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Query: UMLS:C0003873 (rheumatoid arthritis)
 53,068 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between July 1974 and December 1989, carpal tunnel-syndromes (CTS) were operated on in 903 hands of 746 patients. 147 of these patients (191 hands) were suffering from chronic inflammatory joint diseases. In 11 patients CTS was the first sign of rheumatoid arthritis (R.A.). The hands showed intraoperatively in 44.8% (n = 86/191) an extensive tenosynovitis with an aggressive infiltration. In 19% (n = 36/191), we had to extend the obligate tenosynovectomy on the flexor tendon parts of the fingers and ligaments (28 hands). 21 articulosynovectomies on the wrist or finger joints were performed. In 6 hands (8.0%) tendon ruptures were repaired. A questionnaire was completed for 107 of 147 patients (72.8%) (with 145 operated hands). Clinical (77 hands) and electromyographical examinations (49 hands) were performed an average of 5.1 (0.7-15) years postoperatively. 20 patients (13.6%) died, 20 could not be traced. In 86% (n = 125/145) of the patients we achieved relief of pain and a marked reduction of neurological deficits. 96.3% of the patients were content. The improvement of function of the hand after surgical intervention is of a great benefit for the patient with R. A. The overall risks of the procedure are low (complications 14%; no recidivism). Therefore, we recommend surgery in early stages after a confirmed diagnosis or a reasonable suspicion.
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PMID:[Chronic polyarthritis and carpal tunnel syndrome. Results of follow-up]. 772 11

The findings of ultrasonography (US) of 52 tendons of the hands of 14 patients with chronic rheumatoid arthritis (RA) were compared with operative findings obtained subsequently. US showed tenosynovitis as expansion of a hypoechoic area around the tendon. US also enabled pattern classification based on shape, internal echo and border features of the scanned tendon, differentiation of acute and progressive stages among acute inflammation, invasion of tenosynovitis, degeneration, and rupture of the tendon to be made, and the progression of tendon lesions could be ascertained. It was found that in inflammation the tendon was significantly thickened, and in degeneration, the tendon was thinned. By dynamic US scanning, disturbances of tendon movement due to tendon rupture and adhesion to surrounding structures could be detected and differentiated. It was found in this study that preoperative US of the hand of RA patients is very useful for early diagnosis and for the selection of treatment including operative methods.
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PMID:[Preoperative evaluation of tendons in the hands of patients with rheumatoid arthritis by ultrasonography]. 806 79

Degenerative and overuse diseases as well as impingement syndromes of the hand are illustrated and discussed in this review article. Osteoarthritis of the interphalangeal joints as described by Heberden and Bouchard is a ubiquitous articular disease often associated with synovitis and erosive joint destruction. Osteoarthritis of the trapeziometacarpal joint is classified into four stages for proper indication of operation. Overuse can result in stenosing tenosynovitis around the wrist and in synovitis with or without impingement of the flexor or extensor tendons of the digitis or ruptures of the annular and cruciform pulleys. Although diagnosis of these entities is usually made by history and clinical investigation, ultrasound and MRI can be helpful tools in imaging of these diseases. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the characteristic degeneration pattern of the wrist and represent the degeneration mechanisms in scapholunate insufficiency and nonunion of the scaphoid. SLAC wrist is a gradual degeneration classified in three stages and found in posttraumatic scapholunate rupture, calcium pyrophosphate dehydrate deposition disease (CPPD), rheumatoid arthritis, neuropathic diseases, trauma, and beta 2-microglobulin associated amyloid deposition. Ulna impaction syndrome is increasingly recognized as a cause of ulnar sided pain and exhibits a characteristic MRI appearance.
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PMID:Imaging of the hand: degeneration, impingement and overuse. 928 40

The current understanding of tendon biomechanics indicates that indirect injury to the tendon midsubstance requires the presence of preexisting disease during mechanical overload. This belief has been substantiated by the association of extensor pollicis longus rupture with chronic tenosynovitis caused by repetitive activity, inflammatory conditions such as rheumatoid arthritis, and minimally displaced distal radius fractures. This case of acute, traumatic, intratendinous attenuation of the extensor pollicis longus tendon offers a contradiction to the view that midsubstance tendon failure requires preexisting disease.
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PMID:Acute attenuation of the extensor pollicis longus tendon. A case report. 941 36

Synovial inflammation and the destruction which results from recurrent and chronic inflammation lead to arthritis and tenosynovitis. Clinical manifestations are bilateral and symmetrical, affecting virtually all joints. The hands and the feet are the main targets. Cervical involvement should be routinely investigated. X-rays demonstrate the erosion and deformation caused by rheumatoid arthritis. Altogether, the manifestations of the disease constitute a distinct and painful handicap. Treatment should be undertaken as early as possible in the course of rheumatoid arthritis in an attempt to avoid evolution toward irreversible destruction.
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PMID:[Articular and tendon manifestations indicating the stage of rheumatoid polyarthritis]. 950 17

A 25 year-old woman, known to be suffering from destructive rheumatoid arthritis, was admitted to the hospital due to influenza-like symptoms lasting three weeks. Adult Still's disease was diagnosed. During her disease she developed painful ophthalmoplegia due to tenosynovitis of the superior oblique muscle and tendon sheath (Brown's syndrome). Total resolution was obtained within three weeks of corticosteroid therapy.
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PMID:[Brown syndrome in an adult patient with morbus Still]. 962 84

