in all eases were measured to evaluate the treatment out. Results Primary wound healing was achieved in all cases. The followed up time was from 9 months to 24 months with an average of 15.8 months. According to assessment standard described by Li, treatment outcome was graded as excellent in 9 fingers and good in 4 fingers. Conclusion Metacarpophalangeal joint replacement is an effective method to treat rheumatoid arthritis.

  13. MAGNETIC RESONANCE IMAGING OF THE SACROILIAC JOINT IN DIFFERENTIAL DIAGNOSIS OF EARLY POLYARTICULAR PSORIATIC AND RHEUMATOID ARTHRITIS (STUDY DATA REMARKA

    Directory of Open Access Journals (Sweden)

    Elena Yu Loginova

    2014-01-01

    Full Text Available Diagnosis of lesions of the spine and sacroiliac joints may be helpful in discrimination between early psoriatic arthritis (ePsA and early rheumatoid arthritis (eRA.Objective. To assess the significance of inflammatory back pain (IBP, HLA-B27, and active sacroiliitis (ASI confirmed by magnetic resonance imaging (MRI for differential diagnosis of polyarticular ePsA and eRA.Materials and Methods. The study included 29 patients with ePsA (13 males and 16 females, mean age 36.52 ± 11.27 years, average duration of the disease 13.03 ± 9.77 months and 25 patients with eRA (7 males and 18 females, mean age 52.68 ± 14.7 years, average duration of the disease 4.0 ± 1.72 months. Presence of IBP (according to the ASAS criteria and HLA-B27 were assessed (in 27 patients with PsA and in 20 patients with RA; ASI signs were assessed based on the MRI data (bone marrow edema/osteitis. DAS, DAS28, M ± SD, Fisher's exact test, t-test, χ2, the Yule coefficients of association (Q: level from -1 to +1 and Phi were calculated; differences were considered to be statistically significant at p <0.05.Results. In patients with ePsA, ASI was detected by MRI significantly more frequently than in patients with eRA (41.4% and 12% of cases respectively, p < 0.016. No correlation between the presence of ASI and DAS28 was observed in both groups. In the ePsA group, IBP was detected in 17 patients (58.6%; it was long-term in 10 (58.8% of the patients and episodic – in 7 (41.2% patients. Back pain with mechanical rhythm was observed in 3 (12% patients with eRA. HLA-B27 was detected in 9 (33.3% of 27 patients with ePsA and in 3 (15% of 20 patients with eRA (p < 0.014. In patients with ePsA, a very high level of association between ASI and IBP (Q = 0.91, Phi = 0.56; p < 0.003 and a high level of association between ASI and HLA-B27 (Q = 0.75, Phi = 0.56; p < 0.039 were detected. MRI showed no association between the presence of HLA-B27 and ASI signs in patients with RA

  14. Septic arthritis due to tubercular and Aspergillus co-infection.

    Science.gov (United States)

    Kumar, Mukesh; Thilak, Jai; Zahoor, Adnan; Jyothi, Arun

    2016-01-01

    Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB) and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs.

  15. Septic arthritis due to tubercular and Aspergillus co-infection

    Directory of Open Access Journals (Sweden)

    Mukesh Kumar

    2016-01-01

    Full Text Available Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs.

  16. Relationship between wrist bone mineral density and synovitis, erosion by ultra-sonography in female rheumatoid arthritis patients%女性类风湿关节炎患者手腕骨密度检查与超声腕关节骨侵蚀及炎症评分的相关性

    Institute of Scientific and Technical Information of China (English)

    王昱; 耿研; 邓雪蓉; 张卓莉

    2015-01-01

    分别是造成患者手腕BMD异常的相关危险因素。结论:女性RA患者腕部BMD与疾病的病程以及炎症程度相关,ACPA抗体高滴度患者更容易出现骨密度下降。%Objective:To find the correlation of wrist bone mineral density ( BMD ) to wrist synovitis and erosion , by comparing wrist BMD and ultrasonography .Methods: A number of 80 female RA pa-tients were examined by BMD measurement of the femoral neck , spine and non-dominant wrist using du-al-energy X-ray absorptiometry ( DXA ) .Synovitis of the wrist was examined by ultrasonography .The wrist joint ( radiocarpal joint , dorsal midline , and carpoulnar joint ) was assessed in the same side of DXA, with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation , tenosynovi-tis,tendinitis and bone erosion .Colour and power doppler ultrasonography ( PDUS) were used to sum the synovitis score .Results:We found:( 1 ) In the study , 80 female RA patients were enrolled , the mean age was 54.6 ±13.3 (27.0-80.0) years, the disease duration was 48 (12-116) months, and the body Mass Index was 23.0 ±4.0 (14.8-31.2) kg/m2 .The Wrist BMD ( g/cm2 ) in RA significantly reduced, compared with normal controls (0.297 ±0.121 vs.0.420 ±0.180,P<0.01).(2) The Wrist BMD (g/cm2) exceeded in early RA compared with the established RA (0.326 ±0.103 vs.0.285 ± 0 .132 ,P<0 .01 );the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA(47.8%vs.64.9%, P<0.05); the positive rate of bone erosion in wrist by ultra-sound was lower in early RA compared with the established RA (39.1%vs.56.1%, P<0.01).(3) The wrist BMD ( g/cm2 ) in RA with high disease activity reduced compared with moderate and low disease activity (0.267 ±0.140 vs.0.280 ±0.126) and (0.267 ±0.140 vs.0.320 ±0.103) respec-tively , P<0 .05 ) .The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the

  17. Radiologic evaluation of hand and wrist motion.

    Science.gov (United States)

    Bond, J R; Berquist, T H

    1991-02-01

    Abnormal motion due to instability at the carpus and distal radioulnar joint can be difficult to diagnose clinically, and radiologic evaluation can be very helpful. The anatomy and kinematics are complex, and a directed approach is necessary to detect the findings that may be subtle and transient. Plain radiographic evaluation of the distal radioulnar joint is very sensitive to slight variations in patient position, and CT is more accurate when pain or cast immobilization make positioning difficult or when there is associated distal radial deformity. Static carpal instability patterns are present on routine radiographs where examination of the lateral view provides the key to diagnosis. The relations between the longitudinal axes of the radius, lunate, capitate, and scaphoid form the basis for classification of these instabilities. In dynamic carpal instability, routine radiographs are normal. The instability is demonstrated only with positional change or manipulation. Motion views can be very helpful, although direct observation of wrist motion on videotape fluoroscopy is the key to the diagnosis of dynamic instability. MR imaging motion studies provide better soft tissue definition and may show subtle changes in the triangular-fibrocartilage-associated distal radioulnar instability, as well as periarticular tendon subluxation about the wrist. The clinical role of MR imaging in the evaluation of wrist motion has yet to be clearly defined.

  18. The post-arthro-CT of the wrist clinical evaluation

    CERN Document Server

    Scheurecker, G

    2001-01-01

    To compare the diagnostic effectiveness of post-arthro-CT (PACT) and 3-compartment wrist arthrography (AG) both separate and combined versus wrist arthroscopy for scapho-lunate ligament (SLL), luno-triquetral ligament (LTL) and triangular fibrocartilage (TFC) defects and chondromalacia of the carpal bones. Material and methods: in 58 patients (16-69 years) the affected wrist was examined initially by conventional 3-compartment wrist arthrography with digital subtraction technique during injection followed by digital stress images. Afterwards spiral arthro-CT was performed in the semi-coronal and axial plane with 1 mm slice thickness and secondary true-coronal and sagittal reconstructions. Within 1 month arthroscopy was performed in general anesthesia utilizing standard joint entry points combined with routine digital picture archiving. All examinations were evaluated for SLL, LTL and TFC defects, PACT and AS for ChM too. Results: AG versus AS: the following detection rates were observed (AG and AS positive/AG...

  19. Are temporomandibular joint signs and symptoms associated with magnetic resonance imaging findings in juvenile idiopathic arthritis patients? A longitudinal study.

    Science.gov (United States)

    Zwir, Liete M L Figueiredo; Terreri, Maria Teresa R A; Sousa, Soraia Ale; Fernandes, Artur Rocha Corrêa; Guimarães, Antônio Sérgio; Hilário, Maria Odete E

    2015-12-01

    The aims of this longitudinal study were to perform a comprehensive clinical evaluation of temporomandibular joint (TMJ) and to investigate the association between the clinical and magnetic resonance imaging (MRI) findings in the TMJs of patients with juvenile idiopathic arthritis (JIA). Seventy-five patients with JIA participated in this study. All patients underwent a rheumatological examination performed by a paediatric rheumatologist, a TMJ examination performed by a single dentist and an MRI with contrast of the TMJs. These examinations were scheduled on the same date. The patients were examined again 1 year later. Twenty-eight (37.3 %) patients reported symptoms at the first evaluation and 11 (14.7 %) patients at the second evaluation. In relation to signs, 35 (46.7 %) of the patients presented at least one sign at the first evaluation and 29 (38.7 %) at the second. Intense contrast enhancement of TMJ was significantly associated with disease activity (p < 0.001) at the first evaluation and a trend to significance was observed at the second (p = 0.056), with poly/systemic subtypes (p = 0.028 and p = 0.049, respectively), with restricted mouth opening capacity (p = 0.013 and p = 0.001, respectively), with the presence of erosions at both evaluations (p = 0.0001 and p < 0.0001, respectively) and with altered condylar shape at the second evaluation (p = 0.0005). TMJ involvement is highly prevalent in JIA patients, with asymptomatic children presenting severe structural alterations of the TMJ. The TMJ should always be evaluated in JIA patients, even in the absence of signs and symptoms.

  20. Use of technetium-99m methylene diphosphonate and gallium-67 citrate scans after intraarticular injection of Staphylococcus aureus into knee joints of rabbits with chronic antigen-induced arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Mahowald, M.L.; Raskind, J.R.; Peterson, L.; Gerding, D.; Raddatz, D.A.; Shafer, R.

    1986-08-01

    Numerous clinical studies have questioned the ability of radionuclide scans to differentiate septic from aseptic joint inflammation. A clinical study may not be able to document an underlying disease process or duration of infection and, thus, may make conclusions about the accuracy of scan interpretations open to debate. In this study, the Dumonde-Glynn model of antigen-induced arthritis in rabbits was used as the experimental model to study technetium and gallium scans in Staphylococcus aureus infection of arthritic and normal joints. Gallium scans were negative in normal rabbits, usually negative in antigen-induced arthritis, but positive in septic arthritis. The bone scan was usually negative in early infection but positive in late septic arthritis, a finding reflecting greater penetration of bacteria into subchondral bone because of the underlying inflammatory process.

  1. Effect of combination therapy on joint destruction in rheumatoid arthritis: a network meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Niels Graudal

    Full Text Available BACKGROUND: Despite significant cost differences, the comparative effect of combination treatments of disease modifying anti-rheumatic drugs (DMARDs with and without biologic agents has rarely been examined. Thus we performed a network meta-analysis on the effect of combination therapies on progression of radiographic joint erosions in patients with rheumatoid arthritis (RA. METHODS AND FINDINGS: The following combination drug therapies compared versus single DMARD were investigated: Double DMARD: 2 DMARDs (methotrexate, sulfasalazine, leflunomide, injectable gold, cyclosporine, chloroquine, azathioprin, penicillamin or 1 DMARD plus low dose glucocorticoid (LDGC; triple DMARD: 3 DMARDs or 2 DMARDs plus LDGC; biologic combination: 1 DMARD plus biologic agent (tumor necrosis factor α inhibitor (TNFi or abatacept or tocilizumab or CD20 inhibitor (CD20i. Randomized controlled trials were identified in a search of electronic archives of biomedical literature and included in a star-shaped network meta-analysis and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement protocol. Effects are reported as standardized mean differences (SMD. The effects of data from 39 trials published in the period 1989-2012 were as follows: Double DMARD: -0.32 SMD (CI: -0.42, -0.22; triple DMARD: -0.46 SMD (CI: -0.60, -0.31; 1 DMARD plus TNFi: -0.30 SMD (CI: -0.36, -0.25; 1 DMARD plus abatacept: -0.20 SMD (CI: -0.33, -0.07; 1 DMARD plus tocilizumab: -0.34 SMD (CI: -0.48, -0.20; 1 DMARD plus CD20i: -0.32 SMD (CI: -0.40, -0.24. The indirect comparisons showed similar effects between combination treatments apart from triple DMARD being significantly better than abatacept plus methotrexate (-0.26 SMD (CI: -0.45, -0.07 and TNFi plus methotrexate (-0.16 SMD (CI: -0.31, -0.01. CONCLUSION: Combination treatment of a biologic agent with 1 DMARD is not superior to 2-3 DMARDs including or excluding LDGC in preventing

  2. Ozone oxidative postconditioning ameliorates joint damage and decreases pro-inflammatory cytokine levels and oxidative stress in PG/PS-induced arthritis in rats.

    Science.gov (United States)

    Vaillant, Jaqueline Dranguet; Fraga, Angela; Díaz, María Teresa; Mallok, A; Viebahn-Hänsler, Renate; Fahmy, Ziad; Barberá, Ariana; Delgado, Liván; Menéndez, Silvia; Fernández, Olga Sonia León

    2013-08-15

    Rheumatoid Arthritis (RA) is the most prevalent chronic condition present in ~1% of the adult population. Many pro-inflammatory mediators are increased in RA, including Reactive Oxygen Species such as nitric oxide NO, pro-inflammatory cytokines as tumor necrosis factor alpha (TNF-α), interleukin-1beta (IL-1β) and other molecules. Ozone oxidative postconditioning has regulatory effects on some pathological targets associated with RA. Thus, the aim of this study was to investigate the efficacy of ozone therapy in PG/PS-induced arthritis in rats in point of joints inflammation and morphology. Moreover, cytokines, nitric oxide and oxidative stress levels in spleen homogenates were evaluated. Ozone treatment ameliorated joint damage, reduced TNF-α concentrations as well as TNF-α and IL-1β mRNA levels. Besides, cellular redox balance, nitric oxide and fructolysine levels were reestablished after ozone oxidative postconditioning. It was concluded that pleiotropic ozone's effects clarify its therapeutic efficacy in RA. Decreasing inflammation and joint injury, reduction of pro-inflammatory cytokines, TNF-α and IL-1β transcripts and re-establishment of cellular redox balance after ozone treatment were demonstrated.

  3. Evaluation of MR imaging guided steroid injection of the sacroiliac joints for the treatment of children with refractory enthesitis-related arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Fritz, J. [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Eberhard-Karls-University Tuebingen, Department of Diagnostic Radiology, Tuebingen (Germany); Tzaribachev, N. [Eberhard-Karls-University Tuebingen, Department of Hematology, Oncology and General Pediatrics, University Children' s Hospital, Tuebingen (Germany); Klinikum Bad Bramstedt, Department of Pediatric Rheumatology, Bad Bramstedt (Germany); Thomas, C.; Claussen, C.D. [Eberhard-Karls-University Tuebingen, Department of Diagnostic Radiology, Tuebingen (Germany); Carrino, J.A.; Lewin, J.S. [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Pereira, P.L. [Eberhard-Karls-University Tuebingen, Department of Diagnostic Radiology, Tuebingen (Germany); SLK-Kliniken Heilbronn, Department of Radiology, Minimally Invasive Therapies and Nuclearmedicine, Heilbronn (Germany)

    2011-05-15

    To test the hypothesis that MR imaging guided triamcinolone acetonide injection into the sacroiliac joints of children with enthesitis-related arthritis is feasible, accurate and safe; and effectively reduces sacroiliac inflammation and disease progression. A retrospective analysis of 14 children (6/14 [43%] female, 8/14 (57%) male; mean age, 13.2 years; range, 6-16 years) who received MR imaging guided sacroiliac joint injections at 0.2 Tesla or 1.5 Tesla for enthesitis-related arthritis and acute sacroilitis refractory to medical therapy was performed. 20 mg triamcinolone acetonide were injected. Assessed were intra-articular drug delivery; image quality, duration, and complications. Success of therapy was defined by change of sacroiliac inflammation. Remission time and erosions were assessed by follow-up MRI (range, 10-22 months). Twenty four procedures resulted in intra-articular injection. Image quality was sufficient. No complications occurred. Procedure time was 40 min. Sedation time was 22 min. Success of therapy was achieved in 11/14 (79%) children. Sacroiliac inflammation decreased significantly (-59%). Median remission time was 13.7 months. No erosions occurred. MR imaging guided steroid injection of the sacroiliac joints is feasible, accurate, and safe and can effectively reduce sacroiliac inflammatory activity and may therefore aid in the prevention of disease progression. (orig.)

  4. Salvage of a post-traumatic arthritic wrist using the scaphoid as an osteochondral graft.

    Science.gov (United States)

    Marcuzzi, A; Ozben, H; Russomando, A

    2014-09-01

    The authors describe a case of post-traumatic wrist arthritis with an osteochondral defect in the scaphoid fossa of the radius. The patient was treated with proximal row carpectomy, radial styloidectomy and reconstruction of the defect using the proximal half of the scaphoid as an autologous osteochondral graft. Pain relief was achieved while wrist motion and strength were improved. The carpal bones are a source of osteochondral grafts and can be used to expand the indications of motion-preserving wrist salvage procedures.

  5. Rheumatoid arthritis.

    Science.gov (United States)

    Smolen, Josef S; Aletaha, Daniel; McInnes, Iain B

    2016-10-22

    Rheumatoid arthritis is a chronic inflammatory joint disease, which can cause cartilage and bone damage as well as disability. Early diagnosis is key to optimal therapeutic success, particularly in patients with well-characterised risk factors for poor outcomes such as high disease activity, presence of autoantibodies, and early joint damage. Treatment algorithms involve measuring disease activity with composite indices, applying a treatment-to-target strategy, and use of conventional, biological, and newz non-biological disease-modifying antirheumatic drugs. After the treatment target of stringent remission (or at least low disease activity) is maintained, dose reduction should be attempted. Although the prospects for most patients are now favourable, many still do not respond to current therapies. Accordingly, new therapies are urgently required. In this Seminar, we describe current insights into genetics and aetiology, pathophysiology, epidemiology, assessment, therapeutic agents, and treatment strategies together with unmet needs of patients with rheumatoid arthritis.

  6. Arthritis - resources

    Science.gov (United States)

    Resources - arthritis ... The following organizations provide more information on arthritis : American Academy of Orthopaedic Surgeons -- orthoinfo.aaos.org/menus/arthritis.cfm Arthritis Foundation -- www.arthritis.org Centers for Disease Control and Prevention -- www. ...

  7. Animation of Phoenix's Wrist Unlatching

    Science.gov (United States)

    2008-01-01

    This animation shows what happened underneath Phoenix's Robotic Arm wrist on Sol 3. The pin that goes through the loop is what holds the wrist in place. The rotation of the wrist pops the pin free. The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.

  8. Comparative characterization of the data of magnetic resonance imaging, X-ray and clinical studies of the hand and foot joints in patients with early psoriatic arthritis

    Directory of Open Access Journals (Sweden)

    Svetlana Olegovna Krasnenko

    2013-01-01

    Full Text Available The clinical manifestations of psoriatic arthritis (PsA at its early stage may be inadequately informative. In this connection, radiological techniques, such as magnetic resonance imaging (MRI and X-ray study of peripheral joints, in addition to clinical examination are of paramount importance in the diagnosis of early PsA. Objective: To compare the data of clinical examination and various imaging methods (MRI and X-ray of the hand and foot joints in early peripheral PsA. Subjects and methods. The trial included 45 patients (14 men and 31 women; mean age 42.08±13.7 years; median PsA duration 1 year [range 0.55 to 2] with early peripheral PsA without previous therapy with disease-modifying antirheumatic drugs (DMARDs, who met the CASPAR criteria (2006. A standard clinical examination was performed and the activity of peripheral arthritis and the presence of enthesitis and dactylitis were determined in the patients. Not later than 2 days after the clinical examination, a standard X-ray examination of the hands and feet in the direct projection and MRI of the same areas were made. Results. When included into the study, the entire group of patients was found to have a moderate PsA by DAS; its median was 3.12 [2.21 to 3.89]. Cutaneous PsA was noted in 40 patients; 5 persons had a family history of PsA; one female patient had ungual PsA only. In the study group, the clinical signs of enthesitis in the tendon attachments at different sites were revealed in 33 (75.3% patients. Dactylitis was found in 34 (75% patients. The clinical examination showed inflammatory changes in the hand and foot joints in 36 (80% and 38 (84% patients, respectively; while MRT revealed them in 31 (69% and 32 (71% patients. Hand MRI displayed arthritis of the proximal interpha-langeal (PIP, metacarpophalangeal (MCP, and distal interphalangeal (DIP joints in 27 (87%, 21 (68%, and 12 (40% of the 31 patients, respectively. Foot MRI exhibited MCP, PIP, and DIP joint arthritis in

  9. Arthritis in Children

    Science.gov (United States)

    ... Asthma Autism Cancer Chest & Lungs Chronic Conditions Cleft & Craniofacial ... Content Article Body Arthritis is an inflammation of the joints that produces swelling, redness, heat, and pain. Although it is typically thought of as a ...

