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Query: UMLS:C0003864 (arthritis)
 69,039 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neurologic disease is reported to occur in just 10% of patients with mixed connective tissue disease (MCTD). Most commonly, this is manifested by mild trigeminal neuralgia. This report details the clinical and neuropathologic findings of transverse myelitis in a patient with MCTD. Neurologic features include progressive areflexic paraplegia with loss of bowel and bladder function. Neuropathologically there was thinning of the thoracic cord, widespread loss of axons and myelin sheaths, reactive astrocytosis, macrophage formation, vascular thickening with perivascular chronic inflammatory cell infiltration, and calcium deposits. This case demonstrates that severe neurologic disease unresponsive to therapy can occur in MCTD.
Arthritis Rheum
PMID:Transverse myelitis in mixed connective tissue disease. 73 23

In early 1989, the Research Committee of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) established a subcommittee to develop methods to monitor academic progress in physical medicine and rehabilitation (PM&R) units in the US. To develop an indirect baseline of academic productivity in PM&R, the rates and types of publications by PM&R researchers were assessed in eight peer review medical journals. The journals selected consisted of all issues of the following (published in calendar years 1987 to 1989): Archives of Physical Medicine and Rehabilitation, American Journal of Physical Medicine and Rehabilitation, Physical Therapy, Archives of Neurology, Pain, Stroke, Paraplegia, and Arthritis & Rheumatism. The sampling frame consisted of 3,553 journal articles. Affiliation with a PM&R unit or other clinical science unit (other unit), extramural funding sources, and type of manuscript (eg, case report or scientific investigation) were identified and coded. Sixteen percent of all articles were authored by members of PM&R units. The prevalence of scientific reports written by other unit authors (71%) was comparable to that written by PM&R authors (67%) (chi 2[3] = 5.54; p less than .20). There was a greater prevalence of funding by the US Department of Education of studies written by PM&R authors (10%) than of studies written by members of other units (2%) (chi 2[1] = 79.4; p less than .0001). Reports authored by members of other units had a greater prevalence rate of funding from all other sources--federal and private (47% vs 33%; chi 2[1] = 41.2; p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Elements of academic productivity: a comparison of PM&R units versus other clinical science units. 192 3

A histological study of transverse sections of lumbar facet joints from 36 lumbar spines of subjects dying from serious trauma revealed injuries not visible on standard radiography, and in a high percentage of joints. They include fractures of the superior articular process, central infractions of the subchondral bone plate, and tears of the articular capsule, including the ligamentum flavum. The facet joint injuries in young subjects were almost entirely absent from the facet joints of a comparable group of young subjects with no recent history of major trauma. The injuries resemble some of the 'age changes' seen in older subjects dying non-violent deaths. It is suggested that such injuries may lead to early onset facetal arthritis in survivors of major trauma.
Paraplegia 1990 Feb
PMID:Bone and soft tissue injuries in post-mortem lumbar spines. 223 21

Pain is the earliest and most prominent feature of symptomatic spinal metastases. In some cases, pain may have been present for months and dismissed as arthritis or back strain. Local back or neck pain occurring in a cancer patient is due to spinal metastasis until proved otherwise. Once weakness occurs, the disease progresses to paraplegia unless treatment is undertaken. Pedicle erosion is the most common abnormality on spinal films. Irradiation is often effective, but surgery is indicated for radiation failure, unknown diagnosis, pathologic fracture-dislocation and rapid disease progression.
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PMID:Symptomatic spinal metastases. 252 57

Heterotopic ossification is a recognized complication in patients with head injury, burns, paraplegia, or direct trauma to muscle tissue. Heterotopic ossification with hemiplegia following stroke is considered rare. A case of a 53-year-old patient with right hemiplegia who developed painful right hip, limiting range of movement and progress in ambulation, is presented. X-ray and laboratory tests confirmed the presence of heterotopic ossification, suggesting that this condition may not be so rare in patients with a cerebrovascular accident, but may escape recognition, with pain being considered to stem from soft-tissue strain, premorbid arthritis, or altered sensation commonly associated with stroke.
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PMID:Heterotopic ossification in hemiplegia following stroke. 357 39

Seven patients with neuromuscular disorders were examined, including one with cerebral palsy, one with Duchenne muscular dystrophy, two with paraplegia, and three with poliomyelitis; all exhibited skeletal changes mimicking those found in juvenile rheumatoid arthritis and hemophilia. These findings included apparent overgrowth of the epiphyses, periarticular osteoporosis, and joint-space narrowing in seven subjects; accentuation of the trabecular pattern in six; gracile bones and soft-tissue wasting in five; tibiotalar slant in two; and premature epiphyseal closure in one. Changes in osseous vascular dynamics and the debilitation or immobilization found both in patients with neuromuscular disorders and those with arthritis may help explain these overlapping findings. While the clinical distinction between the neuromuscular and arthritic disorders is straightforward, the similarity in radiographic appearance has received little attention. If the clinical history is inadequate, this may result in confusion or misinterpretation by the radiologist. In the absence of more specific findings, such as articular erosions or erosions of the femoral intercondylar notch, the differential diagnosis may be mistakenly limited to juvenile rheumatoid arthritis and hemophilia. In such cases, the neuromuscular disorders should also be considered in the differential diagnosis.
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PMID:Skeletal changes in neuromuscular disorders mimicking juvenile rheumatoid arthritis and hemophilia. 633 2

