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

The authors sought to determine the utility of intravenously administered gadolinium chelates in magnetic resonance imaging (MRI) of patients with rheumatoid arthritis of the shoulder. One shoulder was examined for each of 12 patients--6 men and 6 women, ranging in age from 48 to 71 (average 63) years--with well-established disease. The patients had had the disease for 1 to 25 (average 13) years. Static MRI was performed before and after infusion of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) (0.1 mmol/kg body weight); T1-weighted or proton-density images (repetition time [TR] 600 to 1000 ms, echo time [TE] 15 to 30 ms) were obtained. Images obtained after enhancement were particularly useful in the differentiation of pannus from fluid and also allowed improved delineation of tears of the supraspinatus tendon. In addition, contrast-enhanced dynamic gradient-echo spoiled GRASS sequences (TR 50 ms, TE 11 ms, flip angle 70 degrees) were obtained for all patients; for these sequences the same slice was imaged repeatedly at 20-second intervals. The rate of increase of signal intensity in abnormal synovium varied from 0.64 to 5.83 (average 2.30, standard deviation [SD] 1.67) units/second; the enhancement factor ranged from 1.55 to 4.64 (average 2.63, SD 0.98). The authors conclude that for imaging the shoulder enhancement with Gd-DTPA allows improved distinction between synovial thickening and joint effusion and may improve assessment of the rotator cuff. The wide range in the rate of signal increase and total enhancement during dynamic imaging probably reflected heterogeneity in the study population.
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PMID:Intravenous administration of gadolinium in the evaluation of rheumatoid arthritis of the shoulder. 846 39

Diagnostic imaging of the temporomandibular joint has undergone a revolutionary development during the last two decades. With advanced modalities we have been able to differentiate between different articular entities in patients with temporomandibular joint disorders. The purpose of this article is to review and discuss these modalities and their contribution to our present knowledge, with emphasis made on current trends in diagnostic temporomandibular joint imaging. The main section deals with diagnostic imaging of the subgroup of disorders with internal derangement caused by disk displacement including posttreatment imaging. Imaging of pathologic entities characterized by chronic inflammation such as rheumatoid arthritis are discussed in the second section. Finally, the potential of diagnostic imaging of infrequent conditions such as tumors is briefly reviewed. Magnetic resonance imaging has surpassed arthrography and computed tomography for the evaluation of most patients in these three subgroups. In patients who have various forms of disk displacements with or without accompanying bone abnormalities, a diagnostic accuracy of at least 90% may be achieved by oblique sagittal and coronal magnetic resonance imaging. In addition, alterations in the condylar marrow may be detected. T2-weighted magnetic resonance imaging can make a significant diagnostic contribution by demonstrating inflammatory reactions such as joint effusion and marrow edema. In the subgroup of patients with chronic inflammatory diseases, magnetic resonance imaging may also demonstrate abnormalities not shown with other imaging modalities. Disk deformation, fragmentation, and destruction may indirectly suggest the presence of synovial proliferation/pannus formation, which in selected cases may be directly depicted with intravenous gadopentetate dimeglumine. For more detailed evaluation of the bone condition and of soft tissue calcifications in joints with inflammatory diseases, tumors, or other disorders, computed tomography is the preferable imaging modality.
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PMID:Current trends in temporomandibular joint imaging. 855 65

The potential role of sonography in evaluating the response to therapy of persistent knee joint synovitis (KJS) was assessed in a longitudinal study in pre-and post-arthroscopic (AS) synovectomy in rheumatoid and psoriatic patients. At entry to the study ultrasound (US) detection of synovial proliferation was compared with arthroscopic visualization as the 'gold standard' reference. US joint effusion and synovial thickness measures and predominant patterns of synovial proliferation were recorded by comparing clinical and US indices before and at 2, 6 and 12 months after AS synovectomy, or after KJS relapse up to 24 months. A 12 month survival analysis of clinical and US outcomes of arthroscopic synovectomy was also performed. US detection of morphology and degree of synovial proliferation was correlated with AS macroscopic evaluation. After AS synovectomy, the clinical index and both US joint effusion and synovial thickness were significantly reduced, whereas US patterns of synovial proliferation did not show significant changes. US and clinical indices were significantly correlated in all follow-up measurements and US joint effusion was significantly increased in the relapsed compared with the non-relapsed KJS group. The probability at 12 months of reaching maximum improvement in US joint effusion and synovial thickness outcomes was 99 and 58%, respectively; that for clinical remission of KJS was 72%. Ultrasound evaluation has proven reliable and accurate by the arthroscopic gold standard in detecting changes of rheumatoid arthritis and psoriatic arthritis knee joint synovitis. The correlation of US with clinical findings in pre-and post synovectomy patients suggests that sonography can be used as an objective method in monitoring the response to therapy of inflammatory knee joint disease.
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PMID:Long-term sonographic follow-up of rheumatoid and psoriatic proliferative knee joint synovitis. 861 29

MR imaging is able to demonstrate both the structural changes that occur in rheumatoid arthritis and the inflammatory changes, including synovial proliferation and joint effusion. MR imaging can demonstrate erosion before it is visible on radiographs. Although MR imaging appears to be very helpful in assessing the severity of rheumatoid arthritis and its response to therapy, the optimal technique for this assessment and the ultimate clinical value of MR imaging have yet to be determined.
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PMID:Magnetic resonance imaging of rheumatoid arthritis. 863 14