  10. A flexure-based wrist for needle-sized surgical robots

    Science.gov (United States)

    Losey, Dylan P.; York, Peter A.; Swaney, Philip J.; Burgner, Jessica; Webster, Robert J.

    2013-03-01

    We present a novel flexure-based wrist design intended for use with needle-sized robotic manipulators. It is designed to be mounted at the tip of a traditional surgical needle, deployed through an endoscope working channel, or attached to the tip of a concentric tube robot. In all these applications, the wrist enables dexterity in small spaces. The wrist consists of two stacked flexure joints that are actuated by thin pull wires. In this paper we present the design of the wrist, its kinematics, and an experimental evaluation of the relationship between actuation force and tip displacement conducted using a scale model.

  11. Detection of rheumatoid arthritis using infrared imaging

    Science.gov (United States)

    Frize, Monique; Adéa, Cynthia; Payeur, Pierre; Di Primio, Gina; Karsh, Jacob; Ogungbemile, Abiola

    2011-03-01

    Rheumatoid arthritis (RA) is an inflammatory disease causing pain, swelling, stiffness, and loss of function in joints; it is difficult to diagnose in early stages. An early diagnosis and treatment can delay the onset of severe disability. Infrared (IR) imaging offers a potential approach to detect changes in degree of inflammation. In 18 normal subjects and 13 patients diagnosed with Rheumatoid Arthritis (RA), thermal images were collected from joints of hands, wrists, palms, and knees. Regions of interest (ROIs) were manually selected from all subjects and all parts imaged. For each subject, values were calculated from the temperature measurements: Mode/Max, Median/Max, Min/Max, Variance, Max-Min, (Mode-Mean), and Mean/Min. The data sets did not have a normal distribution, therefore non parametric tests (Kruskal-Wallis and Ranksum) were applied to assess if the data from the control group and the patient group were significantly different. Results indicate that: (i) thermal images can be detected on patients with the disease; (ii) the best joints to image are the metacarpophalangeal joints of the 2nd and 3rd fingers and the knees; the difference between the two groups was significant at the 0.05 level; (iii) the best calculations to differentiate between normal subjects and patients with RA are the Mode/Max, Variance, and Max-Min. We concluded that it is possible to reliably detect RA in patients using IR imaging. Future work will include a prospective study of normal subjects and patients that will compare IR results with Magnetic Resonance (MR) analysis.

  12. Adhesive capsulitis of the wrist. Diagnosis and treatment.

    Science.gov (United States)

    Hanson, E C; Wood, V E; Thiel, A E; Maloney, M D; Sauser, D D

    1988-09-01

    Adhesive capsulitis occurs as a pathologic entity in the shoulder, hip, and ankle joints. Thickening and contracture of the wrist joint capsule were demonstrated on arthrograms performed on ten patients ranging in age from 20 to 82 years. The patients had pain and limited range of motion in the wrist. The findings included: (1) resistance to the injection of smaller than normal volumes of contrast material, (2) obliteration of recesses, and (3) extravasation of the contrast agent along the needle tract. Closed manipulation under general anesthesia of the wrist on four patients resulted in some improvement in range of motion. A distal ulna fracture in one older patient occurred as a complication of manipulation. Careful technique and judicious patient selection are of paramount importance.

  13. Kinematic synthesis of bevel-gear-type robotic wrist mechanisms

    Science.gov (United States)

    Lin, Chen-Chou

    Bevel-gear-type robotic wrist mechanisms are commonly used in industry. The reasons for their popularity are that they are compact, light-weight, and relatively inexpensive. However, there are singularities in their workspace, which substantially degrade their manipulative performance. The objective of this research is to develop an atlas of three-degree-of-freedom bevel-gear-type wrist mechanisms, and through dimensional synthesis to improve their kinematic performance. The dissertation contains two major parts: the first is structural analysis and synthesis, the other is kinematic analysis and dimensional synthesis. To synthesize the kinematic structures of bevel-gear-type wrist mechanisms, the kinematic structures are separated from their functional considerations. All kinematic structures which satisfy the mobility condition are enumerated in an unbiased, systematic manner. Then the bevel-gear-type wrist mechanisms are identified by applying the functional requirements. Structural analysis shows that a three-degree-of-freedom wrist mechanism usually consists of non-fractionated, two degree-of-freedom epicyclic gear train jointed with the base link. Therefore, the structural synthesis can be simplified into a problem of examining the atlas of non-fractionated, two-degree-of-freedom epicyclic gear trains. The resulting bevel-gear-type wrist mechanism has been categorized and evaluated. It is shown that three-degree-of-freedom, four-jointed wrist mechanisms are promising for further improving the kinematic performance. It is found that a spherical planetary gear train is necessarily imbedded in a three-degree-of-freedom, four-jointed wrist mechanism. Therefore, to study the workspace and singularity problems of three-degree-of-freedom four-jointed spherical wrist mechanisms, we have to study the trajectories of spherical planetary gear trains. The parametric equations of the trajectories and some useful geometric properties for the analysis and synthesis of

  14. Robot-aided assessment of wrist proprioception

    Directory of Open Access Journals (Sweden)

    Leonardo eCappello

    2015-04-01

    Full Text Available Introduction. Impaired proprioception severely affects the control of gross and fine motor function. However, clinical assessment of proprioceptive deficits and its impact on motor function has been difficult to elucidate. Recent advances in haptic robotic interfaces designed for sensorimotor rehabilitation enabled the use of such devices for the assessment of proprioceptive function.Purpose. This study evaluated the feasibility of a wrist robot system to determine proprioceptive discrimination thresholds for two different DoFs of the wrist. Specifically, we sought to accomplish three aims: first, to establish data validity; second, to show that the system is sensitive to detect small differences in acuity; third, to establish test-retest reliability over repeated testing.Methodology. Eleven healthy adult subjects experienced two passive wrist movements and had to verbally indicate which movement had the larger amplitude. Based on a subject’s response data a psychometric function was fitted and the wrist acuity threshold was established at the 75% correct response level. A subset of five subjects repeated the experimentation three times (T1, T2 and T3 to determine the test-retest reliability.Results. Mean threshold for wrist flexion was 2.15°± 0.43° and 1.52°± 0.36° for abduction. Encoder resolutions were 0.0075° (flexion-extension and 0.0032° (abduction-adduction. Motor resolutions were 0.2° (flexion-extension and 0.3° (abduction-adduction. Reliability coefficients were rT2-T1=0.986 and rT3-T2=0.971.Conclusions. We currently lack established norm data on the proprioceptive acuity of the wrist to establish direct validity. However, the magnitude of our reported thresholds are physiological plausible and well in line with available threshold data obtained at the elbow joint. Moreover, system has high resolution and is sensitive enough to detect small differences in acuity. Finally, the system produces reliable data over repeated

  15. Clinical management of septic arthritis.

    Science.gov (United States)

    Sharff, Katie A; Richards, Eric P; Townes, John M

    2013-06-01

    Septic arthritis is a rheumatologic emergency as joint destruction occurs rapidly and can lead to significant morbidity and mortality. Accurate diagnosis can be particularly challenging in patients with underlying inflammatory joint disease. This review outlines the risk factors for septic arthritis and summarizes the causative bacterial organisms. We highlight advances in antibiotic management with a focus on new drugs for methicillin-resistant Staphylococcus aureus (MRSA) and discuss the use of adjunctive therapies for treatment of septic arthritis in adults.

  16. CB1 and CB2 contribute to antinociceptive and anti-inflammatory effects of electroacupuncture on experimental arthritis of the rat temporomandibular joint.

    Science.gov (United States)

    Gondim, Delane Viana; Araújo, Joana Cláudia Bezerra; Cavalcante, André Luiz Cunha; Havt, Alexandre; Quetz, Josiane da Siva; Brito, Gerly Anne de Castro; Ribeiro, Ronaldo de Albuquerque; Lima Vale, Mariana

    2012-11-01

    Electroacupuncture (EA) and cannabinoids have been reported to have anti-inflammatory and antinociceptive effects in animal models of arthritis. Male Wistar rats were injected with saline or zymosan (2 mg) into the temporomandibular joint (TMJ). EA (10 Hz, 30 min) was performed 2 h after or 1 h before zymosan administration. AM251 or AM630 (3 mg/kg, i.p.)were administered before EA treatment. Mechanical hypernociception was accessed after zymosan administration. Rats were sacrificed 6 h after zymosan administration and the joint was removed for histopathological analysis. The gene expression of CB₁ and CB₂ receptors was assessed after sacrifice of the TMJ arthritic animals. EA inhibited zymosan-induced hypernociception (p < 0.05). AM251 reversed significantly the antinociceptive effect of EA, suggesting that the CB₁ receptor is involved in this effect. AM630 reversed the anti-inflammatory effect of EA. CB₁ and CB₂ receptor gene expression was upregulated 6 h after zymosan-induced arthritis in the EA-treated group. We observed downregulation of CB₂ receptor gene expression in the EA group at the 24th hour compared with the 6th hour. Higher CB₁ receptor gene expression was also found compared with the 6th hour. EA produced antinociceptive and anti-inflammatory effects, and these effects appeared to be mediated through CB₁ and CB₂ receptor activation.

  17. In vivo Estimation of Human Forearm and Wrist Dynamic Properties.

    Science.gov (United States)

    Park, Kyungbin; Chang, Pyung-Hun; Kang, Sang

    2016-05-27

    It is important to estimate the 3 degree-of-freedom (DOF) impedance of human forearm and wrist (i.e., forearm prono-supination, and wrist flexion-extension and radial-ulnar deviation) in motor control and in the diagnosis of altered mechanical resistance following stroke. There is, however, a lack of methods to characterize 3 DOF impedance. Thus, we developed a reliable and accurate impedance estimation method, the distal internal model based impedance control (dIMBIC)-based method, to characterize the 3 DOF impedance, including cross-coupled terms between DOFs, for the first time. Its accuracy and reliability were experimentally validated using a robot with substantial nonlinear joint friction. The 3 DOF human forearm and wrist impedance of 8 healthy subjects was reliably characterized, and its linear behavior was verified. Thus, the dIMBIC-based method can provide us with 3 DOF forearm and wrist impedance regardless of nonlinear robot joint friction. It is expected that, with the proposed method, the 3 DOF impedance estimation can promote motor control studies and complement the diagnosis of altered wrist and forearm resistance post stroke by providing objective impedance estimates, including cross-coupled terms.

  18. Evaluating automated dynamic contrast enhanced wrist 3 T MRI in healthy volunteers: One-year longitudinal observational study

    Energy Technology Data Exchange (ETDEWEB)

    Rastogi, Anshul, E-mail: anshul.rastogi@bartshealth.nhs.uk [Kennedy Institute of Rheumatology, Imperial College London (United Kingdom); Kubassova, Olga, E-mail: olga@imageanalysis.org.uk [Image Analysis, Leeds (United Kingdom); Krasnosselskaia, Lada V., E-mail: solaguz@yahoo.com [Imaging Sciences Department, Imperial College London (United Kingdom); Lim, Adrian K.P., E-mail: a.lim@imperial.ac.uk [Department of Radiology, Imperial College Healthcare NHS Trust, London (United Kingdom); Satchithananda, Keshthra, E-mail: keshthra.satchithananda@imperial.nhs.uk [Department of Radiology, Imperial College Healthcare NHS Trust, London (United Kingdom); Boesen, Mikael, E-mail: mikael.boesen@gmail.com [Department of Radiology and the Parker Institute, Frederiksberg and Bispebjerg Hospitals (Denmark); Binks, Michael, E-mail: michael.h.binks@gsk.com [GlaxoSmithKline, Stevenage, SG1 2NY (United Kingdom); Hajnal, Joseph V., E-mail: jo.hajnal@kcl.ac.uk [Imaging Sciences Department, Imperial College London (United Kingdom); Taylor, Peter C., E-mail: peter.taylor@kennedy.ox.ac.uk [Kennedy Institute of Rheumatology, Imperial College London (United Kingdom)

    2013-08-15

    Rational and Objective: Dynamic contrast enhanced (DCE)-MRI has great potential to provide quantitative measure of inflammatory activity in rheumatoid arthritis. There is no current benchmark to establish the stability of signal in the joints of healthy subjects when imaged with DCE-MRI longitudinally, which is crucial so as to differentiate changes induced by treatment from the inherent variability of perfusion measures. The objective of this study was to test a pixel-by-pixel parametric map based approach for analysis of DCE-MRI (Dynamika) and to investigate the variability in signal characteristics over time in healthy controls using longitudinally acquired images. Materials and Methods: 10 healthy volunteers enrolled, dominant wrists were imaged with contrast enhanced 3T MRI at baseline, week 12, 24 and 52 and scored with RAMRIS, DCE-MRI was analysed using a novel quantification parametric map based approach. Radiographs were obtained at baseline and week 52 and scored using modified Sharp van der Heidje method. RAMRIS scores and dynamic MRI measures were correlated. Results: No erosions were seen on radiographs, whereas MRI showed erosion-like changes, low grade bone marrow oedema and low-moderate synovial enhancement. The DCE-MRI parameters were stable (baseline scores, variability) (mean ± st.dev); in whole wrist analysis, ME{sub mean} (1.3 ± 0.07, −0.08 ± 0.1 at week 24) and IRE{sub mean} (0.008 ± 0.004, −0.002 ± 0.005 at week 12 and 24). In the rough wrist ROI, ME{sub mean} (1.2 ± 0.07, 0.04 ± 0.02 at week 52) and IRE{sub mean} (0.001 ± 0.0008, 0.0006 ± 0.0009 at week 52) and precise wrist ROI, ME{sub mean} (1.2 ± 0.09, 0.04 ± 0.04 at week 52) and IRE{sub mean} (0.001 ± 0.0008, 0.0008 ± 0.001 at week 24 and 52). The Dynamic parameters obtained using fully automated analysis demonstrated strong, statistically significant correlations with RAMRIS synovitis scores. Conclusion: The study demonstrated that contrast enhancement does occur in

  19. Epidemiology of acute wrist trauma

    DEFF Research Database (Denmark)

    Larsen, C F; Lauritsen, Jens

    1993-01-01

    Epidemiological data on wrist injuries in a population can be used for planning by applying them to criteria for care and thus deriving estimates of provisions for care according to currently desirable standards. In a 1-year study all patients > or = 15 years with acute wrist trauma and treated...... in the emergency room were examined according to an algorithm until a diagnosis was established. The overall incidence of wrist trauma was 69 per 10,000 inhabitants per year. Incidence of wrist trauma requiring x-ray examination was 58 per 10,000 per year. The incidence of distal radius fractures was 27 per 10...... using data from a population-based study. A completeness rate of 0.56 (95% confidence interval: 0.31-0.78) was found. An x-ray had been taken for all patients reporting a fracture thus justifying the use of fractures as an incidence measure when comparing groups of patients with wrist trauma....

  20. The arthritic wrist. II--the degenerative wrist: indications for different surgical treatments.

    Science.gov (United States)

    Laulan, J; Bacle, G; de Bodman, C; Najihi, N; Richou, J; Simon, E; Saint-Cast, Y; Obert, L; Saraux, A; Bellemère, P; Dréano, T; Le Bourg, M; Le Nen, D

    2011-06-01

    For the patient (and the surgeon) the ideal wrist is one that has good mobility, however very often the optimal surgical treatment is one that provides effective pain relief. The patient must be informed of the potential complications and limitations of each procedure. The patient's psychological profile and functional requirements will determine how well he/she adapts to the changes. Also, each surgeon has beliefs and personal experiences that influence the treatment decision and final result. Proximal row carpectomy (PRC) and the Watson procedure are two reference operations for osteoarthritis secondary to scapholunate instability and scaphoid non-union (SLAC and SNAC). Beyond the early complications and drawbacks specific to each, they provide good results that are maintained over time. PRC, which can be performed up to Stage II, is mainly indicated in patients with moderate functional demands, while the Watson procedure is more often done on a patient who performs manual labour, as long as the radiolunate joint space is maintained. Complete denervation is effective in three out of four cases and preserves the remaining mobility. Because of its low morbidity, the procedure can be suggested in patients with a mobile wrist and low functional demands or in older patients, independent of their wrist mobility. Total wrist fusion is not only a rescue procedure. For a young patient who performs heavy manual labour with extensive osteoarthritis and progressive forms of Kienböck's disease, this procedure provides the greatest chance of returning to work and not being socially outcast. The role of osteochondral autografts, implants and wrist prostheses in the treatment arsenal need to be better defined.

  1. MP Joint Arthritis

    Science.gov (United States)

    ... Gardening Safety Turkey Carving Removing a Ring Español Artritis de la base del pulgar Dedo en gatillo ... Gardening Safety Turkey Carving Removing a Ring Español Artritis de la base del pulgar Dedo en gatillo ...

  2. Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection -- Does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS?

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Ostergaard, Mikkel; Conaghan, Philip G;

    2009-01-01

    OBJECTIVE: Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) provides highly sensitive assessment of inflammatory and destructive changes in rheumatoid arthritis (RA) joints, but intravenous (IV) Gd injection prolongs examination time and increases cost, invasiveness, and patient discomfo......: Omitting IV contrast injection did not change scores of bone erosions and bone edema, but decreased the reliability of synovitis scores. However, this disadvantage may for some purposes be outweighed by the possibility to assess more joints and/or greater feasibility....

  3. Septic arthritis caused by Mycobacterium fortuitum and Mycobacterium abscessus in a prosthetic knee joint: case report and review of literature.

    Science.gov (United States)

    Wang, Shu-Xiang; Yang, Chang-Jen; Chen, Yu-Chuan; Lay, Chorng-Jang; Tsai, Chen-Chi

    2011-01-01

    Nontuberculous mycobacterium (NTM) is an infrequent cause of prosthetic knee joint infections. Simultaneous infection with different NTM species in a prosthetic knee joint has not been previously reported. A case of prosthetic knee joint infection caused by Mycobacterium abscessus and M. fortuitum is described in this report. The patient was successfully treated with adequate antibiotics and surgery. The clinical features of sixteen previously reported cases of prosthetic knee joint infection caused by NTM are reviewed.

  4. The Reliability of Disease Activity Score in 28 Joints-C-Reactive Protein Might Be Overestimated in a Subgroup of Rheumatoid Arthritis Patients, When the Score Is Solely Based on Subjective Parameters

    DEFF Research Database (Denmark)

    Jensen Hansen, Inger Marie; Asmussen Andreasen, Rikke; Van Bui Hansen, Mark Nam;

    2016-01-01

    BACKGROUND: Disease Activity Score in 28 Joints (DAS28) is a scoring system to evaluate disease activity and treatment response in rheumatoid arthritis (RA). A DAS28 score of greater than 3.2 is a well-described limit for treatment intensification; however, the reliability of DAS28 might be overe...

