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

We have proposed an alternate assignment criterion for rheumatoid arthritis (RA), pain on squeezing the MCP or MTP joints. The performance of this criterion has been evaluated in 90 patients with RA and in 122 patients with other rheumatological disorders (non-RA). The proportions of patients with various numbers of sites positive (from 0 to 4) were assessed according to diagnosis; most patients with RA had at least one site positive, in comparison to non-RA where most patients had no sites positive. The diagnostic performance of 2+ or 3+ sites was similar, but 3+ is probably preferable because this simultaneously indicated both symmetry and hand and foot involvement. In conclusion, the lateral MCP/MTP squeeze performs well in comparison to many other existing clinical criteria for RA and could substitute for non-independent features (e.g. swelling and arthritis). It is easier to elicit than searching for pain and/or tenderness as fewer sites have to be examined and inter-observer variation was less than with many other clinical criteria.
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PMID:The lateral metacarpophalangeal/metatarsophalangeal squeeze: an alternative assignment criterion for rheumatoid arthritis. 203 Nov 55

Hypermobility of the first ray is one of the causative components in common foot problems (such as hallux valgus) with a large intermetatarsal angle and metatarsus primus varus. Although not always associated with hallux valgus, hypermobility is a predisposing factor for this deformity, especially in conjunction with extrinsic factors, such as disruption of the plantar first metatarsal cuneiform ligament and tendon-muscle imbalance. Hypermobility is also frequently found in adolescents with hallux valgus, especially when associated with a large intermetatarsal angle. Motion at the first metatarsocuneiform joint occurs in the sagittal and transverse planes. Most studies agree that greater than 4 degrees and greater than 8 degrees, respectively, constitutes excessive motion. Clinically, hypermobility is evaluated by determining sagittal motion (the grasping test) and transverse motion (the clinical squeeze test) and by identifying signs such as the presence of a dorsal bunion, intractable plantar keratosis beneath the second metatarsal head, and arthritis of the first and second metatarsocuneiform joint. Radiographically, hypermobility is evaluated by measurements from the modified Coleman block test (for sagittal motion) and the radiographic squeeze test (for transverse motion) and by the identification of signs, such as cortical hypertrophy along the medial border of the second metatarsal shaft, a cuneiform split, the presence of os intermetatarseum, and the round shape and increased medial slope of the first metatarsocuneiform joint. Usually, treatment for hypermobility of the first ray is operative, but surgery is contraindicated for patients less than 20 years of age (especially when the epiphysis is not closed) and for patients with generalized ligamentous laxity, short first metatarsal, and arthritis of the hallux MTP joint. The authors' surgical treatment of choice is arthrodesis of the tarsometatarsal joint (as part of the hallux valgus correction), exostectomy, capsulorraphy, and distal soft tissue release to correct and stabilize the first metatarsal at the apex of the deformity. The authors have found it unnecessary to include the base of the second metatarsal. The main complications associated with the Lapidus procedure and its modifications are nonunion, malunion, and dorsal elevation of the first metatarsal. Although radiographic nonunion is the most frequent complication, only 25% of the patients with this condition have associated clinical findings; the results have been defined as good or excellent in two series. These results closely equal those in rheumatoid or sedentary patients managed with newer, modified, less traumatic techniques that stabilize the first metatarsocuneiform joint with screws rather than with arthrodesis.
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PMID:Hypermobility of the first ray. 1123 92

A 38-year-old female patient developed the symptoms and signs of arthritis in the right tarsal joint for the first time after 14 asymptomatic years following an ileo-colic intestinal bypass operation which had been performed as an emergency procedure for acute ileus due to intestinal adhesions caused by the previous abdominal surgery. Her arthritis took a progressively severe course thereafter, primarily involving the joints of both lower extremities, and 13 years after the onset of symptoms she still continued to have active polyarthritis. However, no concomitant skin lesions of any form had been recognized throughout the course of the arthritis. On the articular radiographs erosive changes were evident in the right tarsal joints and also in the MTP joints of both big toes. Laboratory examinations of the serum revealed negative results for rheumatoid factor, circulating immune-complexes, anti-nuclear antibodies, and anti-DNA antibodies, while the serum level of CRP as well as the erythrocyte sedimentation rate were elevated. Other routine laboratory tests were all unremarkable, and neither HLA-B 27 nor HLA-DR 4 were positive. Therapeutic drug regimens consisting of NSAIDs, oral as well as intraarticular steroids, DMARDs, methotrexate, and combinations of these drugs were unsuccessful in controlling the severe symptoms of the arthritis. In view of this, a revision operation of intestinal bypass was performed 13 years after the onset of the arthritis. After the revision the severe pain of the arthritis began to subside gradually, and 1 year and 6 months later the patient achieved complete remission of the arthritis, and her CRP and ESR values returned to normal.
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PMID:[A case of chronic erosive polyarthritis which developed 14 years after an intestinal bypass operation with subsequent remission by intestinal revision]. 1172 68