The Girdlestone procedure which originally was developed for the treatment of tuberculosis of the hip has found a place in the management of septic hip arthritis and osteomyelitis secondary to pressure sores in spinal cord injury and other myelopathies. Eradication of the septic focus is necessary if amyloid disease is to be prevented. Early diagnosis and aggressive surgery are essential. Surgical treatment entails not only bone removal, but also a thorough joint debridement. This procedure goes hand-in-hand with the appropriate antibiotic treatment given intravenously for an adequate time (4-6 weeks). When available, hyperbaric oxygen therapy is a good treatment. It is important to obliterate a large pseudoarthrosis cavity by muscle transfer from the thigh using a hamstring or a vastus lateralis. Irrigation, suction and drainage are important until the would heals. In summary, 39 patients had 42 Girdlestone procedures without any operative mortality. Seventy percent of the wounds had healed and 30% failed to heal requiring another operation. Recurrences were observed in 10% of the patients, and these cases needed another operation together with hyperbaric oxygen therapy. Eight patients died due to other causes unrelated to the operation. The procedure is rather simple but needs prolonged postoperative care, especially with wound failure or recurrences.
J Am Paraplegia Soc 1983 Oct
PMID:The Girdlestone procedure in spinal cord injured patients: a ten year experience. 664 90

To date, 271 cases of HTLV1-associated paraplegia have been observed in Martinique (French West Indies). The clinical picture consisted mostly in a spastic paraparesis or paraplegia with sphincter disturbances (80%) and lower limbs pains (60%). The severity of the disease appeared variable: after a mean disease duration of 6.5 years, 40% of the patients could walk without help, 35% used a single crutch, and 25% used a couple of crutches or were confined to a wheelchair. A variable neuromuscular component was observed in 70 cases (25.4%). In 38 cases, the peripheral signs (SIGNS) or the myositis were only mild. In contrast, 25 patients presented with severe amyotrophy evoking amyotrophic lateral sclerosis, and 7 other had features of dermatopolymyositis. Lastly, an extra-neural spreading of the disease was extremely frequent, including lymphocytic alveolitis (76%), sicca syndrome (69%) and more rarely uveitis, arthritis or vasculitis.
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PMID:[Paraplegia associated with HTLV 1 in Martinique. Study of 271 cases including 70 with neuromuscular involvement]. 781 96

The purpose of this study was to document what proportion of noninstitutionalized users of manually propelled wheelchairs are affected by wheelchair-related accidents caused by tips and falls, determine the nature and severity of the resulting injuries, and, by comparison with an unaffected group, identify factors associated with the risk of such accidents. We administered a postal questionnaire to as many as possible of the estimated 2055 members of the target population in the province of Nova Scotia. Among the 577 appropriate respondents, 57.4% reported they had completely tipped over or fallen from their wheelchairs at least once, and 66.0% reported having partially tipped. Of the falls and tips that were reported, 46.3% were forward in direction, 29.5% backward and 24.2% sideways. Many of the accidents occurred outdoors or on ramps. A total of 292 injuries were reported by 272 (47.1%) respondents. Most of the injuries (84.3%) were minor (e.g., abrasions, contusions, lacerations and sprains). Of the 15.8% of injuries that were serious, the most common were fractures (10.6%) and concussions (2.7%). Factors that appear to be associated with an increased risk of accidents and injuries included younger age, male gender, paraplegia or spina bifida as the reason for wheelchair use, having had a wheelchair prescribed, some wheelchair features (lightweight, camber, adjustable rear-axle positions, a knapsack), daily use of a wheelchair, propelling the chair with both hands, use of the wheelchair for recreation, use of a sideways transfer (without a transfer board) and doing repairs themselves or having them done by the dealer. Factors associated with a decreased risk include multiple sclerosis, stroke or arthritis as the reason for wheelchair use, attendant propulsion and the use of a one-person assist for transfers. The results of this study, that wheelchair-related accidents caused by tips and falls are very common, that serious injuries are not unusual and that there is a pattern of risk factors, should be useful to wheelchair users, clinicians, manufacturers and regulatory bodies.
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PMID:Wheelchair-related accidents caused by tips and falls among noninstitutionalized users of manually propelled wheelchairs in Nova Scotia. 791 61

Pressure sores are a common complication after spinal cord injury. But great advances in their management (nursing care, prevention and surgery) have been made in the last four decades. Neglected pressure ulcers may affect the adjacent joint, leading to septic arthritis. We report a paraplegic patient with a large trochanteric sore with hip arthritis, in whom we performed an upper femoral resection and acetabular curettage (Girdlestone's technique) and coverage with the homolateral vastus lateralis muscle flap in one stage. Some questions pertaining to this operation are discussed and there is a comparison with other ways of management described in the literature. We conclude that a successful outcome with the management of such large sores depends on a radical, aggressive operation to remove all of the affected tissue, and ensure a safe coverage with a reliable, viable muscle flap. The collaboration and the positive attitude of the patient towards the procedure and the result obtained are decisive in preventing recurrences.
Paraplegia 1993 Feb
PMID:A complicated trochanteric pressure sore: what is the best surgical management? Case report. 844 56


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