  5. Genetic variants in IL15 associate with progression of joint destruction in rheumatoid arthritis : a multicohort study

    NARCIS (Netherlands)

    Knevel, R.; Krabben, A.; Brouwer, E.; Posthumus, M. D.; Wilson, A. G.; Lindqvist, E.; Saxne, T.; de Rooy, D.; Daha, N.; van der Linden, M. P. M.; Stoeken, G.; van Toorn, L.; Koeleman, B.; Tsonaka, R.; Zhernakoza, A.; Houwing-Duistermaat, J. J.; Toes, R.; Huizinga, T. W. J.; van der Helm-van Mil, A.

    2012-01-01

    Background Interleukin (IL)-15 levels are increased in serum, synovium and bone marrow of patients with rheumatoid arthritis (RA). IL-15 influences both the innate and the adaptive immune response; its major role is activation and proliferation of T cells. There are also emerging data that IL-15 aff

  6. [Shortening arthrodesis of three wrist bones].

    Science.gov (United States)

    Delattre, O; Dupont, P; Reau, A F; Rouvillain, J L; Mousselard, H; Catonné, Y

    1997-01-01

    In advanced cases of wrist osteoarthritis with lesions of the radio-scaphoid and mediocarpal joints, and when a proximal row carpectomy is not possible because of lesions of the head of the capitate, we suggest a new technique: The hamate-capitate-lunate shortening arthrodesis with a scaphoid-triquetral resection. The good results observed with proximal row carpectomies, and particularly their long-term reliability, have encouraged us on this new path. Effectively, this operation takes the concept of proximal row carpectomy one step further by reconstructing the head of the capitate with the lunate whose proximal articular surface is often not deteriorated even in very advanced cases of radio and mediocarpal osteoarthritis. The two theoretical concepts of this operation are the shortening of the carpus and respect of the physiological congruence of the radio-lunate joint, the goal being obtain similar results those with proximal row carpectomy, particularly concerning mobility. We present our first two cases with this technique. This new procedure is an alternative to the four bone arthrodesis, particularly in SLAC wrist sequellae when they have evolved to the stage of radio and mediocarpal osteoarthritis.

  7. AN ASSOCIATION OF CYTOKINE LEVELS WITH DISEASE ACTIVITY, AUTOANTIBODY LEVELS, AND JOINT DESTRUCTIVE CHANGES IN EARLY RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    A. S. Avdeeva

    2015-01-01

    Full Text Available Objective: to assess the association of cytokine profile measures with disease activity, autoantibody levels, and joint destructive changes in patients with early rheumatoid arthritis (RA.Subjects and methods. Forty-five patients, including 35 women, with early RA were examined. Their median age was 53.5 [46; 59.5] years; the duration of the disease – 7.0 [4.0; 11.5] months; DAS28 – 5.8 [4.9; 6.4]; 91 and 96% of the patents were positive for rheumatoid factor (RF and anticyclic citrullinated peptide antibodies, respectively. Serum cytokine concentrations were estimated using the xMAP multiplex technology. The modified Sharp method was employed to quantify radiographic changes.Results and discussion. A group of 30 patients with high disease activity (DAS28 >5.1 had higher levels of interleukin (IL-6 (62.3 [36.1; 127.5] pg/ml and IP-10 (6367.8 [3682.7; 10691.3] pg/ml than 15 patients with moderate/low disease activity (DAS28 ≤5.1 (35.8 [13.4; 64.2] and 3222.6 [1881.0; 5671.9] pg/ml, respectively, p < 0.05. The patients highly positive for IgM RF had higher levels (pg/ml of proinflammatory cytokines, such as IL-1β, IL-2, IL-6, IL-12, IL-15, interferon-γ, and tumor necrosis factor-α; the chemokine monocyte chemotactic protein-1 and the growth factors IL-7 and vascular endothelial growth factor (4.8 [2.8; 19.3], 23.0 [7.1; 55.8], 64.2 [41.6; 170.5], 52.2 [30.9; 126.9], 2.4 [0.2; 11.2], 210.8 [119.9; 584.2], 90.7 [42.7; 307/9], 57.5 [26.1; 93.8], 54.9 [37.1; 123.7], and 143.3 [70.6; 249.6] pg/ml than those who were negative/lowly positive for IgM RF (2.3 [1.9; 3.1], 4.9 [2.9; 16.8], 24.9 [20.4; 45.4], 25.6 [19.9; 57.1], 0.2 [0.01; 1.65], 94.4 [86.3; 138.9], 37.3 [23.6; 47.7], 20.9 [12.3; 33.9], 32.6 [28.1; 37.8], 74.2 [53.5; 147.6], respectively (p < 0.05.Conclusion. There are significant differences in cytokine profile measures in patients with early RA in relation to disease activity and serum autoantibody levels.

  8. “Remotion” Total Wrist Arthroplasty: Preliminary Results of a Prospective International Multicenter Study of 215 Cases

    DEFF Research Database (Denmark)

    Herzberg, Guillaume; Boeckstyns, Michel Ernest Henri; Sorensen, Allan Ibsen;

    2012-01-01

    preoperative and postoperative reports of "ReMotion" TWA at regular intervals. The cases of 7 centers with more than 15 inclusions were considered for this article. A total of 215 wrists were included. In the rheumatoid arthritis (RA; 129 wrists) and nonrheumatoid arthritis (non-RA; 86 wrists) groups......This study reports the current results of an international multicenter study of one last generation total wrist arthroplasty (TWA) ("ReMotion," Small Bone Innovation, Morristown, PA). The two first authors (G.H. and M.B.) built a Web-based prospective database including clinical and radiological...... with the previous generation TWA. The level of evidence for this study is IV....

  9. Kinesio Taping® of the metacarpophalangeal joints and its effect on pain and hand function in individuals with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Sarah Roberts

    2016-02-01

    Full Text Available Background: In persons suffering from rheumatoid arthritis (RA, the metacarpophalangeal (MCP joints are commonly affected, resulting in inflammation, pain, joint instability, diminished grip strength and difficulties with function. However, the effectiveness of Kinesio Taping® of the MCP joints in alleviating the symptoms has not been established.Aim: To determine the effectiveness of bilateral Kinesio Taping® of the MCP joints on pain, range of motion, grip strength and hand function in elderly individuals previously diagnosed with RA.Methods: A repeated measure, experimental design was used over a 7-week period with the Kinesio Taping group (n = 30 receiving bilateral space correction Kinesio Taping® of the MCP joints with a joint protection (JP group (n = 31 participating in JP workshops. The Kinesio Tape® was worn for 3 days a week with four applications during the data collection process. For the control group, 2-hour JP educational–behavioural workshops were run weekly for 4 weeks. Weekly assessments were completed for grip strength, ulnar deviation and pain (VAS, and two pre-intervention assessments and one post-intervention assessment was completed for the Michigan Hands Outcomes Questionnaire (MHQ.Results: Kinesio Taping® of the MCP joints showed a significant decrease in pain (p = 0.001 and improved range of motion (p = 0.001 bilaterally. JP was found to have a significant improvement in grip strength (p = 0.001 bilaterally and in the work (p = 0.01 and activities of daily living (ADL (p = 0.01 sections of the MHQ. No significant difference was found between groups after intervention in the majority of outcomes (p = 0.24 except for grip strength where a significant difference was found.Conclusion: Kinesio Taping® of the MCP joints is an effective conservative intervention to improve pain and MCP ulnar deviation in individuals with RA.Significance of the work: Kinesio Taping® of the MCP joints of individuals with RA showed a

  10. The effects of electromechanical wrist robot assistive system with neuromuscular electrical stimulation for stroke rehabilitation.

    Science.gov (United States)

    Hu, X L; Tong, K Y; Li, R; Xue, J J; Ho, S K; Chen, P

    2012-06-01

    An electromyography (EMG)-driven electromechanical robot system integrated with neuromuscular electrical stimulation (NMES) was developed for wrist training after stroke. The performance of the system in assisting wrist flexion/extension tracking was evaluated on five chronic stroke subjects, when the system provided five different schemes with or without NMES and robot assistance. The tracking performances were measured by range of motion (ROM) of the wrist and root mean squared error (RMSE). The performance is better when both NMES and robot assisted in the tracking than those with either NMES or robot only (Pmotor functions in the hand, wrist and elbow functions after the training, as indicated by the clinical scores of Fugl-Meyer Assessment, Action Research Arm Test, Wolf Motor Function Test; and also showed reduced spasticity in the wrist and the elbow as measured by the Modified Ashworth Score of each subject. After the training, the co-contractions were reduced between the flexor carpi radialis and extensor carpi radialis, and between the biceps brachii and triceps brachii. Assistance from the robot helped improve the movement accuracy; and the NMES helped increase the muscle activation for the wrist joint and suppress the excessive muscular activities from the elbow joint. The NMES-robot assisted wrist training could improve the hand, wrist, and elbow functions.

  11. Effect of Bizhongxiao decoction and its dismantled formulae on IL-1 and TNF levels in collagen-induced arthritis in rat synovial joints

    Directory of Open Access Journals (Sweden)

    Guo Ya-jing

    2012-11-01

    Full Text Available Abstract Background Rheumatoid arthritis (RA, a chronic autoimmune disease, affects sufferers in many different ways. Treatment of this chronic condition is particularly challenging. Traditional Chinese Medicine (TCM provides alternatives. Bizhongxiao decoction (BZX is a TCM complex, which has been used clinically for many years to treat RA. The purpose of this study is to compare the effects of BZX decoction and its dismantled formulae on IL-1 and TNF-1 levels in rats with RA, and to elucidate its mechanism of action. Methods Ninety healthy normal female SD rats were randomly divided into six groups: normal (control, model, BZX decoction, and the three dismantled formulae (I: heat-clearing and detoxication, II: dissipating dampness, and III: blood circulation promotion. Apart from the normal (control group, the rats in each group were injected subcutaneously with bovine type II collagen and complete Freund adjuvant to establish a collagen-induced arthritis model, so that inhibition of foot swelling in the rats by BZX decoction and its dismantled formulae could be observed. Immunohistochemistry was used to assess the levels of the inflammatory cytokines IL-1 and TNF in synovial joints at various time points. Results Twenty-one days after the model was established, the levels of TNF and IL-1 were significantly higher in the model group, BZX decoction group and dismantled formula groups I, II and III than in the normal controls (P  Conclusions BZX decoction and the three dismantled formulae examined down-regulated the inflammatory factors IL-1 and TNF in collagen-induced arthritis rat models, but BZX exerted the strongest effect.

  12. Wrist sprain - aftercare

    Science.gov (United States)

    ... a moderate injury and may require splinting or casting to stabilize the joint. Grade 3 -- Ligaments are ... anti-inflammatory medicine. Chronic sprains may need steroid injections and possibly surgery.

  13. Distal Radius Fracture (Broken Wrist)

    Science.gov (United States)

    .org Distal Radius Fracture (Broken Wrist) Page ( 1 ) The radius is the larger of the two bones of the forearm. The ... the distal end. A fracture of the distal radius occurs when the area of the radius near ...

  14. 膝关节骨性关节炎21例临床分析%An Analysis of 21 Cases for Knee Joint Bone Arthritis

    Institute of Scientific and Technical Information of China (English)

    肖文玖; 袁序

    2001-01-01

    采用关节腔内注射透明质酸钠治疗膝关节骨性关节炎患者21例,有效率86.7%,优良率65.3%,无效率12.4%。结果显示,用透明质酸钠注射液进行关节腔注射,是治疗膝关节骨性关节炎比较有效的方法。%The authors have treated 21 cases of knee joint bone arthritis byinjection.It has shown good cure results:Excellent,86.7%,good,65.3%,poor,12.4%.

  15. Ulnar Neuropathy at the Wrist

    OpenAIRE

    2009-01-01

    A case of ulnar nerve compression at the wrist within Guyon’s canal is reported. The clinical presentation initially appeared consistent with an ulnar nerve entrapment at the elbow. The true diagnosis of an ulnar sensorimotor nerve lesion occurring within the canal of Guyon was made electrophysiologically. Magnetic resonance imaging demonstrated compression of the nerve within the canal by a ganglionic cyst, which was confirmed by surgical intervention. Ulnar nerve entrapment at the wrist is ...

  16. X-ray characteristics of wrists in calcium pyrophosphate crystal deposition disease. Is pseudogout a major cause of scapholunate advanced collapse?

    Science.gov (United States)

    Taniguchi, Y; Yoshida, M; Tamaki, T

    1997-10-01

    Deposition of calcium pyrophosphate dihydrate (CPPD) crystals has been considered to be a cause of scapholunate advanced collapse (SLAC) wrist. The aim of this study was to look at X-ray changes in wrist joints affected by CPPD crystal deposition disease and to determine whether crystal deposition is a cause of SLAC wrist. A total of 150 wrists of 78 patients with CPPD crystal deposition disease were examined. In our population of Japanese patients with CPPD crystal deposition disease, the incidence of SLAC wrist was very low, and no case of Stage III SLAC wrist was found. We therefore conclude that SLAC wrist is not a radiographic characteristic of CPPD crystal deposition disease and that pyrophosphate crystal deposition cannot be a major cause of SLAC wrist.

  17. SEPTIC ARTHRITIS OF THE HIP IN ADULTS: A RARE PRESENTATION

    Directory of Open Access Journals (Sweden)

    Kuppa

    2015-01-01

    Full Text Available Septic Arthritis also known as infectious arthritis, can be bacterial or fungal arthritis. The condition is an inflammation of a joint that is caused by an infection. Typically, Septic Arthritis affects one large joint in the body such as knee or hip. Generally, Septic Arthritis is present with complete absorption of the head of the Femur in infants. A case was encountered in which the complete absorption of the femoral head was seen in adults also

  18. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Summary of OMERACT 6 MR Imaging Module

    DEFF Research Database (Denmark)

    McQueen, F; Lassere, M; Edmonds, J;

    2003-01-01

    Magnetic resonance image (MRI) scanning is a new method for imaging and quantifying joint inflammation and damage in rheumatoid arthritis (RA). Over the past 4 years, the OMERACT MR Imaging Group has been developing and testing the RA-MRI scoring system (RAMRIS) for use in RA. The OMERACT filter...... correlates closely with histological evidence and work continues on validating MR erosions with reference to radiographic techniques. The RAMRIS has demonstrated good reliability for bone erosion and synovitis at the wrists and metacarpophalangeal joints subject to reader training, with slightly lower levels...... of reader agreement for bone edema. Reliability was less satisfactory in discriminating between 2 time points, and further work is required if the score is to be used to monitor change. Feasibility also needs to be considered for the practical application of the score, including the time taken for scanning...

  19. Validity and reproducibility of self-administered joint counts. A prospective longitudinal followup study in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Prevoo, MLL; Kuper, IH; vantHof, MA; vanLeeuwen, MA; vandePutte, LBA; vanRiel, PLCM

    1996-01-01

    Objective. To investigate the reproducibility and validity of self-administered joint counts (JC), measuring tenderness, swelling and the combination of both, in a longitudinal study, Methods. At the outpatient department a form self-administered by patients (SAI-form), was used to measure joint inv

  20. New wrist bones of the Malagasy giant subfossil lemurs.

    Science.gov (United States)

    Hamrick, M W; Simons, E L; Jungers, W L

    2000-05-01

    Recently discovered wrist bones of the Malagasy subfossil lemurs Babakotia radofilai, Palaeopropithecus ingens, Mesopropithecus dolichobrachion, and Megaladapis madagascariensis shed new light on the postcranial morphologies and positional behaviors that characterized these extinct primates. Wrist bones of P. ingens resemble those of certain modern hominoids in having a relatively enlarged ulnar head and dorsally extended articular surface on the hamate, features related to a large range of rotation at the inferior radioulnar and midcarpal joints. The scaphoid of P. ingens is also similar to that of the extant tree sloth Choloepus in having an elongate, palmarly directed tubercle forming a deep radial margin of the carpal tunnel for the passage of large digital flexors. In contrast, wrist remains of Megaladapis edwardsi and M. madagascariensis exhibit traits observed in the hands of extant pronograde, arboreal primates; these include a dorsopalmarly expanded pisiform and well-developed "spiral" facet on the hamate. Moreover, Megaladapis spp. and Mesopropithecus dolichobrachion possess bony tubercles (e.g., scaphoid tubercle and hamate hamulus) forming the carpal tunnel that are relatively similar in length to those of modern pronograde lemurs. Babakotia and Mesopropithecus differ from Megaladapis in exhibiting features of the midcarpal joint related to frequent supination and radioulnar deviation of the hand characteristic of animals that use vertical and quadrumanous climbing in their foraging behaviors. Comparative analysis of subfossil lemur wrist morphology complements and expands upon prior inferences based on other regions of the postcranial skeleton, and suggests a considerable degree of locomotor and postural heterogeneity among these recently extinct primates.

  1. Clinical and Serological Findings in Juvenile Patients with Idiopathic Arthritis in Southwestern of Iran

    Directory of Open Access Journals (Sweden)

    Soheila Alyasin

    2014-10-01

    Full Text Available Introduction: The purpose of this study was to describe clinical features and serological findings of children with idiopathic arthritis in south-western Iran.Methods: This descriptive study included 60 patients with juvenile idiopathic arthritis who were referred to a pediatric rheumatology clinic at a university hospital during 6-month period. Initial manifestations, first laboratory tests and clinical course of patients were reviewed.Results: Sixty children (32 boys and 28 girls with idiopathic arthritis ranged in age from 1.5 to 16 years. The mean age at the first presentation was 4.92 years (SD= 3.68. Oligoarthritis was the most common subtype in 27 (45%, followed by systemic- onset in 17 (28.3% and polyarthritis in 16 (26.7% of patients. The most commonly involved joints were knee 53(88.3%, ankle 28(46.6% and wrist 27(45%. Uveitis was detected in two patients, and positivity for ANA titer was revealed in one patient. Conclusions: In this study, the pattern of most clinical features in different subtypes of juvenile idiopathic arthritis resembles to other studies. Positive ANA was less; however, the low numbers of Iranian patients with uveitis was noteworthy.

  2. [Septic arthritis and spondylitis].

    Science.gov (United States)

    Fujikawa, Yosuke

    2014-10-01

    Septic arthritis and spondylitis in elderly adult are uncommon disease. But symptoms and signs of septic arthritis and spondylitis are an important medical emergency, with high mortality and morbidity. Delayed or inadequate treatment can result in irreversible joint destruction and neurological condition. Early diagnoses as well as prompt and effective treatment are essential for avoiding severe outcomes. In spite of advances in diagnostic imaging techniques, the incidence of septic arthritis and spondylitis appears to have been increased. The aging of the population, the widespread use of immunosuppressant therapies, including systemic corticosteroids, cytokines and anticytokines, and growing resistance to conventional antibiotics seem to be the major cause.

  3. Management of osteoarthrosis of the thumb joints.

    Science.gov (United States)

    Berger, Aaron J; Meals, Roy A

    2015-04-01

    We present current concepts and evidence to optimize diagnosis and management of osteoarthritis in the thumb joints. Numerous options and controversies exist for surgical treatment of carpometacarpal joint arthritis. Fewer options exist for metacarpophalangeal joint arthritis. Surgical treatment for interphalangeal arthritis is mainly arthrodesis.

  4. Ultrasound colour Doppler is associated with synovial pathology in biopsies from hand joints in rheumatoid arthritis patients

    DEFF Research Database (Denmark)

    Andersen, Martin; Ellegaard, Karen; Hebsgaard, Josephine B;

    2014-01-01

    OBJECTIVES: Little is known regarding the association between ultrasound-determined pathological synovial blood flow and synovial pathology in rheumatoid arthritis (RA). We therefore examined the association between colour Doppler ultrasound imaging and synovitis assessed by histopathology......-3). Data were clustered within patients, thus a linear mixed model was applied for the statistical tests. Parsimony in the statistical models was achieved omitting covariates from the model in the case of what was judged no statistical significance (p>0.1). RESULTS: Doppler colour fraction showed...

  5. An introduction to the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Edmonds, J; McQueen, F;

    2005-01-01

    This article gives a short overview of the development and characteristics of the OMERACT rheumatoid arthritis MRI scoring system (RAMRIS), followed by an introduction to the use of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. With this atlas, MRIs of wrist and metacarpophala......This article gives a short overview of the development and characteristics of the OMERACT rheumatoid arthritis MRI scoring system (RAMRIS), followed by an introduction to the use of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. With this atlas, MRIs of wrist...