Osteoarthritis (OA) is the most common form of arthritis and patients with meniscal and ligament injuries of the knee are at high risk to develop the disease. The purpose of this study was to evaluate molecular and structural changes occurring in four articular cartilage (AC) regions from the knees of anterior cruciate ligament (ACL)-transected rabbits at 3 and 8 weeks post-surgery. Rabbit AC from the lateral and medial femoral condyles (LFC and MFC) as well as from the medial and lateral tibial plateau (MTP and LTP) were processed for histology and for semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) analysis for a subset of relevant molecules (collagen II, aggrecan. biglycan, decorin, fibromodulin, MMP-1, -3, -13, and TIMP-1). While the most severe histological changes were observed in the MTP starting as early as 3 weeks post-ACL transection based on Mankin scores, histological examination demonstrated a progression of osteoarthritic changes in the MFC from 3 to 8 weeks post-surgery. In contrast, very few changes were observed within both the LFC and LTP, and these changes did not worsen with increasing time after surgery. The water content increased significantly in the MFC at 8 weeks post-ACL transection and at both 3 and 8 weeks post-ACL transection in the MTP. Significant decreases in DNA content were observed for the MFC, LTP and MTP at 8 weeks post-ACL transection. Total RNA yields from the MFC and MTP were significantly elevated at 8 weeks post-ACL transection, while in the lateral compartment total RNA was unchanged following ACL transection. Analysis of mRNA levels for a subset of matrix molecules, proteinases and proteinase inhibitors, by RT-PCR demonstrated significant region-specific changes at the mRNA level following ACL transection. These results show that following ACL transection, complex molecular, as well as structural changes occur early in cartilage and that the observed changes are both region-specific and time-dependent.
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PMID:Assessment of specific mRNA levels in cartilage regions in a lapine model of osteoarthritis. 1203 28

First MTP joint arthrodesis continues to be a time-honored, effective, and valuable procedure as a primary or secondary surgery for various pathologies afflicting the first ray segment. Though commonly thought of as a salvage procedure, it has proven beneficial in the management of primary hallux limitus and rigidus, geriatric hallux valgus deformity, severe arthritis of any etiology, and conditions in which joint instability or deformity are not readily correctable by more traditional approaches. Since its initial description in the 1800s, the procedure has continued to be popular among orthopedic and podiatric surgeons. Success of the procedure is highly dependent on the position of fusion. Though surgeons are often fascinated and at times obsessed with a particular fixation technique, it cannot be over-emphasized that this takes a back seat to the importance of achieving proper position to meet the needs of an individual patient. Unlike joint resection or implant arthroplasty procedures, which commonly leave the hallux lacking stability and propulsion, first MPJ fusion has been shown to be effective during weight bearing and propulsion. The success enjoyed by the senior author continues to reinforce that motion is not necessary at the first MTP joint for good, pain-free function.
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PMID:First metatarsophalangeal joint arthrodesis. 1501 33

Podagra is a term used to describe acute monoarthritis of the first metatarsophalangeal (1st MTP) joint. The most common diagnoses of arthritis in this joint are: crystal-induced synovitis, septic arthritis, traumatic conditions and reactive arthritis. When etiologies other than gout are involved this is frequently referred to as pseudopodagra. We report the case of a patient who presented with pain and swelling of the 1st MTP The absence of intraarticular crystals and hyperuricemia encouraged further evaluation of the patient. A cardiac murmur was investigated by echocardiography, which revealed valvular vegetations and the diagnosis of infective endocarditis (IE) was established. This is the first reported case of a podagra-like presentation of IE. As in this case, the diagnosis of gout should rest on findings beyond the presence at 1st MTP arthritis, with evaluation of all extraarticular signs in order to rule out other possible diagnoses.
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PMID:Pseudopodagra: A presenting manifestation of infective endocarditis. 1589