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by progressive damage of synovial-lined joints and variable extra-articular manifestations. Tendon and bursal involvement are frequent and often clinically dominant in early disease. RA can affect any joint, but it is usually found in metacarpophalangeal, proximal interphalangeal and metatarsophalangeal joints, as well as in the wrists and knee. Articular and periarticular manifestations include joint swelling and tenderness to palpation, with morning stiffness and severe motion impairment in the involved joints. The clinical presentation of RA varies, but an insidious onset of pain with symmetric swelling of small joints is the most frequent finding. RA onset is acute or subacute in about 25% of patients, but its patterns of presentation also include palindromic onset, monoarticular presentation (both slow and acute forms), extra-articular synovitis (tenosynovitis, bursitis), polymyalgic-like onset, and general symptoms (malaise, fatigue, weight loss, fever). The palindromic onset is characterized by recurrent episodes of oligoarthritis with no residual radiologic damage, while the polymyalgic-like onset may be clinically indistinguishable from polymyalgia rheumatica in elderly subjects. RA is characteristically a symmetric erosive disease. Although any joint, including the cricoarytenoid joint, can be affected, the distal interphalangeal, the sacroiliac, and the lumbar spine joints are rarely involved. The clinical features of synovitis are particularly apparent in the morning. Morning stiffness in and around the joints, lasting at least 1 h before maximal improvement is a typical sign of RA. It is a subjective sign and the patient needs to be carefully informed as to the difference between pain and stiffness. Morning stiffness duration is related to disease activity. Hand involvement is the typical early manifestation of rheumatoid arthritis. Synovitis involving the metacarpophalangeal, proximal interphalangeal and wrist joints causes a characteristic tender swelling on palpation with early severe motion impairment and no radiologic evidence of bone damage. Fatigue, feveret, weight loss, and malaise are frequent clinical signs which can be associated with variable manifestations of extra-articular involvement such as rheumatoid nodules, vasculitis, hematologic abnormalities, Felty's syndrome, and visceral involvement. Although there is no laboratory test to exclude or prove the diagnosis of rheumatoid arthritis, several laboratory abnormalities can be detected. Abnormal values of the tests for evaluation of systemic inflammation are the most typical humoral features of RA. These include: erythrocyte sedimentation rate, acute phase proteins and plasma viscosity. Erythrocyte sedimentation rate and C-reactive protein provide the best information about the acute phase response. The C-reactive protein is strictly correlated with clinical assessment and radiographic changes. Plain film radiography is the standard investigation to assess the extent of anatomic changes in rheumatoid arthritis patients. The radiographic features of the hand joints in early disease are characterized by soft tissue swelling and mild juxtaarticular osteoporosis. In the the past 10 years, ultrasonography has gained acceptance for studying joint, tendon and bursal involvement in RA. It may improve the early clinical assessment and the follow-up of these patients, showing such details as synovial thickening even within finger joints. Other imaging techniques, such as magnetic resonance, computed tomography and scintigraphy may provide useful information about both the features and the extent for anatomic damage in selected rheumatoid arthritis patients. The natural history of the disease is poorly defined; its clinical course is fluctuating and the prognosis unpredictable. RA is an epidemiologically relevant cause of disability. An adequate early treatment of RA may alter the diseas
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PMID:The clinical features of rheumatoid arthritis. 965 97

Seven patients with subcutaneus of the extensor pollicis longus tendon (EPL) in rheumatoid arthritis were studied. There were one man and six women. The mean age of the patients was 56. 9 years, with a range of 47 to 83 years. The duration of the disease was from 0.2 to 6 years, its average 3 years. An interval between rupture of the tendon and operation was 9 days to 18 months. Tendon transfers of the extensor indicis proprius tendons were performed in 3 cases, sutures in 2 cases and free tendon graft of the palmaris longus in one case. All cases showed very active tenosynovitis around the EPLs, which were ruptured near Lister's tubercle. The histopathological findings of the ruptured EPL revealed that synovial proliferative tissue with chronic inflammatory cells infiltration were invading into the tenion tissue directly. The synovial granulatins might weaken the tendon and repetitive mechanical stress on the tendon at Lister's tubercle could result in the rupture of EPLs.
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PMID:[Tendon rupture of the extensor pollicis longus tendon in rheumatoid arthritis]. 972 56

A 77-year-old woman with a seropositive nodular rheumatoid arthritis and vasculitis, who was treated with high doses of corticosteroids and intravenous cyclophosphamide, developed miliary tuberculosis that was heralded by a tenosynovitis in her right wrist. A 1-year course of anti-tuberculous therapy resulted in complete resolution of the tenosynovitis and disseminated infection.
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PMID:Miliary tuberculosis presenting as tenosynovitis in a case of rheumatoid arthritis. 982 Nov 1

The cases histories of 51 rheumatoid arthritis patients (58 hands) were examined retrospectively with respect to the incidence of tendon rupture. Factors that were associated with tendon rupture such as X-ray changes in the wrist joint and clinical findings of the hand preceding the tendon rupture were statistically analysed. In a separate study, prophylactic tenosynovectomy and wrist synovectomy were performed on 42 joints in 35 patients who had two or more risk factors. This group of patients was then analysed for subsequent tendon rupture and recurrent synovitis. The risk factors for the extensor tendon rupture in the dorsal wrist joint were found to be: dorsal dislocation of the distal ulna; a scallop sign on X-ray; and tenosynovitis persisting for at least 6 months. Prophylactic surgery effectively prevented rupture of the tendons in patients who had two or more risk factors for extensor tendon rupture.
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PMID:Risk factors and prophylactic tenosynovectomy for extensor tendon ruptures in the rheumatoid hand. 982 14


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