  6. Prosthetic Joint Infection due to Mycobacterium avium-intracellulare in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature

    Science.gov (United States)

    Schneider, Brenton; Alpern, Jonathan D.

    2017-01-01

    Nontuberculous mycobacteria (NTM) are a rare cause of prosthetic joint infections (PJI). However, the prevalence of NTM infections may be increasing with the rise of newer immunosuppressive medications such as biologics. In this case report, we describe a rare complication of immunosuppressive therapies and highlight the complexity of diagnosing and treating PJI due to NTM. The patient is a 79-year-old Caucasian male with a history of severe destructive rheumatoid arthritis on several immunosuppressive agents and right hip osteoarthritis s/p total hip arthroplasty 15 years previously with several complex revisions, presenting with several weeks of worsening right hip and abdominal pain. A right hip CT scan revealed periprosthetic fluid collections. Aspiration of three fluid pockets was AFB smear-positive and grew Mycobacterium avium-intracellulare. The patient was deemed a poor surgical candidate. He underwent a limited I&D and several months of antimycobacterial therapy but clinically deteriorated and opted for hospice care. PJI caused by NTM are rare and difficult to treat. The increased use of biologics and prosthetic joint replacements over the past several decades may increase the risk of PJI due to NTM. A high index of suspicion for NTM in immunosuppressed patients with PJI is needed.

  7. Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated?

    Energy Technology Data Exchange (ETDEWEB)

    Stomp, Wouter; Bloem, Johan L.; Reijnierse, Monique [Leiden University Medical Center, Department of Radiology, P.O. Box 9600, Leiden (Netherlands); Krabben, Annemarie; Heijde, Desiree van der; Huizinga, Tom W.J.; Helm-van Mil, Annette H.M. van der [Leiden University Medical Center, Department of Rheumatology, P.O. Box 9600, Leiden (Netherlands); Oestergaard, Mikkel [University of Copenhagen, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spinal Diseases, Glostrup Hospital, Glostrup (Denmark)

    2015-05-01

    To evaluate whether intravenous gadolinium (Gd) contrast administration can be eliminated when evaluating synovitis and tenosynovitis in early arthritis patients, thereby decreasing imaging time, cost, and invasiveness. Wrist MRIs of 93 early arthritis patients were evaluated by two readers for synovitis of the radioulnar, radiocarpal, and intercarpal joints, according to the Rheumatoid Arthritis MRI Scoring method (RAMRIS), and for tenosynovitis in ten compartments. Scores of MRI images without Gd contrast enhancement were compared to scores obtained when evaluating all, including contrast-enhanced, MRI images as reference. Subsequently, a literature review and pooled analysis of data from the present and two previous studies were performed. At the individual joint/tendon level, sensitivity to detect synovitis without Gd contrast was 91 % and 72 % for the two readers, respectively, with a specificity of 51 % and 81 %. For tenosynovitis, the sensitivity was 67 % and 54 %, respectively, with a specificity of 87 % and 91 %. Pooled data analysis revealed an overall sensitivity of 81 % and specificity of 50 % for evaluation of synovitis. Variations in tenosynovitis scoring systems hindered pooled analyses. Eliminating Gd contrast administration resulted in low specificity for synovitis and low sensitivity for tenosynovitis, indicating that Gd contrast administration remains essential for an optimal assessment. (orig.)

  8. USE OF TECHNOLOGIES OF PLASTIC AND RECONSTRUCTIVE MICROSURGERY IN TREATMENT OF PATIENTS WITH WRIST PATHOLOGY

    Directory of Open Access Journals (Sweden)

    D. I. Kutyanov

    2011-01-01

    Full Text Available We have analyzed the results of treatment of 44 patients with injuries and tumors of wrist. The main aims of microsurgical interventions in such patients were replacement of bone defects (40,9%, replacement of skin defects (25,0%, and also elimination of contractures of wrist joint and fingers (20,5%. At the same time high frequency of use of bony flaps was caused mostly not by the need in replacement of defects of bones, but by the need in stabilization of wrist joint aiming to create the conditions for normal function of fingers. It has been stated that the use of technologies of plastic and reconstructive microsurgery in patients with wrist pathology is not the main factor determing the good result of treatment. The good result of treatment is mainly determined by the condition of fingers, not only appropriate surgical treatment but also adequate rehabilitation helps them achieve their necessary function.

  9. [Post-traumatic carpal collapse (SLAC- and SNAC-wrist)--stage classification and therapeutic possibilities].

    Science.gov (United States)

    Krimmer, H; Krapohl, B; Sauerbier, M; Hahn, P

    1997-09-01

    Longstanding scaphoid nonunion or scapholunate ligament injuries can lead to carpal collapse. SLAC-wrist (scapholunate advanced collapse) following scapholunate dissociation and SNAC-wrist (scaphoid nonunion advanced collapse) after missed fusion of scaphoid fracture should be differentiated. Severity of degenerative changes is classified by three stages. In stage I where arthrosis is limited to the radial styloid reconstructive procedures of the scaphoid or scapholunate ligament are the treatment of choice. In stage II including arthrosis of the radioscaphoid joint and stage III with additional arthrosis in the midcarpal joint these procedures are excluded. Salvage procedures preserving wrist mobility like midcarpal fusion or proximal row carpectomy are preferable to total wrist fusion which represents the last line of defence.

  10. A three-dimensional quantitative analysis of carpal deformity in rheumatoid wrists.

    Science.gov (United States)

    Arimitsu, S; Murase, T; Hashimoto, J; Oka, K; Sugamoto, K; Yoshikawa, H; Moritomo, H

    2007-04-01

    We have measured the three-dimensional patterns of carpal deformity in 20 wrists in 20 rheumatoid patients in which the carpal bones were shifted ulnarwards on plain radiography. Three-dimensional bone models of the carpus and radius were created by computerised tomography with the wrist in the neutral position. The location of the centroids and rotational angle of each carpal bone relative to the radius were calculated and compared with those of ten normal wrists. In the radiocarpal joint, the proximal row was flexed and the centroids of all carpal bones translocated in an ulnar, proximal and volar direction with loss of congruity. In the midcarpal joint, the distal row was extended and congruity generally well preserved. These findings may facilitate more positive use of radiocarpal fusion alone for the deformed rheumatoid wrist.

  11. Reconstructed animation from four-phase grip MRI of the wrist with ulnar-sided pain.

    Science.gov (United States)

    Oda, T; Wada, T; Iba, K; Aoki, M; Tamakawa, M; Yamashita, T

    2013-09-01

    In order to visualize dynamic variations related to ulnar-sided wrist pain, animation was reconstructed from T2* coronal-sectioned magnetic resonance imaging in each of the four phases of grip motion for nine wrists in patients with ulnar pain. Eight of the nine wrists showed a positive ulnar variance of less than 2 mm. Ulnocarpal impaction and triangular fibrocartilage complex injury were assessed on the basis of animation and arthroscopy, respectively. Animation revealed ulnocarpal impaction in four wrists. In one of the four wrists, the torn portion of the articular disc was impinged between the ulnar head and ulnar proximal side of the lunate. In another wrist, the ulnar head impacted the lunate directly through the defect in the articular disc that had previously been excised. An ulnar shortening osteotomy successfully relieved ulnar wrist pain in all four cases with both ulnocarpal impaction and Palmer's Class II triangular fibrocartilage complex tears. This method demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously and should be of value in investigating dynamic pathophysiology causing ulnar wrist pain.

  12. Dynamic magnetic resonance imaging of the metacarpophalangeal joints in rheumatoid arthritis, early unclassified polyarthritis, and healthy controls

    DEFF Research Database (Denmark)

    Klarlund, Mette; Østergaard, Mikkel; Rostrup, Egill

    2000-01-01

    .00001). From the healthy control group, an upper limit (mean+2SD) of normal enhancement was established for the 2nd to 5th MCP joints, which served to identify abnormal EE rates in the corresponding joints of patients. The patients had higher EE rates in the 2nd to 5th MCP joints than had the healthy controls...... AND METHODS: We examined 42 RA and 23 early unclassified polyarthritis patients, and 12 healthy controls in a cross-sectional study. Dynamic MRI (repeated FLASH-MR images after injection of a contrast agent) was performed through the 2nd to the 5th MCP joint. Two methods for identification of the enhancing...... synovial membrane were compared: 1) outlining of enhancing synovial membrane on subtraction images and 2) automated recognition by principal component analysis (PCA). The early enhancement (EE) rate was calculated on the basis of the first method. RESULTS: Method 1) and 2) were closely associated (P

  13. Power Doppler sonography with and without echo-enhancing contrast agent and contrast-enhanced MRI for the evaluation of rheumatoid arthritis of the shoulder joint: differentiation between synovitis and joint effusion

    Energy Technology Data Exchange (ETDEWEB)

    Wamser, G. [Department of Diagnostic Radiology, Klinikum Augsburg, Augsburg (Germany); Diagnostic Radiology, Klinik Dr. Schindlbeck, Seestrasse 43, 82211, Herrsching (Germany); Bohndorf, K.; Vollert, K.; Buecklein, W. [Department of Diagnostic Radiology, Klinikum Augsburg, Augsburg (Germany); Schalm, J. [Department of Internal Medicine I, Klinikum Augsburg, Augsburg (Germany)

    2003-06-01

    To evaluate patients with clinically active rheumatoid arthritis (RA) of the shoulder for joint effusion and synovitis using conventional sonography, power Doppler (PD) sonography with and without echo-enhancing contrast agent, and contrast-enhanced MRI.Design and patients Twenty-four patients (mean age 64 years) with known RA had one symptomatic shoulder evaluated by conventional gray-scale sonography and PD sonography before and after intravenous administration of the echo-enhancing contrast agent Levovist (300 mg/ml, 2.5 g). The degree and extent of the altered echo pattern in the subacromial bursa, axillary recess and glenohumeral joint seen by conventional gray-scale sonography and the intensity of vascular signals of PD sonography were compared with the findings of MRI obtained with T2-weighted turbo spin-echo sequences and contrast-enhanced T1-weighted fat-saturated spin-echo sequences. MRI was evaluated by two readers in consensus without knowledge of the sonographic findings. MRI, which was used as the reference examination, detected joint effusion in 71% (17/24) and synovitis in 92% (22/24) of the patients. Conventional sonography revealed an abnormal articular echo pattern in 96% (23/24) of the patients, especially in the axillary recess and subacromial bursa, but failed to attribute the altered echo pattern to either fluid or specific synovitis. PD sonography allowed a specific diagnosis of synovitis in 33% (8 patients), which increased to 50% (12 patients) after administration of an echo-enhancing contrast agent. In 42% (10/24) of the patients, the findings of synovitis demonstrated by MRI corresponded to an altered echo pattern by conventional sonography, but vascular signals were absent by PD sonography with or without echo-enhancing contrast agent. Using MRI as the ''gold standard,'' PD sonography with and without echo-enhancing contrast agent cannot reliably identify synovitis or distinguish synovial inflammation from effusion

  14. Kinematics of robot wrists

    Science.gov (United States)

    Paul, R. P.; Stevenson, C. N.

    1983-05-01

    Robots for use in assembly and other interactive tasks must be able to respond to both forces and velocity commands within their workspace. By considering a general six-joint robot it is shown that all such robots are limited in their ability to respond in orientation to feedback commands. It is also shown that it is simple to predict, if not to avoid, these regions of degeneracy in which the manipulator loses a degree of freedom.

  15. A repeated-measures analysis of the effects of soft tissues on wrist range of motion in the extant phylogenetic bracket of dinosaurs: Implications for the functional origins of an automatic wrist folding mechanism in Crocodilia.

    Science.gov (United States)

    Hutson, Joel David; Hutson, Kelda Nadine

    2014-07-01

    A recent study hypothesized that avian-like wrist folding in quadrupedal dinosaurs could have aided their distinctive style of locomotion with semi-pronated and therefore medially facing palms. However, soft tissues that automatically guide avian wrist folding rarely fossilize, and automatic wrist folding of unknown function in extant crocodilians has not been used to test this hypothesis. Therefore, an investigation of the relative contributions of soft tissues to wrist range of motion (ROM) in the extant phylogenetic bracket of dinosaurs, and the quadrupedal function of crocodilian wrist folding, could inform these questions. Here, we repeatedly measured wrist ROM in degrees through fully fleshed, skinned, minus muscles/tendons, minus ligaments, and skeletonized stages in the American alligator Alligator mississippiensis and the ostrich Struthio camelus. The effects of dissection treatment and observer were statistically significant for alligator wrist folding and ostrich wrist flexion, but not ostrich wrist folding. Final skeletonized wrist folding ROM was higher than (ostrich) or equivalent to (alligator) initial fully fleshed ROM, while final ROM was lower than initial ROM for ostrich wrist flexion. These findings suggest that, unlike the hinge/ball and socket-type elbow and shoulder joints in these archosaurs, ROM within gliding/planar diarthrotic joints is more restricted to the extent of articular surfaces. The alligator data indicate that the crocodilian wrist mechanism functions to automatically lock their semi-pronated palms into a rigid column, which supports the hypothesis that this palmar orientation necessitated soft tissue stiffening mechanisms in certain dinosaurs, although ROM-restricted articulations argue against the presence of an extensive automatic mechanism. Anat Rec, 297:1228-1249, 2014. © 2014 Wiley Periodicals, Inc.

  16. Septic arthritis in adult horses.

    Science.gov (United States)

    Carstanjen, B; Boehart, S; Cislakova, M

    2010-01-01

    Septic arthritis in horses is a serious disease which can become life-threatening. In case the infection can be eliminated before irreversible joint damage occurs, complete recovery is possible. This article gives an overview of the literature concerning etiology, diagnosis and strategies of therapy in cases of septic arthritis in adult horses, with special reference to novel options of treatment.

  17. Ulnar neuropathy at the wrist.

    Science.gov (United States)

    Pearce, Carisa; Feinberg, Joseph; Wolfe, Scott W

    2009-09-01

    A case of ulnar nerve compression at the wrist within Guyon's canal is reported. The clinical presentation initially appeared consistent with an ulnar nerve entrapment at the elbow. The true diagnosis of an ulnar sensorimotor nerve lesion occurring within the canal of Guyon was made electrophysiologically. Magnetic resonance imaging demonstrated compression of the nerve within the canal by a ganglionic cyst, which was confirmed by surgical intervention. Ulnar nerve entrapment at the wrist is uncommon and difficult to diagnose; therefore, it is important to understand the nerve's anatomical course and distribution to allow for accurate diagnosis by clinical and electrodiagnostic evaluations. Electrodiagnosis is an important tool in identifying ulnar nerve lesions at the wrist while excluding other disorders in the differential and recognizing coexisting pathology.

  18. Viral arthritis

    Science.gov (United States)

    Infectious arthritis - viral ... Arthritis may be a symptom of many virus-related illnesses. It usually disappears on its own without ... the rubella vaccine, only a few people develop arthritis. No risk factors are known.

  19. Evaluation of lesions of the internal ligaments of the wrist; conventional magnetic resonance imaging versus MR arthrography (MRA

    Directory of Open Access Journals (Sweden)

    Heba Ahmed Kamal

    2014-09-01

    Conclusion: MR arthrography is a potent additional tool facilitating the diagnosis of different pathologic entities affecting the major internal ligaments of the wrist joint and helps to reduce arthroscopic interventions.

  20. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update.

    Science.gov (United States)

    Agca, R; Heslinga, S C; Rollefstad, S; Heslinga, M; McInnes, I B; Peters, M J L; Kvien, T K; Dougados, M; Radner, H; Atzeni, F; Primdahl, J; Södergren, A; Wallberg Jonsson, S; van Rompay, J; Zabalan, C; Pedersen, T R; Jacobsson, L; de Vlam, K; Gonzalez-Gay, M A; Semb, A G; Kitas, G D; Smulders, Y M; Szekanecz, Z; Sattar, N; Symmons, D P M; Nurmohamed, M T

    2017-01-01

    Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.

  1. Robot-Aided Mapping of Wrist Proprioceptive Acuity across a 3D Workspace

    Science.gov (United States)

    Marini, Francesca; Squeri, Valentina; Morasso, Pietro; Konczak, Jürgen; Masia, Lorenzo

    2016-01-01

    Proprioceptive signals from peripheral mechanoreceptors form the basis for bodily perception and are known to be essential for motor control. However we still have an incomplete understanding of how proprioception differs between joints, whether it differs among the various degrees-of-freedom (DoFs) within a particular joint, and how such differences affect motor control and learning. We here introduce a robot-aided method to objectively measure proprioceptive function: specifically, we systematically mapped wrist proprioceptive acuity across the three DoFs of the wrist/hand complex with the aim to characterize the wrist position sense. Thirty healthy young adults performed an ipsilateral active joint position matching task with their dominant wrist using a haptic robotic exoskeleton. Our results indicate that the active wrist position sense acuity is anisotropic across the joint, with the abduction/adduction DoF having the highest acuity (the error of acuity for flexion/extension is 4.64 ± 0.24°; abduction/adduction: 3.68 ± 0.32°; supination/pronation: 5.15 ± 0.37°) and they also revealed that proprioceptive acuity decreases for smaller joint displacements. We believe this knowledge is imperative in a clinical scenario when assessing proprioceptive deficits and for understanding how such sensory deficits relate to observable motor impairments. PMID:27536882

  2. Robot-Aided Mapping of Wrist Proprioceptive Acuity across a 3D Workspace.

    Science.gov (United States)

    Marini, Francesca; Squeri, Valentina; Morasso, Pietro; Konczak, Jürgen; Masia, Lorenzo

    2016-01-01

    Proprioceptive signals from peripheral mechanoreceptors form the basis for bodily perception and are known to be essential for motor control. However we still have an incomplete understanding of how proprioception differs between joints, whether it differs among the various degrees-of-freedom (DoFs) within a particular joint, and how such differences affect motor control and learning. We here introduce a robot-aided method to objectively measure proprioceptive function: specifically, we systematically mapped wrist proprioceptive acuity across the three DoFs of the wrist/hand complex with the aim to characterize the wrist position sense. Thirty healthy young adults performed an ipsilateral active joint position matching task with their dominant wrist using a haptic robotic exoskeleton. Our results indicate that the active wrist position sense acuity is anisotropic across the joint, with the abduction/adduction DoF having the highest acuity (the error of acuity for flexion/extension is 4.64 ± 0.24°; abduction/adduction: 3.68 ± 0.32°; supination/pronation: 5.15 ± 0.37°) and they also revealed that proprioceptive acuity decreases for smaller joint displacements. We believe this knowledge is imperative in a clinical scenario when assessing proprioceptive deficits and for understanding how such sensory deficits relate to observable motor impairments.

  3. Ultrasound and MRI measurements of joint cartilage in healthy children. A validation study

    DEFF Research Database (Denmark)

    Spannow, A H; Stenboeg, E; Jensen, Mogens Pfeiffer;

    2011-01-01

    Purpose: In juvenile idiopathic arthritis (JIA), proliferative changes in the synovium and synovial fluid accumulation are pathological findings responsible for damage to the cartilaginous tissue and periarticular bone, which are late radiographic findings in conventional radiography. Early...... detection of these joint changes would allow the clinicians to initiate relevant therapies as is essential for the long-term outcome of JIA. Ultrasonography (US) has shown great potential for this purpose but validation in a pediatric setting is needed. The objective of this study was to validate US.......5 millimeters. The coefficient of variation (CV) was found to be good (16 %) except for in the case of the wrist joint (20 %). Conclusion: We found a good level of agreement and no significant systematic joint size-related differences in cartilage thickness measurements between MRI and US. US appears...