Rheumatoid Arthritis is a chronic disease of unknown origin. It affects the joints, but also virtually every other organ. Its cause remains still unknown. The prevalence rate is approximately 1% worldwide, with some racial differences. Women are affected three times more often than men. Symmetric swelling of the joints and a substantial morning stiffness are the typical signs of the disease. Most often the wrists, MCP and PIP joints, and the ankle and MTP joints are affected. The arthritis is usually progressive, leading to destructive changes of the affected joints. Neurological symptoms can occur following destruction of the atlantoaxial joint. Diagnosis and classification of the disease follows the 1987 revised American Rheumatism Association criteria, but for practical purposes the approach described by Visser et al. seems more useful, calculating odds ratios for persisting and erosive disease. Effective treatment can start earlier with this approach. Conventional radiology and serum markers, especially the newer antibodies against CCP are important aids in diagnosing rheumatoid arthritis. Diseases to be separated from rheumatoid are other arthritides of autoimmune origin, the cristal arthropathies, vasculitides, septic and parainfectious arthritides, osteoarthritis, and paraneoplastic syndromes.
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PMID:[Rheumatoid arthritis--clinical picture and important differential diagnoses]. 1594 14

Osteoarthritis is the commonest form of arthritis, at least amongst Caucasians and is frequently polyarticular. Genetic factors are now considered pivotal in the aetiopathogenesis of polyarticular osteoarthritis (POA). This document proposes a nexus between the gene most commonly mutated amongst Caucasian peoples, notably the HFE gene and an appreciable subset of POA patients who have a clinically recognisable OA phenotype. It is hypothesised that there are at least 2 major POA phenotypes each of which is associated with discrete genotypes. Type 1 POA characterized by Heberden's or Bouchard's nodes with prominent DIP, PIP, knee joint (medial compartment) and Great toe MTP joint involvement corresponds to the putative nodal generalized form of OA or NGOA (proposed Type 1 POA phenotype). As yet no genetic marker has been defined for this POA subset. The second is a hitherto less well recognized phenotype characterized by involvement of the index and/or middle finger metacarpophalangeal (MCP2,3) joints and the elbows, ankles and possibly the intertarsal and tarsometatarsal joints. The hip and knee joints may sometimes also be involved. This different joint distribution corresponds closely to the pattern observed in the arthropathy that often accompanies hereditary haemochromatosis. It is predicted that mutations in the HFE gene will associate strongly with the proposed Type 2 POA phenotype and serve as a genetic marker for this clinically recognisable subset.
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PMID:Polyarticular osteoarthritis--two major phenotypes hypothesized. 1621 1

Gout is the most common inflammatory arthropathy for men. Asymptomatic hyperuricemia, which should lead to diet, but not to medication, is much more common still. Increased uric acid levels mostly result from diminished renal excretion, which is more commonly familiar than secondary (renal failure, diuretics). With the first episode of often typical (red, hot, exquisitely painful first MTP joint) acute arthritis or with urate nephrolithiasis, increased uric acid turns pathological. Attacks are treated with NSAIDs or corticosteroids. More common attacks, chronic gout, or urate nephropathy are definite indications for long-term (at least 5 years) therapy with allopurinol or febuxostat. Additional anti-inflammatory medication will be necessary during the first months. Calcium pyrophosphate deposition arthropathy, the second common crystal-induced arthritis, is diagnosed by synovial fluid analysis or for chondrocalcinosis. Treatment for attacks resembles therapy of acute gout; causal therapy is possible in case of secondary forms (e.g. hypothyroidism. hyperparathyroidism, hemochromatosis).
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PMID:[Crystal-induced arthritis--old but important]. 1756 56

The differential diagnosis for monoarticular arthritis is extensive. Patient omissions from the history can compound this broad diagnostic dilemma. A case report is presented of a 32-year-old female with an eight-month history of isolated right first metatarsophalangeal joint (MTPJ) pain, after exhaustive, non-specific diagnostic evaluation. An open biopsy was performed, and a 3.5 cm wooden foreign body, believed to be the result of an injury 18 years prior, was excised from the 1st MTP. Open biopsy may be required as an important part of the workup for definitive diagnosis of a foreign body synovitis. A discussion regarding the presentation, clinical and diagnostic findings follows.
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PMID:Latent foreign body synovitis. 1758 44


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