  4. The carpal stretch test at the rheumatoid wrist.

    Science.gov (United States)

    Shimizu, Hiroyuki; Beppu, Moroe; Matsusita, Kazuhiko; Arai, Takeshi; Yoshida, Noriyuki

    2012-01-01

    The purpose of this study was to evaluate the radiographic changes of the carpus for rheumatoid wrists in patients who underwent the Sauvé-Kapandji procedure by examining the clinical results and comparing pre- and postoperative radiographic measurements. We studied 43 wrists in 37 patients who showed vertical laxity in the radiocarpal and midcarpal joint on preoperative carpal stretch test. Pain was improved in all patients and the forearm rotation angles of the wrist were significantly improved after the operation. The carpal collapse ratio was significantly reduced after the operation. The carpal collapse reduction rate was significantly greater in the group with than that in the group without midcarpal joint vertical laxity on the carpal stretch test. Although the Sauvé-Kapandji procedure was not sufficiently effective in preventing carpal collapse, it did have a protective effect against ulnar carpal shift. The results of our study showed that vertical laxity of the midcarpal joint was the risk factor of the carpal collapse after Sauvé-Kapandji procedure.

  5. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders

    DEFF Research Database (Denmark)

    Agca, R; Heslinga, S C; Rollefstad, S;

    2017-01-01

    and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing...... was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist...... is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which...

  6. Clinical management of septic arthritis in cattle.

    Science.gov (United States)

    Desrochers, André; Francoz, David

    2014-03-01

    Synovial fluid, ultrasound, and radiographic imaging are common diagnostic tools for septic arthritis. Mycoplasma septic arthritis is suspected in calves with clinical signs of otitis and pneumonia. Commonly affected joints are carpus, stifle, and tarsus. Treatment strategy must include long-term antibiotics, anti-inflammatories, and joint lavage. Knowledge of communication and boundaries for commonly affected joints is essential to perform joint lavage and arthrotomy.

  7. The Potential Risk Factors Relevant to Lateral Epicondylitis by Wrist Coupling Posture.

    Directory of Open Access Journals (Sweden)

    Su-Ya Lee

    Full Text Available The use of awkward wrist postures and unskilled techniques might induce lateral epicondylitis. This study thus investigated the effects of wrist deviation combined with extension and movement velocity on the dynamic performances of the wrist muscles during the coupling posture via a custom-made bi-planar isokinetic dynamometer. Thirty subjects were recruited to perform the isokinetic testing. We measured the muscle strengths and activities for the wrist extensors and flexors during concentric and eccentric contractions at three movement velocities, 30°s-1, 90°s-1, and 180°s-1, combined with three wrist postures, neutral position (NP, radial deviation (RD, and ulnar deviation (UD. The root mean square (RMS of the electromyographic signal in the extensor digitorum communis (EDC, normalized peak torque of extensors, and ratio of normalized peak torque between wrist extensors and flexors, were all greater in the NP than RD and UD in both contractions. The ratio of RMS between EDC and flexor digitorum superficialis (FDS had a significantly greater value in RD than UD during the concentric contraction. The EDC showed significantly higher activity at the fast velocity in both contractions. Nevertheless, a significantly higher RMS of the electromyographic signal between EDC and FDS and the ratio of strength between wrist extensors and flexors were found at slow velocity in both contractions. The wrist deviation combined with extension and movement velocity of the wrist joint should thus be considered as influential factors which might alter the dynamic performances, and may result in further injury of the elbow joint.

  8. The Potential Risk Factors Relevant to Lateral Epicondylitis by Wrist Coupling Posture

    Science.gov (United States)

    Lee, Su-Ya; Chieh, Hsiao-Feng; Lin, Chien-Ju; Jou, I-Ming; Kuo, Li-Chieh; Su, Fong-Chin

    2016-01-01

    The use of awkward wrist postures and unskilled techniques might induce lateral epicondylitis. This study thus investigated the effects of wrist deviation combined with extension and movement velocity on the dynamic performances of the wrist muscles during the coupling posture via a custom-made bi-planar isokinetic dynamometer. Thirty subjects were recruited to perform the isokinetic testing. We measured the muscle strengths and activities for the wrist extensors and flexors during concentric and eccentric contractions at three movement velocities, 30°s-1, 90°s-1, and 180°s-1, combined with three wrist postures, neutral position (NP), radial deviation (RD), and ulnar deviation (UD). The root mean square (RMS) of the electromyographic signal in the extensor digitorum communis (EDC), normalized peak torque of extensors, and ratio of normalized peak torque between wrist extensors and flexors, were all greater in the NP than RD and UD in both contractions. The ratio of RMS between EDC and flexor digitorum superficialis (FDS) had a significantly greater value in RD than UD during the concentric contraction. The EDC showed significantly higher activity at the fast velocity in both contractions. Nevertheless, a significantly higher RMS of the electromyographic signal between EDC and FDS and the ratio of strength between wrist extensors and flexors were found at slow velocity in both contractions. The wrist deviation combined with extension and movement velocity of the wrist joint should thus be considered as influential factors which might alter the dynamic performances, and may result in further injury of the elbow joint. PMID:27171198

  9. 75 FR 17417 - Joint Meeting of the Arthritis Advisory Committee and the Drug Safety and Risk Management...

    Science.gov (United States)

    2010-04-06

    ... Management Advisory Committee. This meeting was announced in the Federal Register of March 8, 2010 (75 FR... meeting. SUPPLEMENTARY INFORMATION: In the Federal Register of March 8, 2010, FDA announced that a joint... drug (NSAID) product indicated for the treatment of the signs and symptoms of osteoarthritis....

  10. Equine Septic Arthritis and Serum Amyloid A

    OpenAIRE

    Ludwig, Elsa Karen

    2016-01-01

    Bacterial infection within a joint, septic arthritis, is a serious condition in horses that can lead to long-term joint disease if the infection is not resolved quickly. Equine septic arthritis is diagnosed primarily based on clinical signs and synovial fluid cytology. Septic synovial fluid is characterized by significant elevations in total protein (TP) and total nucleated cell count (TNCC). However, in some cases it can be difficult to distinguish between septic arthritis and non-septic joi...

  11. Physical Performance Characteristics of Military Aircraft Maintenance Personnel Resistant to Work-Related Musculoskeletal Disorders of the Hand and Wrist

    Science.gov (United States)

    2006-01-01

    inflammatory disorders include tendonitis, trigger finger, and tenosynovitis. Nerve compression conditions include carpal tunnel syndrome and ulnar ...workers with about 20% attributed to the wrist, hand, or finger (BLS, 2005). Inflammatory, nerve compression, and degenerative conditions such as...tendonitis, carpal tunnel syndrome , and arthritis are included in the category of WMSDs. Risk factors such as repetition, vibration, awkward positions

  12. Sternoclavicular joint septic arthritis following paraspinal muscle abscess and septic lumbar spondylodiscitis with epidural abscess in a patient with diabetes: a case report

    Directory of Open Access Journals (Sweden)

    Shioya Nobuki

    2012-06-01

    Full Text Available Abstract Background Septic arthritis of the sternoclavicular joint (SCJ is extremely rare, and usually appears to result from hematogenous spread. Predisposing factors include immunocompromising diseases such as diabetes. Case presentation A 61-year-old man with poorly controlled diabetes mellitus presented to our emergency department with low back pain, high fever, and a painful mass over his left SCJ. He had received two epidural blocks over the past 2 weeks for severe back and leg pain secondary to lumbar disc herniation. He did not complain of weakness or sensory changes of his lower limbs, and his bladder and bowel function were normal. He had no history of shoulder injection, subclavian vein catheterization, intravenous drug abuse, or focal infection including tooth decay. CT showed an abscess of the left SCJ, with extension into the mediastinum and sternocleidomastoid muscle, and left paraspinal muscle swelling at the level of L2. MRI showed spondylodiscitis of L3-L4 with a contiguous extradural abscess. Staphylococcus aureus was isolated from cultures of aspirated pus from his SCJ, and from his urine and blood. The SCJ abscess was incised and drained, and appropriate intravenous antibiotic therapy was administered. Two weeks after admission, the purulent discharge from the left SCJ had completely stopped, and the wound showed improvement. He was transferred to another ward for treatment of the ongoing back pain. Conclusion Diabetic patients with S. aureus bacteremia may be at risk of severe musculoskeletal infections via hematogenous spread.

  13. Comparative Expression Analyses of Pro- versus Anti-Inflammatory Mediators within Synovium of Patients with Joint Trauma, Osteoarthritis, and Rheumatoid Arthritis

    Science.gov (United States)

    Shaqura, Mohammed; John, Thilo; Likar, Rudolf; Ebied, Reham Said; Schäfer, Michael

    2017-01-01

    Synovial injury and healing are complex processes including catabolic effects by proinflammatory cytokines and anabolic processes by anti-inflammatory mediators. Here we examined the expression of pro- versus anti-inflammatory mediators in synovium of patients with diagnostic arthroscopy (control), joint trauma (JT), osteoarthritis (OA), and rheumatoid arthritis (RA). Synovial samples from these patients were subjected to RT-PCR and double immunofluorescence confocal microscopy of pro- and anti-inflammatory mediators as well as immune cell markers. Interestingly, pro- and anti-inflammatory mediators were expressed predominantly in granulocytes in patients with JT and in macrophages, lymphocytes, and plasma cells in patients with OA and RA. Interestingly, parallel to the severity of inflammation, proinflammatory mediators IL-1β, TNF-α, and 5-LOX specific mRNA as well as immunoreactive (IR) cells were significantly more abundant in patients with RA and JT than in those with OA. However, anti-inflammatory mediators 15-LOX, FPR2, and IL-10 specific mRNA as well as IR cells were significantly more abundant in patients with OA than in those with JT and RA. These findings show that upregulation of proinflammatory mediators contributes to the predominantly catabolic inflammatory process in JT and RA synovium, whereas upregulation of anabolic anti-inflammatory mediators counteracts inflammation resulting in the inferior inflammatory process in OA synovium.

  14. Usefulness of interposition arthroplasty in the Sauvé-Kapandji procedure for rheumatoid wrist.

    Science.gov (United States)

    Tanaka, Nobuyuki; Sakahashi, Hisashi; Hirose, Kazuya; Ishima, Takumi; Ishii, Seiichi

    2004-01-01

    The aim of synovectomy combined with the Sauvé-Kapandji (S-K) procedure for the treatment of a rheumatoid wrist is to obtain a stable painless wrist that retains sufficient mobility for function. However, loss of motion occurs postoperatively in most cases. In our study of 59 rheumatoid patients, the results of the transposition of distal strips of retinaculum into the radiocarpal and ulnocarpal joints for interposition arthroplasty to maintain wrist motion (interposition group), and transposition below the extensors to provide a gliding surface (SK group) were evaluated. The distal end of the ulna was fixed to the radius with poly-L-lactic acid screws, and a proximal strip of retinaculum was placed above the extensors after synovectomy of the rheumatoid wrist. Clinical symptoms, radiographic changes, and postoperative complications were assessed 3-9 years (mean 5.9 years) postoperatively. Patients in the interposition group showed better postoperative results, including wrist motion, than those of patients in the SK group. Both procedures resulted in only minor complications such as superficial skin necrosis, hematoma, and superficial infection. We concluded that interposition arthroplasty combined with the S-K procedure using a distal strip of retinaculum might be a safe and appropriate method for wrist reconstruction following synovectomy of a rheumatoid wrist.

  15. The use of upper limb orthoses in patients with rheumatoid arthritis: a literature review in the field of occupational therapy

    Directory of Open Access Journals (Sweden)

    Talita Silvério de Souza Silva

    2015-09-01

    Full Text Available Introduction: Rheumatoid arthritis is a chronic systemic disease that most often affects smaller joints such as hands and wrists. It may cause deformities that jeopardize hand function, thus impacting the subject occupational performance. In order to assist the hand function restoration, occupational therapists often use orthosis to improve autonomy and/or independence to perform daily activities in patients with rheumatoid arthritis. Objective: This study aimed to identify the upper limb’s orthoses used in patients with rheumatoid arthritis, who were assisted by the Occupational Therapy, featuring the population, the type of research and the outcomes obtained. Method: This study is literature review and its selection criteria consists of publications in English, Spanish and Portuguese published within the last ten years, divided between experimental, observational and case studies, all with diagnosis of rheumatoid arthritis and assisted by an occupational therapist. Twelve articles were selected for review. Findings: The literature review points out the benefits achieved through the use of the orthosis to manual dexterity, grip strength, pain relief and aspects related to comfort and patient satisfaction. Conclusion: In this context, the orthosis appears as an important assistive technology resource to keep function and restore compromised activities.

  16. A structurally decoupled mechanism for measuring wrist torque in three degrees of freedom

    Science.gov (United States)

    Pan, Lizhi; Yang, Zhen; Zhang, Dingguo

    2015-10-01

    The wrist joint is a critical part of the human body for movement. Measuring the torque of the wrist with three degrees of freedom (DOFs) is important in some fields, including rehabilitation, biomechanics, ergonomics, and human-machine interfacing. However, the particular structure of the wrist joint makes it difficult to measure the torque in all three directions simultaneously. This work develops a structurally decoupled instrument for measuring and improving the measurement accuracy of 3-DOF wrist torque during isometric contraction. Three single-axis torque sensors were embedded in a customized mechanical structure. The dimensions and components of the instrument were designed based on requirement of manufacturability. A prototype of the instrument was machined, assembled, integrated, and tested. The results show that the structurally decoupled mechanism is feasible for acquiring wrist torque data in three directions either independently or simultaneously. As a case study, we use the device to measure wrist torques concurrently with electromyography signal acquisition in preparation for simultaneous and proportional myoelectric control of prostheses.

  17. Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures.

    Science.gov (United States)

    Vitale, Mark A; Brogan, David M; Shin, Alexander Y; Berger, Richard A

    2016-03-01

    Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre- and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p notch step-off, diastasis or DRUJ

  18. Artritis infecciosa y su relación con la articulación temporomandibular Infectious arthritis and its relationship with the temporomandibular joint

    Directory of Open Access Journals (Sweden)

    V. Iturriaga Wilder

    2012-02-01

    Full Text Available La artritis infecciosa (AI es, como su nombre lo indica, la infección de una articulación del cuerpo producida por un agente que puede ser bacteriano, viral o fúngico (Bluestone, 1980; García & Picazo, 1996. Esta patología es poco común y poco documentada cuando afecta la articulación temporomandibular, existiendo sólo reporte de casos. Por lo anterior, muchas veces pasa desapercibida por distintos profesionales del área de la salud. El diagnóstico de la AI mediante radiología no aporta gran información en etapas tempranas de la patología (Lavy, 2007; Visser & Tupper, 2009. Un método de diagnóstico utilizado en grandes articulaciones del cuerpo es el cultivo de líquido sinovial (Lavy; Visser & Tupper, examen complejo de realizar en la articulación temporomandibular dado su tamaño y pequeña cantidad de fluido sinovial, siendo así el diagnóstico de AI en gran medida clínico, y en el caso de la articulación temporomandibular es aún más importante la experticia y conocimientos del clínico. El tratamiento se debe basar en la eliminación del agente causal mediante farmacoterapia orientada a la eliminación de éste (Lavy; Visser & Tupper. La artritis infecciosa por sus características de avance rápido, agresivo y degenerativo, debe ser considerada como un posible diagnóstico en la articulación temporomandibular, por lo que esta revisión bibliográfica presenta información acabada sobre la epidemiología, etiopatogenia, diagnóstico y tratamiento de dicha patología existente en diversas bases de datos y literatura contemporánea.Infectious arthritis (IA is, as its name implies, infection of a joint in the body caused by an agent that can be bacterial, viral or fungal (Bluestone, 1980, Garcia & Picazo, 1996. This condition is uncommon and poorly documented when it affects the temporomandibular joint (TMJ, and there are only case reports. Due to this is often unnoticed by other professionals in the field of health. The

  19. Magnetic resonance imaging findings in 84 patients with early rheumatoid arthritis: bone marrow oedema predicts erosive progression

    DEFF Research Database (Denmark)

    Haavardsholm, E.A.; Boyesen, P.; Østergaard, Morten;

    2008-01-01

    consecutive patients with RA with disease duration disease activity, conventional radiographs of both hands and wrists and MRI of the dominant wrist. MR...... of the dominant wrist may help clinicians to determine which patients need early and aggressive treatment to avoid subsequent joint damage Udgivelsesdato: 2008/6...

  20. MicroPure imaging for the evaluation of microcalcifications in gouty arthritis involving the first metatarsophalangeal joint: a preliminary study.

    Directory of Open Access Journals (Sweden)

    Lu Yin

    Full Text Available OBJECTIVE: To assess the value of MicroPure, a new ultrasound image processing technique, in identifying microcalcifications (formed by monosodium urate crystals in the first metatarsophalangeal joints attacked by gout compared to gray-scale ultrasound images. MATERIALS AND METHODS: Thirty-six patients who fulfilled the study inclusion criteria underwent gray-scale ultrasound and MicroPure examinations of the first metatarsophalangeal joints attacked by gout. Static images of the target areas were acquired using gray-scale ultrasound and MicroPure. Two independent and blinded investigators analyzed the images to determine the number of microcalcifications and to score for image quality and artifacts. RESULTS: The two investigators observed significantly more microcalcifications with MicroPure compared to gray-scale ultrasound (ρ<0.001. The level of agreement between the investigators consistently increased from gray-scale ultrasound to MicroPure imaging (gray-scale interclass correlation coefficient of 0.69 vs. MicroPure interclass correlation coefficient of 0.81. One investigator preferred the MicroPure image quality over gray-scale ultrasound (ρ<0.001, but the other investigator disagreed (ρ<0.001. Both investigators observed fewer artifacts with MicroPure than with gray-scale ultrasound (ρ<0.009. CONCLUSION: MicroPure imaging identified significantly more microcalcifications than gray-scale ultrasound.

  1. Arthroscopy of the wrist: anatomy and classification of carpal instability.

    Science.gov (United States)

    Cooney, W P; Dobyns, J H; Linscheid, R L

    1990-01-01

    Carpal instability can be defined as the lack of ligamentous and skeletal support adequate to maintain a wrist stable to external forces of pinch and grasp. This instability may be static or dynamic. It has been classified as (a) carpal instability, dissociated (CID), a situation in which one or more of the ligaments are torn, and (b) carpal instability, nondissociative (CIND), a situation in which the ligaments are intact but stretched. Carpal instability can also be the result of carpal bone malalignment from various causes. Arthroscopy can be particularly useful in assessing carpal instability, however arthrography with contrast medium, fluoroscopy, and stress loading should precede this arthroscopic assessment. Arthroscopy allows visualization of the volar radiocarpal and ulnocarpal ligaments of the wrist, and the arthroscopic examination can be combined with manual manipulation of the carpal bones to detect laxity of those ligaments, to examine stability of the scapholunate and lunotriquetral interosseous ligaments, and to show instability of the distal radioulnar joint.

  2. Measuring Sleep by Wrist Actigraph.

    Science.gov (United States)

    1979-10-01

    C-804G UNCLASSIFIED N i* mhEEmohmhEmhI * - 1 1 ~ 2 AD REPORT NUMBER 1 MEASURING SLEEP BY WRIST ACTIGRAPH * ANNUAL REPORT Daniel F . Kripke, Daniel J...9 17 ~. Daniel F ./iripke, Daniel J./Mullaney.,.~~ DADl17-78-C-8040 and Sam/Messin -..~w.Y~~pn.MITWIATION NAME AND ADDRESS 10. PROGRAM ELEMENT. PROJECT

  3. Artrite da gota tofácea crônica mimetizando artrite reumatoide Chronic tophaceous gout mimicking rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Juliana F. Sarmento

    2009-12-01

    Full Text Available A gota é um distúrbio no metabolismo das purinas, usualmente associado à ocorrência de crises recorrentes de artrite nas articulações dos membros inferiores em homens entre 40-50 anos, e com o desenvolvimento de tofos subcutâneos nos pacientes com doença de longa evolução. Casos de pacientes com artrite gotosa crônica que mimetizam quadros de artrite reumatoide e vice-versa são raros. Descrevemos o caso de um paciente de 56 anos, com quadro de artrite poliarticular, simétrica e deformante, comprometendo principalmente as articulações de mãos e punhos, com nódulos subcutâneos difusos pelo corpo, alterações radiográficas atípicas e urolitíase, que, após avaliação clínica e dos exames complementares, recebeu diagnóstico de gota tofácea crônica mutilante mimetizando artrite reumatoide.Gout is a disorder of purine metabolism, usually associated with recurrent bouts of arthritis in the joints of the lower limbs, affecting men 40 to 50 years of age, which leads to the development of subcutaneous tophi in patients with long-lasting disease. Cases of patients with chronic gouty arthritis mimicking rheumatoid arthritis, and vice-versa, are rare. This report describes the case of a 56-year old male with symmetric, deforming, and polyarticular arthritis affecting, specially, the joints of the hands and wrists, with diffuse subcutaneous nodules throughout his body, atypical radiographic findings, and urolithiasis. Following clinical evaluation and additional tests, this patient received a diagnosis of chronic tophaceous gout mimicking mutilating rheumatoid arthritis.

  4. Differential Diagnosis of Polyarticular Arthritis.

    Science.gov (United States)

    Pujalte, George G A; Albano-Aluquin, Sheila A

    2015-07-01

    Polyarticular arthritis is commonly encountered in clinical settings and has multiple etiologies. The first step is to distinguish between true articular pain and nonarticular or periarticular conditions by recognizing clinical patterns through the history and physical examination. Once pain within a joint or joints is confirmed, the next step is to classify the pain as noninflammatory or inflammatory in origin. Noninflammatory arthritis, which is mostly related to osteoarthritis, has a variable onset and severity and does not have inflammatory features, such as warm or swollen joints. Osteoarthritis usually presents with less than one hour of morning stiffness and pain that is aggravated by activity and improves with rest. A review of systems is usually negative for rashes, oral ulcers, or other internal organ involvement. In contrast, inflammatory arthritis generally causes warm, swollen joints; prolonged morning stiffness; and positive findings on a review of systems. Once inflammatory arthritis is suspected, possible diagnoses are sorted by the pattern of joint involvement, which includes number and type of joints involved, symmetry, and onset. The suspicion for inflammatory arthritis should be confirmed by the appropriate serologic/tissue and/or imaging studies in the clinical setting or in consultation with a subspecialist.

  5. Total ankle joint replacement.

    Science.gov (United States)

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications.

  6. Neonatal septic arthritis.

    Science.gov (United States)

    Halder, D; Seng, Q B; Malik, A S; Choo, K E

    1996-09-01

    Neonatal septic arthritis has always been considered as separate from its counterpart in older children. The condition is uncommon but serious. Affected neonates usually survive, but with permanent skeletal deformities. Ten cases of neonatal septic arthritis were diagnosed between January 1989 and December 1993 in the neonatal intensive care units of two referral hospitals in the state of Kelantan, Malaysia. All except one neonate was born prematurely. The mean age of presentation was 15.6 days. Joint swelling (10/10), increased warmth (7/10) and erythema of the overlying skin (7/10) were the common presenting signs. Vague constitutional symptoms preceded the definitive signs of septic arthritis in all cases. The total white cell counts were raised with shift to the left. The knee (60%) was not commonly affected, followed by the hip (13%) and ankle (13%). Three neonates had multiple joint involvement. Coexistence of arthritis with osteomyelitis was observed in seven neonates. The commonest organism isolated was methicillin resistant Staphylococcus aureus (9/10). Needle aspiration was performed in nine neonates and one had incision with drainage. Follow up data was available for five neonates and two of these had skeletal morbidity. Early diagnosis by frequent examination of the joints, prompt treatment and control of nosocomial infection are important for management.

  7. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint

    Directory of Open Access Journals (Sweden)

    Griffin Damian R

    2010-01-01

    Full Text Available Abstract Background Hip replacement (arthroplasty surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint. For older patients, several designs of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money. However, in younger more active patients, there is approximately a 50% failure rate at 25 years for traditional implants. Hip resurfacing is a relatively new arthroplasty technique. In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified, including the risk of femoral neck fracture and collapse of the head of the femur.The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty. Secondary aims include assessment of complication rates for both procedures as well cost effectiveness. Methods/design All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study. A randomisation sequence will be produced and administered independently. After consenting, all patients will be clinically reviewed and hip function, quality of life and physical activity level will be assessed through questionnaires. The allocated surgery will then be performed with the preferred technique of the surgeon. Six weeks post-operation hip function will be assessed and complications recorded. Three, six and 12 months post-operation hip function, quality of life and physical activity level will be assessed. Additional information about patients' out-of-pocket expenses will also be collected. Trial registration Current Controlled Trials ISRCTN33354155 UKCLRN portfolio ID 4093

  8. 舒筋洗外用颗粒促进 colles 骨折后期腕关节功能恢复的临床观察%Clinical Observation of the Wrist Joint Function Recovery after Colles Fracture at the Late Stage Treated with Shujin External Granules

    Institute of Scientific and Technical Information of China (English)

    沈钊雄; 沈楚龙; 黄明喜; 郭雪霞

    2015-01-01

    Objective To observe the clinical efficacy on the wrist joint functional recovery of Col-les fracture at the late stage treated with the fumigation of shujinxi external granules and functional exercises. Methods Two hundred and twenty patients of Colles fracture with conservative treatment were randomized into a treatment group and a control group,110 cases in each one. The manipulation reduction and splint fixa-tion were used and the splint was removed in 5 to 7 weeks in the two groups. In the treatment group,the fumi-gation of shujinxi external granules and functional exercises were applied. In the control group,the warm water washing and functional exercise were adopted. The treatment was for 6 weeks. Results At the same time points(in the 2nd week and the 6th week),the range of movement(ROM)of wrist joint in the treatment group was better than that in the control group,indicating the significant difference(P < 0. 05). In 6 weeks of treat-ment,the clinical efficacy in the treatment was better than that in the control group,indicating the significant difference(P < 0. 05). Conclusion For Colles fracture at the late stage,the fumigation of shujinxi external granules better promotes the functional recovery of wrist joint and achieves the definite clinical efficacy.%目的:观察舒筋洗外用颗粒熏洗配合功能锻炼促进 colles 骨折后期腕关节功能恢复的临床疗效。方法将220例 colles 骨折保守治疗患者随机分为治疗组和对照组各110例,两组均经手法复位夹板外固定5~7周后拆除夹板,治疗组采用舒筋洗外用颗粒熏洗配合功能锻炼治疗;对照组采用温开水外洗配合功能锻炼治疗,均治疗6周。结果同一时间点(第2周、第6周)治疗组患者腕关节活动度均优于对照组,两组比较差异有统计学意义(P <0.05);6周后治疗组临床疗效评定优于对照组,两组比较差异有统计学意义(P <0.05)。结论 Colles 骨折后期采用舒

  9. Neonatal Candida arthritis

    Directory of Open Access Journals (Sweden)

    Saurabh Sharma

    2014-01-01

    Full Text Available Fungal arthritis is an uncommon yet serious disorder in the newborn. Delay in diagnosis and management can lead to significant morbidity. We report our experience with management of two such cases. Two preterm neonates with multifocal arthritis caused by Candida were studied. Diagnosis was made by clinical examination, laboratory investigations, radiological investigations and culture. Both were treated by aspiration, arthrotomy and antifungal therapy. One patient recovered fully from the infection while the other had growth disturbances resulting in limb length inequality at recent followup. Prompt and expeditious evacuation of pus from joints and antifungal therapy is imperative for treatment. Associated osteomyelitis leads to further difficulty in treatment.

  10. Pyrocarbon spacer as a trapezium replacement for arthritis of the trapeziometacarpal joint; a follow-up study of 60 cases.

    Science.gov (United States)

    Szalay, Gabor; Meyer, Christof; Scheufens, Tanja; Schnettler, Reinhard; Christ, Ralph; Schleicher, Iris

    2013-12-01

    Rhizarthrosis is the most common degenerative joint disease of the hand, affecting about 10% of the population. We report our results with trapezium replacement using a pyrocarbon spacer. Between January 2005 and April 2010, 70 patients underwent trapeziectomy with interposition of a pyrocarbon spacer. Sixty patients were examined at an average follow-up of 23.6 (5-64) months after the operation. Six (8.6%) of the 70 implanted pyrocarbon spacers dislocated. Based on the assessment scale devised by Buck-Gramcko, 19 patients achieved a very good outcome (31.6%), 31 patients (51.6%) had a good outcome, six results were satisfactory (10%) and four patients (6.6%) had a poor result. In this study, trapeziectomy and implantation of a pyrocarbon spacer achieved good or very good results in 83.2% of cases. The high cost of the implant and the observed rate of spacer dislocation should however be considered critically. While the short-term results of this method are encouraging, long-term outcomes will show whether this technique can keep up with the good results of suspension arthroplasty.

  11. Significance of magnetic resonance imaging for early rheumatoid arthritis activity

    Directory of Open Access Journals (Sweden)

    E Y Pogozeva

    2009-01-01

    Full Text Available Objective. To assess possibility of magnetic resonance image (MRI application for rheu- matoid arthritis (RA activity and severity assessment.Material and methods. 100 pts with RA who fulfilled the 1987 ACR criteria with disease duration less than 12 months were included. Standard clinical examination with evaluation of tender and swollen joint counts, acute phase markers, hand and foot X-ray and hand MRI with 0,2 T Artoscan apparatus (ESAOTE Biomedica, Italy were performed.Results. MRI showed hand joint synovitis in 94,5%, erosions – in 67,3% of cases. X-ray examination revealed erosions in only 20,8% of pts. Localization of erosions revealed by X-ray and MRI coincided in 36,4% of cases and in 61,8% of pts erosions were detected only by MRI. MRI confirmed clinical conclusion about presence or absence of metacarpophalangeal and wrist joint synovitis in 64,5% and 74,5% of cases respectively. In8,2% and 21,8% MRI revealed signs of synovitis in clinically intact joints. MRI synovitis score correlated with clinical and laboratory measures of disease activity – DAS 28 (r=0,37, p=0,001, CRP(r=0,30, p=0,001, ESR (r=0,42, p=0,001, HAQ (r=0,24, p=0,001. Weak correlation was revealed between ESR and presence of erosions (r=0,29, CRP, ESR and MRI signs of bone marrow edema (r=0,27, p=0,005 and r=0,29, p=0,002 respectively. Relationship between laboratory and clinical features was weaker and referred only to CRP level and swollen joint count (p=0,05.Conclusion. MRI signs may be used as additional and independent measures of inflammatory activity (particularly synovitis score and severity of RA

  12. Psoriatic Arthritis

    Science.gov (United States)

    ... your body. Some people with psoriasis have psoriatic arthritis. It causes pain, stiffness, and swelling of the ... physical exam and imaging tests to diagnose psoriatic arthritis. There is no cure, but medicines can help ...

  13. Sporotrichal arthritis.

    OpenAIRE

    1991-01-01

    Sporotrichal arthritis is a rare disease entity. Diagnosis is often difficult and delayed. Presentation may be either monoarticular or polyarticular. A case of polyarticular sporotrichal arthritis which exemplifies these problems is reported.

  14. Psoriatic Arthritis

    Science.gov (United States)

    ... Call for Letters of Interest Call for Topics Axial Spondyloarthritis Glucocorticoid-Induced Osteoporosis Gout Juvenile Idiopathic Arthritis ... be affected. Psoriatic arthritis in the spine, called spondylitis , causes stiffness in the back or neck, and ...

  15. Can total wrist arthroplasty be an option in the treatment of the severely destroyed posttraumatic wrist?

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Herzberg, Guillaume; Sørensen, Allan Ibsen;

    2013-01-01

    Background Severely destroyed posttraumatic wrists are usually treated by partial or total wrist fusion or proximal row carpectomy. The indications for and longevity of total wrist arthroplasty (TWA) are still unclear. Case Description The aim of this study was to analyze a series in which one la...

  16. Polyarticular Septic Arthritis in an Immunocompetent Adult: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Annelise Miller

    2015-01-01

    Full Text Available Septic arthritis is a clinical emergency requiring prompt diagnosis and treatment to avoid significant morbidity and mortality. Polyarticular septic arthritis (PASA accounts for 15% of all infectious arthritides and rarely occurs in immunocompetent adults. Staphylococcus aureus is the most commonly isolated organism, with infection primarily affecting knees, shoulders, elbows, and hips. The morbidity associated with PASA is very high, and mortality in treated cases of PASA may be as high as 50% of cases. We report a case of PASA with associated epidural abscess in a healthy adult male, who presented with complaints of arthralgia and limited range of motion of his left shoulder, wrist, and ankle. He also presented with low back pain and motor weakness associated with an epidural abscess spanning L2-S1, with multilevel vertebral osteomyelitis. Surgical washout of the affected joints as well as decompressive laminectomies was performed, and he received a standard course of intravenous antibiotics. Staphylococcus aureus was isolated from joint aspirations and from blood cultures. The patient had a full neurological and functional recovery postoperatively with no sequelae. To the best of our knowledge this is the only case report of Staphylococcus aureus PASA with concomitant epidural abscess in an immunocompetent adult.

  17. Polyarticular Septic Arthritis in an Immunocompetent Adult: A Case Report and Review of the Literature.

    Science.gov (United States)

    Miller, Annelise; Abduljabbar, Fahad; Jarzem, Peter

    2015-01-01

    Septic arthritis is a clinical emergency requiring prompt diagnosis and treatment to avoid significant morbidity and mortality. Polyarticular septic arthritis (PASA) accounts for 15% of all infectious arthritides and rarely occurs in immunocompetent adults. Staphylococcus aureus is the most commonly isolated organism, with infection primarily affecting knees, shoulders, elbows, and hips. The morbidity associated with PASA is very high, and mortality in treated cases of PASA may be as high as 50% of cases. We report a case of PASA with associated epidural abscess in a healthy adult male, who presented with complaints of arthralgia and limited range of motion of his left shoulder, wrist, and ankle. He also presented with low back pain and motor weakness associated with an epidural abscess spanning L2-S1, with multilevel vertebral osteomyelitis. Surgical washout of the affected joints as well as decompressive laminectomies was performed, and he received a standard course of intravenous antibiotics. Staphylococcus aureus was isolated from joint aspirations and from blood cultures. The patient had a full neurological and functional recovery postoperatively with no sequelae. To the best of our knowledge this is the only case report of Staphylococcus aureus PASA with concomitant epidural abscess in an immunocompetent adult.

  18. Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique

    Science.gov (United States)

    van Onna, M; Ten Cate, D F; Tsoi, K L; Meier, A J L; Jacobs, J W G; Westgeest, A A A; Meijer, P B L; van Beek, M C; Rensen, W H J; Bijlsma, J W J

    2016-01-01

    Objectives In rheumatoid arthritis (RA), treat-to-target strategies require instruments for valid detection of joint inflammation. Therefore, imaging modalities are increasingly used in clinical practice. Optical spectral transmission (OST) measurements are non-invasive and fast and may therefore have benefits over existing imaging modalities. We tested whether OST could measure disease activity validly in patients with RA. Methods In 59 patients with RA and 10 patients with arthralgia, OST, joint counts, Disease Activity Score (DAS) 28 and ultrasonography (US) were performed. Additionally, MRI was performed in patients with DAS28<2.6. We developed and validated within the same cohort an algorithm for detection of joint inflammation by OST with US as reference. Results At the joint level, OST and US performed similarly inproximal interphalangeal-joints (area under the receiver-operating curve (AUC) of 0.79, p<0.0001) andmetacarpophalangeal joints (AUC 0.78, p<0.0001). Performance was less similar in wrists (AUC 0.62, p=0.006). On the patient level, OST correlated moderately with clinical examination (DAS28 r=0.42, p=0.001), and US scores (r=0.64, p<0.0001). Furthermore, in patients with subclinical and low disease activity, there was a correlation between OST and MRI synovitis score (RAMRIS (Rheumatoid Arthritis MRI Scoring) synovitis), r=0.52, p=0.005. Conclusions In this pilot study, OST performed moderately in the detection of joint inflammation in patients with RA. Further studies are needed to determine the diagnostic performance in a new cohort of patients with RA. PMID:26452538

  19. Septic arthritis of the temporomandibular joint as a complication of acute otitis media in a child: A rare case and the importance of real-time PCR for diagnosis.

    Science.gov (United States)

    Bast, F; Collier, S; Chadha, P; Collier, J

    2015-11-01

    We document the case of a 7-year-old boy who presented with pain in his left ear and trismus after a diagnosis of acute otitis media one week previously. His blood inflammatory markers were raised and magnetic resonance imaging (MRI) showed significant left temporomandibular joint effusion and partial attenuation of the left mastoid. A clinical diagnosis of septic arthritis of the TMJ was made and the patient was commenced on broad-spectrum antibiotics. Analysis using real time PCR enabled identification of the offending organism, confirmation of the diagnosis and antibiotic treatment to be specifically tailored for treatment.

  20. Wrist proprioceptive acuity: A comprehensive robot-aided assessment.

    Science.gov (United States)

    Cappello, Leonardo; Contu, Sara; Konczak, Juergen; Masia, Lorenzo

    2015-08-01

    Proprioception is the sense of the body awareness. Proprioceptive deficits represent frequent consequences of several neurological conditions like stroke, Parkinson's disease and others. The assessment of such somatosensory function is crucial, although the available clinical tests are not sensitive enough. The human wrist is a crucial joint for many activities of daily living and to address the lack of its characterization in terms of proprioceptive acuity the authors in previous studies proposed a novel method that combined the use of a 3-DoF robot and a threshold haunting paradigm. Further experiments were performed to characterize the proprioceptive acuity of the dominant wrist for adduction, extension, pronation and supination by using a 2-alternative-forced-choice test. The acuity thresholds obtained from six subjects (mean values ± standard deviation of 1.65±0.39 for extension, 1.13±0.34 for adduction, 1.90±0.58 for pronation and 1.70±0.30 for supination) were finally combined with the ones harvested in the previous studies for flexion and abduction in order to build the first comprehensive database of human wrist proprioceptive acuity.

  1. Report - Recurrent hip arthritis diagnosed as juvenile idiopathic arthritis: A case report.

    Science.gov (United States)

    Chang, Tung-Ming; Yang, Kuender D; Yong, Su-Boon

    2016-05-01

    Juvenile idiopathic arthritis is the most common rheumatic disease in childhood. It is a chronic inflammatory disease associated with arthritis of unknown etiology that begins before the age of 16 and persists for longer than 6 weeks. In this report, the case of a child who suffered recurrent alternative hip arthritis with bilateral hip arthritis is examined, in which he was finally diagnosed as suffering from Juvenile idiopathic arthritis. A 14-year-old boy of Taiwanese origin presented with a normal birth and developmental history. At the age of 10, right-side hip joint pain was experienced, which later migrated to the left side. On further inspection, synovium hypertrophy, cartilage erosion and hip turbid fluid accumulation were found and aseptic arthritis was presumed to be the primary cause. However, after re-examining both his clinical history and presentation, Juvenile idiopathic arthritis was the final diagnosis. Any child presenting with repeat joint swelling are at risk of Juvenile idiopathic arthritis. This is still to be the case if symptoms recede or heal and no initial diagnosis is made. Therefore, a better understanding of the risk of recurrent arthritis is needed. It cannot be emphasized strongly enough that Juvenile idiopathic arthritis should be suspected at all times when a child suffers from recurrent aseptic arthritis of the hip joint.

  2. [Juvenile idiopathic arthritis].

    Science.gov (United States)

    Herlin, Troels

    2002-08-19

    The new classification of juvenile idiopathic arthritis (JIA) is described in this review. Clinical characteristics divide JIA in to subtypes: systemic, oligoarticular (persistent and extended type), RF-positive and--negative polyarticular, enthesitis-related arthritis and psoriatic arthritis. In addition to the clinical characteristics, genetic and biochemical differences suggest that JIA could be regarded as a general term covering various diseases. Complications described are uveitis, temporomandibular joint affection and growth disturbances. The therapeutic strategy should be planned individually according to age, subtype and disease activity and carried out as teamwork with several specialties. Drugs showing significant effectiveness in controlled studies are primarily methotrexate and sulphasalazine. An immunomodulating agent, etanercept, a soluble TNF alpha-receptor fusion protein, has shown a promising effect in severe polyarticular JIA refractory to methotrexate treatment.

  3. The effect of isometric exercise of the hand on the synovial blood flow in patients with rheumatoid arthritis measured by color Doppler ultrasound.

    Science.gov (United States)

    Ellegaard, Karen; Torp-Pedersen, Søren; Lund, Hans; Pedersen, Kirsten; Henriksen, Marius; Danneskiold-Samsøe, Bente; Bliddal, Henning

    2013-01-01

    In 90% of patients with rheumatoid arthritis (RA), the joints of the hand are affected. Studies of grip strength training have not indicated a negative effect on disease activity after training. Introduction of ultrasound Doppler (USD) to measure increased blood flow induced by inflammation has made it possible to investigate the direct effect on blood supply in the synovium after training. In this case-control study, 24 patients with RA with USD activity in the wrist joint participated. The USD activity was measured by the color fraction (CF) (CF = colored pixels/total number of pixels in ROI). Twenty-four patients were assigned to an 8-week grip strength training program. At baseline and after 8 weeks of training, an USD examination of the wrist joint was performed. In the training group, we measured grip strength and pain in the wrist joint. Six patients withdrew from the training because of pain or change in medication. Eighteen patients served as control group. There was a modest, not significant, decrease in the CF in response to training (1.86%; P = 0.08). Grip strength increased 8.8% after training (P = 0.055). Pain in motion deceased after training (P = 0.04). No difference in the CF was seen between the training and control groups, neither at baseline nor at follow-up (P = 0.82 and P = 0.48). Patients withdrawing from training had a significantly higher CF than the other patients (P > 0.001). The results in this study might indicate that the flow in the synovium assessed by USD is not affected by grip strength training.

  4. Healthy Joints Matter

    Science.gov (United States)

    ... my joints more healthy? Definitions What can go wrong? Although you might think arthritis affects only older ... Discovery Into Health ® Home | Health Information | Research | Funding | News & Events | About Us | Portal en español | Asian-Language ...

  5. Lactobacillus casei reduces the inflammatory joint damage associated with collagen-induced arthritis (CIA) by reducing the pro-inflammatory cytokines: Lactobacillus casei: COX-2 inhibitor.

    Science.gov (United States)

    Amdekar, Sarika; Singh, Vinod; Singh, Rambir; Sharma, Poonam; Keshav, Poonam; Kumar, Avnish

    2011-04-01

    This study evaluated the therapeutic efficacy of Lactobacillus casei in treating rheumatoid arthritis using collagen-induced arthritis (CIA) animal model. Healthy female Wistar rats (weight-180-200 g) were included in this study. Oral administration of L. casei was started on the same day. Indomethacin was used as standard reference drug. Serum level of IL-6, α-TNF, and IL-10 were observed. Four-point arthritis indexes were also assessed at the end of week for 28th day. L. casei-treated rats had shown normal histopathology without any synovial infiltration, pannus formation, cartilage, and bone destruction. Arthritis score was also lower for the group treated with L. casei. Oral administration of L. casei significantly decreased the pro-inflammatory cytokines. Present study suggests that L. casei has potent antiarthritic effect in CIA model. Inhibition of COX-2 via inhibiting the pro-inflammatory cytokines is an understanding of the complex interactions involved in these pathways.

  6. A case of rheumatoid arthritis with blood magnet therapy%血液磁极化疗法治疗类风湿关节炎1例

    Institute of Scientific and Technical Information of China (English)

    邓农

    2003-01-01

    @@ CLINICAL MATERIALS The patient Zhang, a female of 37 years, was a nursery school teach-er. She began to have a pain in her proximal interphalangeal joints ofboth hands and could not clench her both fists after a cold. Then shehad edema, pain, stiffness, and limited activities in her both wrist,elbow and knee joints which were obvious in the morning. She hadbeen diagnesed as rheumatoid arthritis and treated with dexam-eththason, aspirin, and jinopirin per os but the therapeutic effect wasnot significant. The patient came to our magnet therapy center in Oc-tober 2000. Physical examination showed that body temperature was37. 4 ℃, blood pressure, 127/100 mmHg, normal development, eu-trophia, normal head shape, symmetric thorax, regular heart rhythm,with no pathological murmur, no abnormal respiratory sound heard,plane and soft abdomen, no touched liver or spleen, but obvious strongbowel sound. Local symptoms and signs included: pain and edema inphalangeal joints of both hands which could not clench, pain andstiffness and limited activities in both knee and elbow joints especiallyobvious in the morning. Laboratory examinarions showed normal bloodroutine examination results, 54 mm of blood sedimentation, andpositive rheumatoid factor. The diagnosis was rheumatoid arthritis.

  7. Bone pathology inpsoriatic arthritis

    Directory of Open Access Journals (Sweden)

    V. V. Badokin

    2007-01-01

    Full Text Available Objective. To study different variants of osteolysis in pts with psoriatic arthritis (PA and to reveal their relationship with other clinico-radiological features of joint damage. Material and methods. 370 pts with definite PA having different variants of joint damage were included. Radiological examination of bones and joints (in some cases large picture frame was performed. Morphological evaluation of synovial biopsies was done in 34 pts with PA and 10 pts with rheumatoid arthritis (RA. Results. Different types of osteolysis were revealed in 80 (21,6% pts. Osteolytic variant of joint damage was present in 29 pts. 33 pts had acral, 48 — intra-articular osteolysis and 16 - true bone atrophy. Frequency and intensity of bone resorption were associated with severity of PA. Acral osteolysis correlated with arthritis of distal interphalangeal joints and onychodystrophy. Intra-articular osteolysis was most often present in distal interphalangeal joints of hands and metacarpophalangeal joints (39,6% and 41,7% respectively. Characteristic feature of PA was combination of prominent resorption with formation of bone ankylosis and periosteal reaction. Ankylosis was present in 33,3% of pts with intra-articular osteolysis and in 60% of pts with combination of different osteolysis variants. Systemic reaction of microcirculation in synovial biopsies was most prominent in osteolytic variant: marked thickening of capillary and venule basal membrane with high level of acid phosphatase, increased capillary and precapillary blood flow with stasis features, vascular lymphocyte and macrophage infiltration, productive vasculitis with annular wall thickening, thrombovasculitis and villi deep layer sclerosis. Conclusion. Different variants of osteolysis show bone involvement in PA. Acral and intra- articular osteolysis association with bone ankylosis and periostitis proves their common pathogenetic entity.

  8. IMAGING OF PSORIATIC ARTHRITIS

    Directory of Open Access Journals (Sweden)

    S. D'Angelo

    2011-09-01

    Full Text Available Imaging of psoriatic arthritis (PsA is important for two reasons: the differential diagnosis from other arthritides and the assessment of structural damage that can be inhibited by the new drugs such as the anti-TNFα agents. Plain film radiographic findings of peripheral arthritis have been important in elaborating the concept of PsA as a separate disease entity. Characteristic aspects of psoriatic peripheral arthritis help the differentiation from rheumatoid arthritis. High-resolution ultrasonography (US, US combined with power Doppler (PDUS and magnetic resonance imaging (MRI can be used to image joint synovitis of PsA. Radiologic features of spondylitis associated with psoriasis are similar to spondylitis associated with reactive arthritis and differ from those of primary ankylosing spondylitis (AS and the spondylitis associated with inflammatory bowel disease. MRI is very sensitive for the early diagnosis of sacroiliitis. There have been no MRI studies on the spine of patients with PsA. In primary AS bone oedema in the vertebral bodies is an indicator of active disease and can ameliorate during anti-TNFα therapy. Historically, plain film radiography have played a pivotal role in defining enthesitis lesions of SpA. However, entheseal bone changes appear late. US and MRI have proved to be a highly sensitive and non invasive tools. Recent US and MRI studies on both finger and toe dactylitis have established that dactylitis is due to flexor tenosynovitis and marked adjacent soft tissue swelling with a variable degree of small joint synovitis. There is no evidence of enthesitis of the insertion of the flexor digitorum tendons and of the attachment of the caspsule of the digit joints. Key words: Enthesitis, dactylitis, spondyloarthritis, ultrasound, magnetic resonance, imaging

  9. THE CURATIVE EFFECT OF MINIMALLY INVASIVE TREATMENT OF 27 CASE OF GOUTY ARTHRI-TIS OF KNEE JOINT%微创治疗膝关节痛风性关节炎27例疗效观察

    Institute of Scientific and Technical Information of China (English)

    陶建峰; 王爱军; 陈德生; 赵立彦

    2014-01-01

    目的:探讨关节镜手术治疗膝关节痛风性关节炎的方法及疗效。方法应用关节镜微创技术对27例膝关节痛风性关节炎患者行关节清理、滑膜切除、半月板修整或切除及关节软骨修整,术后辅助药物治疗及功能康复练习。结果27例痛风性关节炎患者术中均可见不同程度的尿酸盐结晶沉积,术后肿痛症状均得到明显缓解,关节功能得到改善,随访6~36个月均得到满意疗效。结论对于内科治疗无效,反复发作或痛风石形成的膝关节痛风性关节炎,关节镜手术治疗具有诊断明确、创伤小、方法简单、效果显著等优点,可作为膝关节痛风性关节炎的外科治疗首选方法。%Objective To investigate the methods and efficacy of arthroscopic surgical treatment of knee gouty arthritis .Methods Arthroscopic minimally invasive techniques which included joint clean -up ,sy-novectomy ,trimming or removal of the meniscus and articular cartilage dressing were used in 27 patients with knee gouty arthritis ,postoperative assisted drug treatment and functional rehabilitation exercises .Re-sults Twenty -seven patients with gouty arthritis were seen in different levels of urate crystal deposition , postoperative swelling and pain symptoms were eased significantly improved joint function ,the outcome of followed up for 6~36 months were satisfied .Conclusions Arthroscopic surgery in the treatment of gouty arthritis of the knee has a clear diagnosis ,less invasive ,simple method ,significant effect .It can be used as the preferred method of surgical treatment of knee gouty arthritis .

  10. Can magnetic resonance imaging differentiate undifferentiated arthritis?

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Duer, Anne; Hørslev-Petersen, K

    2005-01-01

    A high sensitivity for the detection of inflammatory and destructive changes in inflammatory joint diseases makes magnetic resonance imaging potentially useful for assigning specific diagnoses, such as rheumatoid arthritis and psoriatic arthritis in arthritides, that remain undifferentiated after...... conventional clinical, biochemical and radiographic examinations. With recent data as the starting point, the present paper describes the current knowledge on magnetic resonance imaging in the differential diagnosis of undifferentiated arthritis....

  11. Septic arthritis in immunocompetent and immunosuppressed hosts.

    Science.gov (United States)

    Wang, Dingyuan Alvin; Tambyah, Paul Anantharajah

    2015-04-01

    Septic arthritis has long been considered an orthopedic emergency. Historically, Neisseria gonorrhoeae and Staphylococcus aureus have been the most common causes of septic arthritis worldwide but in the modern era of biological therapy and extensive use of prosthetic joint replacements, the spectrum of microbiological causes of septic arthritis has widened considerably. There are also new approaches to diagnosis but therapy remains a challenge, with a need for careful consideration of a combined medical and surgical approach in most cases.

  12. Galectin-3: A key player in arthritis.

    Science.gov (United States)

    Hu, Yong; Yéléhé-Okouma, Mélissa; Ea, Hang-Korng; Jouzeau, Jean-Yves; Reboul, Pascal

    2017-01-01

    Arthritis is more and more considered as the leading reason for the disability in the world, particularly regarding its main entities, rheumatoid arthritis and osteoarthritis. The common feature of arthritis is inflammation, which is mainly supported by synovitis (synovial inflammation), although the immune system plays a primary role in rheumatoid arthritis and a secondary one in osteoarthritis. During the inflammatory phase of arthritis, many pro-inflammatory cytokines and mediators are secreted by infiltrating immune and resident joint cells, which are responsible for cartilage degradation and excessive bone remodeling. Amongst them, a β-galactoside-binding lectin, galectin-3, has been reported to be highly expressed and secreted by inflamed synovium of rheumatoid arthritis and osteoarthritis patients. Furthermore, galectin-3 has been demonstrated to induce joint swelling and osteoarthritis-like lesions after intra-articular injection in laboratory animals. However, the mechanisms underlying its pathophysiological role in arthritis have not been fully elucidated. This review deals with the characterization of arthritis features and galectin-3 and summarizes our current knowledge of the contribution of galectin-3 to joint tissue lesions in arthritis.

  13. What Is Reactive Arthritis?

    Science.gov (United States)

    ... Arthritis PDF Version Size: 69 KB November 2014 What is Reactive Arthritis? Fast Facts: An Easy-to- ... Information About Reactive Arthritis and Other Related Conditions What Causes Reactive Arthritis? Sometimes, reactive arthritis is set ...

  14. Effect of a treat-to-target strategy based on methotrexate and intra-articular betamethasone with or without additional cyclosporin on MRI-assessed synovitis, osteitis, tenosynovitis, bone erosion, and joint space narrowing in early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Møller-Bisgaard, S; Ejbjerg, B J; Eshed, I;

    2017-01-01

    OBJECTIVES: To investigate whether a treat-to-target strategy based on methotrexate (MTX) and intra-articular (IA) betamethasone suppresses magnetic resonance imaging (MRI)-determined measures of disease activity and reduces joint destruction in early rheumatoid arthritis (eRA) patients, and to i......OBJECTIVES: To investigate whether a treat-to-target strategy based on methotrexate (MTX) and intra-articular (IA) betamethasone suppresses magnetic resonance imaging (MRI)-determined measures of disease activity and reduces joint destruction in early rheumatoid arthritis (eRA) patients......, and to investigate whether concomitant cyclosporin A (CyA) provides an additional effect. METHOD: In the 2-year randomized, double-blind, treat-to-target trial CIMESTRA, 160 patients with eRA (... no consistent statistically significant differences between treatment groups. CONCLUSIONS: In this eRA treat-to-target trial, MTX and intra-articular glucocorticoids markedly reduced, but did not eliminate, MRI osteitis, synovitis, and tenosynovitis. Accordingly, minimal but statistically significant increases...

  15. Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

    Science.gov (United States)

    Daily, James W; Yang, Mini; Park, Sunmin

    2016-08-01

    Although turmeric and its curcumin-enriched extracts have been used for treating arthritis, no systematic review and meta-analysis of randomized clinical trials (RCTs) have been conducted to evaluate the strength of the research. We systemically evaluated all RCTs of turmeric extracts and curcumin for treating arthritis symptoms to elucidate the efficacy of curcuma for alleviating the symptoms of arthritis. Literature searches were conducted using 12 electronic databases, including PubMed, Embase, Cochrane Library, Korean databases, Chinese medical databases, and Indian scientific database. Search terms used were "turmeric," "curcuma," "curcumin," "arthritis," and "osteoarthritis." A pain visual analogue score (PVAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used for the major outcomes of arthritis. Initial searches yielded 29 articles, of which 8 met specific selection criteria. Three among the included RCTs reported reduction of PVAS (mean difference: -2.04 [-2.85, -1.24]) with turmeric/curcumin in comparison with placebo (P turmeric/curcumin treatment (mean difference: -15.36 [-26.9, -3.77]; P = .009). Furthermore, there was no significant mean difference in PVAS between turmeric/curcumin and pain medicine in meta-analysis of five studies. Eight RCTs included in the review exhibited low to moderate risk of bias. There was no publication bias in the meta-analysis. In conclusion, these RCTs provide scientific evidence that supports the efficacy of turmeric extract (about 1000 mg/day of curcumin) in the treatment of arthritis. However, the total number of RCTs included in the analysis, the total sample size, and the methodological quality of the primary studies were not sufficient to draw definitive conclusions. Thus, more rigorous and larger studies are needed to confirm the therapeutic efficacy of turmeric for arthritis.

  16. Biomarkers of inflammation in patients with unclassified polyarthritis and early rheumatoid arthritis. Relationship to disease activity and radiographic outcome

    DEFF Research Database (Denmark)

    Knudsen, L.S.; Klarlund, M.; Skjodt, H.;

    2008-01-01

    OBJECTIVE: To determine plasma interleukin 6 (pIL-6), plasma vascular endothelial growth factor (pVEGF), and serum (s) YKL-40 in patients with early rheumatoid arthritis (RA) and unclassified polyarthritis (PA), and investigate their relationship with radiographic outcome. METHODS: pIL-6 and p......VEGF were determined by ELISA and sYKL-40 by an in-house radioimmunoassay in 51 patients with early RA and 21 with PA. Patients were followed with clinical and biochemical measurement every month for 2 years. Conventional radiographs of hands, wrists, and forefeet were scored according to the Larsen method......, and magnetic resonance imaging of 2nd to 5th metacarpophalangeal joints of the dominant hand were evaluated for presence or absence of bone erosions. RESULTS: Baseline pIL-6, pVEGF, sYKL-40, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were elevated in RA patients compared to healthy...

  17. Differentiation between early rheumatoid arthritis patients and healthy persons by conventional and dynamic contrast-enhanced magnetic resonance imaging

    DEFF Research Database (Denmark)

    Axelsen, Mette Bjørndal; Ejbjerg, B J; Hetland, M L

    2014-01-01

    OBJECTIVES: To identify the magnetic resonance imaging (MRI) parameter that best differentiates healthy persons and patients with early rheumatoid arthritis (RA), and to investigated responsiveness to treatment of various MRI parameters. METHOD: Conventional MRI and dynamic contrast-enhanced (DCE......)-MRI of the hand were performed once for 26 healthy persons, and before and after 6 and 12 months of disease-modifying anti-rheumatic drug (DMARD) treatment for 14 early RA patients, using a 1.0-T MRI unit. One-slice DCE-MRI was analysed using Dynamika version 4.2. The number of enhancing voxels (Nvoxel......), the initial rate of enhancement (IRE), the maximum enhancement (ME), ME×Nvoxel, and IRE×Nvoxel were calculated for wrist and 2nd-5th metacarpophalangeal (MCP) joints. Conventional MR images were evaluated using the RA MRI scoring system (RAMRIS) synovitis score. RESULTS: Using DCE-MRI, enhancement...

  18. A Conceptual Project of a Device for Human Wrist Functional Rehabilitation

    Science.gov (United States)

    Lewandowski, B.; Olinski, M.; Wudarczyk, S.; Gronowicz, A.

    2016-12-01

    In the paper, the problems of devices supporting functional rehabilitation of a human wrist were addressed. A literature review and a description of selected devices together with an indication of their advantages and disadvantages were conducted. The biomechanical structure of a human wrist was analyzed. On this basis and after taking into consideration ranges of motion of the selected joints the concept of a new mechanism was developed. A 3D model of the device was built in the Autodesk Inventor system. For the purpose of simulations another model was developed in the MSC Adams system. Issues of drives and sensors selection, as well as requirements for the control system, were examined.

  19. The discrepancy between clinical and ultrasonographic remission in rheumatoid arthritis is not related to therapy or autoantibody status.

    Science.gov (United States)

    Spinella, Amelia; Sandri, Gilda; Carpenito, Giacomo; Belletti, Lorenza; Mascia, Maria Teresa

    2012-12-01

    To evaluate the clinical remission by means of power Doppler ultrasonographic (PDUS) monitoring in a group of patients with rheumatoid arthritis (RA) in clinical remission (DAS28 therapy with DMARDS, anti-TNF, or no therapy in clinical remission according to ACR criteria and DAS 28 inflammation in the past. US examination evaluated the presence of active synovitis, power Doppler signal, and synovial hypertrophy on the following bilateral joints: metacarpophalangeal-proximal interphalangeal joints-flexor tendons (on 2°-3° fingers) and wrist (radiocarpal and midcarpal joints). In 19 patients, there was an agreement between clinical and US parameters. However, 35 patients with clinical remission showed a positive ultrasonographic assessment and at least an active parameter. No statistic correlation was found between US examination and antibody assessment (anti-CCP and/or RF). Patients in therapy with anti-TNF or other therapies showed similar US assessment without significant statistical differences. Among eleven patients that presented swollen and tender joints at the latest physical examination, which preceded US exam, just 5 patients had an US confirmation too. In the other patients, the PDUS did not confirm the presence of inflammation in the corresponding swollen and tender joints or showed a positive ultrasonographic assessment in other locations. The remission state is a great therapy target and not only through the biological therapy. Synovial inflammation could persist independently from type of therapy or autoantibody status.

  20. Cutaneous manifestations of rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Bhanu Prakash

    2015-02-01

    Full Text Available Rheumatoid arthritis (RA is a multisystem autoimmune disease, affecting the joints predominantly, and extra-articular sites like skin, lungs, heart etc. The American College of Rheumatology (ACR in collaboration with the European League Against Rheumatism (EULAR in 2010, revised the 1987 ACR classification criteria for RA. The criteria covered four areas (joint involvement, serodiagnosis, acute phase reactants, duration of arthritis and established a point value on a scale of 0 to 10. Patients with a value of 6 or higher are classified as having RA.

  1. A Robot for Wrist Rehabilitation

    Science.gov (United States)

    2007-11-02

    hand. After reviewing each of these kinematic options, a cardan joint was found to be the most appropriate (see Figure 3). A mockup is shown in figure 4...motors for pronation/supination. Because the flexion/extension and abduction/adduction Fig.2. Curved Slider Fig.3. Cardan Joint Kinematics Fig.4

  2. Reactive Arthritis

    Directory of Open Access Journals (Sweden)

    Eren Erken

    2013-06-01

    Full Text Available Reactive arthritis is an acute, sterile, non-suppurative and inflammatory arthropaty which has occured as a result of an infectious processes, mostly after gastrointestinal and genitourinary tract infections. Reiter syndrome is a frequent type of reactive arthritis. Both reactive arthritis and Reiter syndrome belong to the group of seronegative spondyloarthropathies, associated with HLA-B27 positivity and characterized by ongoing inflammation after an infectious episode. The classical triad of Reiter syndrome is defined as arthritis, conjuctivitis and urethritis and is seen only in one third of patients with Reiter syndrome. Recently, seronegative asymmetric arthritis and typical extraarticular involvement are thought to be adequate for the diagnosis. However, there is no established criteria for the diagnosis of reactive arthritis and the number of randomized and controlled studies about the therapy is not enough. [Archives Medical Review Journal 2013; 22(3.000: 283-299

  3. The paediatric wrist revisited - findings of bony depressions in healthy children on radiographs compared to MRI

    Energy Technology Data Exchange (ETDEWEB)

    Avenarius, Derk M.F.; Eldevik, Petter [University Hospital North Norway, Department of Radiology, Tromsoe (Norway); Ording Mueller, Lil-Sofie [University Hospital North Norway, Department of Radiology, Tromsoe (Norway); Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Owens, Catherine M. [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom); Rosendahl, Karen [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Department of Surgical Sciences, Bergen (Norway); Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom)

    2012-07-15

    The presence of erosions is used for diagnosis and monitoring of disease activity in juvenile idiopathic arthritis (JIA). Assessment of carpal bone erosions in children is challenging due to lack of normal references. To define normal appearances of bony depressions in the wrist on radiographs and MRI. MRI and radiography of the wrist were performed in 88 healthy children, 5-15 years of age. We assessed the number of bony depressions within the carpals/proximal metacarpals on both modalities, separately and combined. A total of 75 carpal depressions were identified on radiography compared to 715 on MRI. The number of bony depressions identified radiographically showed no statistically significant difference across age-groups. Within the metacarpals, there was no significant difference between bony depressions identified by MRI or radiography, except at the bases of the second metacarpal. Bony depressions that resemble erosions are normal findings in the wrist in children. MRI identifies more depressions than radiographs in the carpus. Some bony depressions occur at typical locations and should be accounted for when assessing the wrist in JIA to avoid overstaging. (orig.)

  4. Pseudoseptic pseudogout in progressive pseudorheumatoid arthritis of childhood.

    OpenAIRE

    Bradley, J D

    1987-01-01

    Progressive pseudorheumatoid arthritis of childhood is an uncommon arthropathy of unknown aetiology, which is related to spondyloepiphyseal dysplasia tarda. Previous reports have noted the absence of joint inflammation in this disease. An adult is described here with this arthropathy, who developed episodic acute inflammatory arthritis that mimicked septic arthritis, but proved to be pseudogout. The relation between pseudogout and progressive pseudorheumatoid arthritis of childhood is discussed.

  5. Bilateral Acromioclavicular Septic Arthritis as an Initial Presentation of Streptococcus pneumoniae Endocarditis

    Directory of Open Access Journals (Sweden)

    Neda Hashemi-Sadraei

    2014-01-01

    Full Text Available Infective endocarditis (IE is infrequently associated with septic arthritis. Moreover, septic arthritis of the acromioclavicular (AC joint is rarely reported in the literature. We report a case of Streptococcus pneumoniae IE in a patient who presented with bilateral AC joint septic arthritis and we review the literature on the topic.

  6. [Summary of the practice guideline 'Rheumatoid arthritis' (first revision) from the Dutch College of General Practitioners

    NARCIS (Netherlands)

    Wiersma, T.J.; Flikweert, S.; Bosch, W.J.H.M. van den

    2004-01-01

    The guideline covers the evaluation of patients with one or more painful joints without previous injury and focuses on the distinction between rheumatoid arthritis and other joint complaints. In the case of rheumatoid arthritis, the arthritis is based on aseptic synovitis and is nearly always associ

  7. The Sauvé-Kapandji procedure for posttraumatic wrist disorders: further experience.

    Science.gov (United States)

    De Smet, L A; Van Ransbeeck, H

    2000-06-01

    A prospective survey was conducted to evaluate the outcome of the Sauvé-Kapandji procedure for posttraumatic wrist disorders. Eighty four patients were treated, all with posttraumatic disorders of the distal radioulnar joint, 73 as an isolated procedure, 11 in combination with another wrist procedure. There was significant pain decrease and high patient satisfaction (74%). The range of motion increased in the flexion/extension arc from 109 degrees to 124 degrees (p = 0.006) and, in those with limited forearm rotation, from 71 degrees to 134 degrees (p = 0.006). According to the Mayo Clinic wrist score, we obtained 20 excellent, 34 good, 18 fair and 12 poor results. Complications were rare.

  8. Ultrasound-guided procedures around the wrist and hand: How to do

    Energy Technology Data Exchange (ETDEWEB)

    Orlandi, Davide; Corazza, Angelo [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Silvestri, Enzo [Diagnostica per Immagini, Ospedale Evangelico Internazionale, Corso Solferino 29A, 16100 Genova (Italy); Serafini, Giovanni [Dipartimento di Diagnostica per Immagini, Ospedale Santa Corona, Via XXV Aprile 38, 17037 Pietra Ligure, Savona (Italy); Savarino, Edoardo Vincenzo [Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Via Giustiniani, Padova (Italy); Garlaschi, Giacomo [Dipartimento di Scienze per la Salute, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Mauri, Giovanni [Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milano (Italy); Cimmino, Marco Amedeo [Dipartimento di Medicina Interna, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Sconfienza, Luca Maria, E-mail: io@lucasconfienza.it [Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milano (Italy); Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Piazza Malan 2, San Donato Milanese, Milano (Italy)

    2014-07-15

    Ultrasound has emerged as a low-cost, radiation-free and effective imaging technique to detect joint abnormalities and to guide percutaneous procedures. Being superficial, wrist and hand tendons and joints represent a good target to perform such procedures using ultrasound guidance. This kind of approach allows for a clear and real-time visualization of the needles during their whole path. In this setting, the knowledge of technical aspects and tips is essential to act in the most accurate way on target tissues that can be as small as a few millimetres. The aim of this review is to summarize the local treatments of inflammatory and degenerative disease described in literature (such as treatment of De Quervain's tenosynovitis, trigger finger, trapezio-metacarpal joint osteoarthritis, etc.), emphasizing precautions and tricks based on day-by-day experience that may help to improve the outcome of percutaneous ultrasound-guided procedures around the wrist and hand.

  9. Risk factors for hand-wrist disorders in repetitive work

    DEFF Research Database (Denmark)

    Thomsen, J. F.; Mikkelsen, S.; Andersen, JH

    2007-01-01

    OBJECTIVES: To identify the risk of hand-wrist disorders related to repetitive movements, use of hand force and wrist position in repetitive monotonous work. METHODS: Using questionnaires and physical examinations, the prevalence and incidence of hand-wrist pain and possible extensor tendonitis...... (wrist pain and palpation tenderness) were determined in 3123 employees in 19 industrial settings. With the use of questionnaires and video recordings of homogenous work tasks number of wrist movements, hand force requirements and wrist position were analysed as risk factors for hand-wrist disorders...

  10. Biologic therapy of rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Damjanov Nemanja

    2009-01-01

    Full Text Available Rheumatoid arthritis (RA and juvenile idiopathic/rheumatoid arthritis (JIA are chronic, inflammatory, systemic, auto-immune diseases characterized by chronic arthritis leading to progressive joint erosions. The individual functional and social impact of rheumatoid arthritis is of great importance. Disability and joint damage occur rapidly and early in the course of the disease. The remarkably improved outcomes have been achieved initiating biologic therapy with close monitoring of disease progression. Biologic agents are drugs, usually proteins, which can influence chronic immune dysregulation resulting in chronic arthritis. According to the mechanism of action these drugs include: 1 anti-TNF drugs (etanercept, infiximab, adalimumab; 2 IL-1 blocking drugs (anakinra; 3 IL-6 blocking drugs (tocilizumab; 4 agents blocking selective co-stimulation modulation (abatacept; 5 CD 20 blocking drugs (rituximab. Biologics targeting TNF-alpha with methotrexate have revolutionized the treatment of RA, producing significant improvement in clinical, radiographic, and functional outcomes not seen previously. The new concept of rheumatoid arthritis treatment defines early diagnosis, early aggressive therapy with optimal doses of disease modifying antirheumatic drugs (DMARDs and, if no improvement has been achieved during six months, early introduction of biologic drugs. The three-year experience of biologic therapy in Serbia has shown a positive effect on disease outcome.

  11. [Functional results after proximal row carpectomy (PRC) in patients with SNAC-/SLAC-wrist stage II].

    Science.gov (United States)

    Baumeister, S; Germann, G; Dragu, A; Tränkle, M; Sauerbier, M

    2005-04-01

    The proximal row carpectomy (PRC) is a motion preserving procedure which creates a new joint without arthrosis. It is a frequently used procedure in stage II of a posttraumatic degenerative arthrosis of the wrist after scaphoid nonunion or scapholunate ligament instability (SNAC-/SLAC-wrist). In this retrospective analysis the functional postoperative results of this operation are compared in light of a homogenous indication (SNAC-/SLAC-wrist stage II). In 38 patients PRC was performed for a stage II SNAC- (n = 29) or SLAC-wrist (n = 9) between June 1994 and March 2002. Postoperative examination included range of motion and grip strength. Pain was assessed using a visual analogue scale (VAS 0 - 100). The DASH questionnaire (disability of the arm, shoulder and hand) was used to evaluate the disabilities in activities of daily living (ADL). Thirty patients (79 %) with a mean age of 39 years (23 - 59) were evaluated with a mean follow-up of 27 months (6 - 100). Mean extension and flexion of the wrist reached 75 degree which was 57 % of the contralateral hand. Mean radial and ulnar deviation was 33 degree corresponding with 52 % of the contralateral hand. The average grip strength was 50 % of the unaffected side. The postoperative DASH score was 27.4. Pain with strenuous activity was reduced by 40 %, resting pain by 77 %. Three patients showed radiological signs of a radiocapitate arthrosis, one patient needed conversion into a complete wrist arthrodesis. Our results are in concordance with the literature. However, our follow-up time is relatively short and we cannot make any conclusion about the long-term outcome. PRC is a technically straightforward procedure for treatment of carpal collapse. For stage II of the SNAC-/SLAC-wrist we consider the resection of the proximal carpal row an alternative procedure to the midcarpal arthrodesis particularly in patients who require less grip strength and when a shorter postoperative immobilization is reasonable.

  12. Three-dimensional Doppler ultrasound findings in healthy wrist and finger tendon sheaths

    DEFF Research Database (Denmark)

    Ammitzboll-Danielsen, Mads; Janta, Iustina; Torp-Pedersen, Søren;

    2016-01-01

    BACKGROUND: The aim was to investigate the presence of feeding vessels in or in close proximity to extensor and flexor tendon sheaths at the wrists level and in finger flexor tendon sheaths in healthy controls, using 3D ultrasound (US), which may cause pitfalls, in order to ensure correct...... interpretation of Doppler signals when diagnosing tenosynovitis. METHOD: Forty healthy participants (20 women and 20 men age 23-67 years) without prior history of arthritis, tendon diseases or present pain in their hands were included. Twenty participants had 3D Doppler US of the second and third finger...... and twenty of the right wrist. US was carried out using a GE Logiq E9 unit with a 3D US probe. The colour Doppler settings were to published recommendation. RESULTS: The feeding vessels in or in close proximity to the tendon sheaths were found in the flexor and extensor tendons sheaths at least once in each...

  13. Home Care Guide on Juvenile Rheumatoid Arthritis (For Parents).

    Science.gov (United States)

    Giesecke, Linda L.; And Others

    The booklet, written by the medical staff of a children's hospital, provides information for parents of children with juvenile rheumatoid arthritis (JRA). Arthritis is a swelling of the joint(s) in children and lasts for over 6 weeks (sometimes many years). Aspirin is the main medicine given for JRA, and it works not only to control pain but also,…

  14. The Child with Arthritis in the School Setting

    Science.gov (United States)

    Sanzo, Maria

    2008-01-01

    Arthritis is a condition often associated with the elderly. However, arthritis affects approximately 275,000 children nationwide. Symptoms may vary from one swollen joint to multiply affected joints coupled with fatigue, fever, and rash. Its effect on the school-age child can range from missing a few days of school per year to hospitalizations…

  15. Design of a Compact, Reconfigurable, Prosthetic Wrist

    Directory of Open Access Journals (Sweden)

    Arthur Zinck

    2012-01-01

    Full Text Available The design of a prosthetic wrist is the result of compromises between the function and the practicality of the device. Conventional prosthetic wrists use a single degree of freedom to produce pro/supination of the hand. It has not been demonstrated that this is the most functional alignment for a single axis. Previous work by the authors suggests that if the wrist must have only one rotatory axis then a more oblique orientation would be more functional. To test this idea, a compact wrist with a single axis and spherical design has been made that will allow any axis of rotation to be selected and the functional performance of the resulting arm be tested.

  16. Favorable results after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E. H.; Herzberg, G.; Merser, Søren

    2013-01-01

    Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non....... The wrists had been reviewed annually and analysis was done on the latest follow-up data. Results 60 patients had been operated (5 bilaterally), 5 wrists had been revised, and 52 were available for follow-up (with the revised cases excluded). The pain scores, QuickDASH scores, ulnar flexion, and supination...... for the whole group were statistically significantly better at follow-up. There were no statistically significant differences between the rheumatoid and the non-rheumatoid patients except for motion, which was better in the non-rheumatoid group. The motion obtained depended on the preoperative motion. Implant...

  17. Carpal kinematics in quadrupedal monkeys: towards a better understanding of wrist morphology and function.

    Science.gov (United States)

    Daver, Guillaume; Berillon, Gilles; Grimaud-Hervé, Dominique

    2012-01-01

    The purpose of this study is to provide new data on carpal kinematics in primates in order to deepen our understanding of the relationships between wrist morphology and function. To that end, we provide preliminary data on carpal kinematics in seven species of quadrupedal monkeys that have not been previously investigated in this regard (cercopithecoids, n = 4; ceboids, n = 3). We radiographed wrists from cadavers at their maximum radial and ulnar deviations, as well as at maximum flexion and extension. We took angular measurements to quantify the contribution of the mobility of the two main wrist joints (antebrachiocarpal and midcarpal) with respect to total wrist mobility. We also recorded qualitative observations. Our quantitative results show few clear differences among quadrupedal monkeys for radioulnar deviation and flexion-extension: all the primates studied exhibit a greater midcarpal mobility (approximately 54-83% of the total range of motion) than antebrachiocarpal mobility; however, we identified two patterns of carpal kinematics that show the functional impact of previously recognised morphological variations in quadrupedal monkeys. Firstly, qualitative results show that the partition that divides the proximal joint of the wrist in ceboids results in less mobility and more stability of the ulnar part of the wrist than is seen in cercopithecoids. Secondly, we show that the olive baboon specimen (Papio anubis) is characterised by limited antebrachiocarpal mobility for extension; this effect is likely the result of a radial process that projects on the scaphoid notch, as well as an intraarticular meniscus. Because of these close relationships between carpal kinematics and morphology in quadrupedal monkeys, we hypothesise that, to some extent, these functional tendencies are related to their locomotor hand postures.

  18. Computed tomographic feature of tuberculous arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hak Hee; Lee, Hae Giu; Cha, Eun Suk; Kang, Kyung Jin; Jeon, Jeong Su; Park, Young Ha; Yim, Jung Ik; Bahk, Yong Whee [Catholic University Medical Collage, Seoul (Korea, Republic of)

    1992-07-15

    The sparsity of publication concerning CT findings of tuberculous arthritis prompted authors to retrospectively evaluate 12 patients with tuberculous arthritis for characteristic CT findings. In each patients, the diagnosis of tuberculous arthritis was confirmed by surgery or biopsy. The CT examinations were evaluated by two radiologists retrospectively. Involved joints were the hip joint in seven patients, the sacroiliac joint in three patients, and the shoulder and ankle joint in one patient each. CT features included subchondral bony erosion(12 patients), soft tissue mass in the joint space(nine), widening of the joint space(eight), ipsilateral music atrophy(eight), thickening of the joint capsule(seven), intra-articular effusion(six), soft tissue abscess(five), and bony sclerosis(four). In seven patients with the duration of symptoms less than 1 year, thickening of joint capsule and intra-articular effusion were the predominant findings, while bony sclerosis, gross bone destruction, and soft tissue mass in joint space were seen in five patients with the duration of symptoms longer than 1 year. Our results indicate that CT is useful in the diagnosis of tuberculous arthritis by demonstrating characteristic pathologic changes of the joint space, soft tissue abnormality and bony involvement.

  19. 小针刀结合手法对髌骨骨折内固定术后膝关节创伤性关节炎的治疗效果观察%Curative Effect Observation on Needle Knife Combined With Manipulation on Patella Fracture After Internal Fixation of Knee Joint Traumatic Arthritis

    Institute of Scientific and Technical Information of China (English)

    乔正华

    2015-01-01

    ObjectiveTo observe the summary with needle knife combined with surgery for patelar fracture by internal fixation after traumatic arthritis of knee joint treatment effect.Methods Study from 32 cases of patelar fracture by internal fixation after knee joint traumatic arthritis patients with smal needle knife combined with surgical treatment.Results32 cases of patelar fracture internal fixation after the treatment of traumatic arthritis of the knee joint was 93.8%.Conclusion Patelar fracture after internal fixation of knee joint traumatic arthritis patients with needle knife combined with operation therapy significantly.%目的:观察总结小针刀结合手法对髌骨骨折内固定术后膝关节创伤性关节炎的治疗效果。方法研究收治的32例髌骨骨折内固定术后膝关节创伤性关节炎患者用小针刀联合手法治疗效果。结果32例髌骨骨折内固定术后膝关节创伤性关节炎治疗后优良率为93.8%。结论髌骨骨折内固定术后膝关节创伤性关节炎患者实施小针刀结合手法治疗疗效显著。

  20. Acromioclavicular septic arthritis and sternoclavicular septic arthritis with contiguous pyomyositis.

    Science.gov (United States)

    Corey, Sally A; Agger, William A; Saterbak, Andrew T

    2015-03-01

    Acromioclavicular (AC) and sternoclavicular (SC) septic arthritis with contiguous pyomyositis are rare, especially in immunocompetent individuals. We report a case of septic AC joint with pyomyositis of the deltoid and supraspinatus muscles and a separate case with septic SC joint with pyomysitis of the sternocleidomastoid muscle. Both patients had similar presentations of infections with Staphylococcus aureus and were successfully treated with surgical incision and drainage followed by prolonged antibiotic therapy.