By definition, monoarticular arthritis means one-joint involvement, even though, in fact, such a condition is often an oligoarthritis because as many as two or three separate joints will be involved. Arthritis is often limited and may regress, so that it is frequently misdiagnosed. Sometimes, a monoarticular condition may be a polyarthritis onset (i.e., rheumatoid arthritis). Monoarticular arthritis can be caused by many factors, such as infections (septic arthritis), nonspecific inflammatory processes (reactive arthritis), crystals deposition (gout, CPPD crystal deposition disease), trauma, neoplasm (pigmented villonodular synovitis), immunologic conditions (amyloidosis) and hormonal changes (parathyroid disease). Its onset is usually acute and sometimes dramatic, with fever, pain and joint swelling, so that a decision must be made promptly to stop rapid illness evolution and to prevent the irreversible destruction of cartilage and bone (especially in septic arthritis). Diagnostic studies are performed with mono-bilateral radiographs of the joint. Radiographic findings (i.e., soft tissue swelling, joint effusion, widening and thinning of joint spaces, bone erosions and destruction of bone surface) are typical of the disease, but some findings (e.g., type of evolution and progression), laboratory tests, synovial biopsy and arthroscopy can differentiate infectious from inflammatory forms. Scintigraphy can depict isotopic joint uptake, before articular abnormalities are demonstrated with radiography, thanks to its high sensitivity; nevertheless, because of its low specificity, scintigraphy may miss some kinds of lesions (including osteoarthritis) and cannot easily differentiate osteomyelitis from septic arthritis. CT and MRI play a secondary, though not negligible, role, especially to study such deep infections as psoas abscesses, which may mimic arthritides.
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PMID:[Monoarthritis]. 868 51

Rheumatoid pseudocysts of which pathogenesis are not well known, are commonly observed in the major joints of the body, especially knees in rheumatoid patients. This report investigated the pseudocysts in the knee of a rheumatoid patient radiologically and immunohistochemically. A sixty-three-year-old woman with rheumatoid arthritis who had pseudocysts in the femoral lateral condyle and tibial plateau was hospitalized to have the lesions surgically removed. The MRI findings showed a connection between the pseudocysts and the joint cavity. A window of 1 x 1 cm2 was made at the tibial anterior cortex and the contents of the pseudocyst were resected and hydroxyapatite granules were inserted into the lesion after the removal of the pseudocyst tissue. In the histological findings, the specimen from the tibial pseudocyst revealed fibrous connective tissue with a few inflammatory cells, while the synovial specimen revealed the fibrous tissue with intense inflammatory cells infiltration forming lymphoid follicules. In immunohistochemical findings, both specimens showed positive with anti-HLA class I, anti-HLA DR, anti-CD44 and anti-HSP70 antibodies. The pathological findings of the pseudocystic lesion were similar to those of synovia, and it was considered that the synovia had invaded into the bone and formed the pseudocystic lesion. The MRI findings also support this hypothesis. The pseudocystic lesion was surrounded by bone and it was isolated from cytokain-rich joint effusion. This isolation from rheumatic joint effusion may explain the weaker inflammation of the pseudocystic lesion than that of synovia.
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PMID:[A case study of immunohistochemical findings of rheumatic pseudocystic lesions in the femoral lateral condyle and tibial plateau--the comparison with synovial lesions]. 891 Oct 84

The knees of forty-three patients suffering from rheumatoid arthritis (RA) were examined using pre- and post-contrast MRI in an attempt to assess the extent and frequency of all abnormalities in the RA knee. Features evaluated by MRI were: synovial thickening, joint effusion, bone destruction, popliteal cysts, periarticular soft tissue swelling, abnormal tendons and bone marrow changes. A scoring system (0-2) was used to determine the relationship between the various signs of RA in order to identify those that may be relevant for the assessment of therapeutic response. It seems that the assessment of inflamed synovium is the major criterion for the determination of disease activity in RA.
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PMID:MRI evaluation of the knee in rheumatoid arthritis. 901 88

It is apparent that from the work of the authors and many others, including the work of Rivard, Sledge, Zuckerman, among others, that radiosynovectomy has an important role to play in providing effective treatment of affected joints associated with rheumatoid arthritis and other forms of arthritis as well as the hemophiliac joint. The treatment offers relief from the effects of recurrent joint effusion with an approximately 60% to 66% favorable response and from recurrent hemarthrosis in the hemophiliac joint with an approximately 75% to 80% favorable response. The impact of providing radiosynovectomy as an alternative to surgical synovectomy is seen, where postoperative side effects such as joint stiffness are avoided, improved quality of life is repeatedly documented, and the cost savings in health care dollars, particularly evident in the hemophiliac joint in this relatively small population, are potentially enormous. With almost two million people in the United States suffering from rheumatoid arthritis, the potential savings in health care dollars is also enormous. As with any use of in vivo radiopharmaceuticals, the potential for radiation-induced damage exists. However, with a 25 plus year record of use, more optimally configured radiopharmaceuticals, and the addition of maneuvers to minimize potential joint leakage, the risk of radiation induced damage appears to be minimal. It appears as though radiosynovectomy is an effective as well as cost-effective alternative to surgical synovectomy and is becoming the procedure of choice particularly in the hemophiliac patient with recurrent hemarthrosis and synovitis who has failed medical therapy. It is also the procedure of choice in patients for whom surgery is contraindicated because of the presence of clotting factor inhibitors.
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PMID:Radiosynovectomy's clinical applications and cost effectiveness: a review. 936 46

Any cervical spine segment may be affected by rheumatoid arthritis, but destructive changes are most prominent at the craniocervical junction. Cervical involvement is a devastating complication of the disease, because of the risk of a range of neurological complications (paresthesia, cervical myelopathy, vertebro-basilar insufficiency), and even sudden death from medullary compression. However, the incidence of both cervical rheumatoid arthritis and its neurological complications are still debated, being respectively reported in 17-86% and 11-70% of the patients, according to the variability in neurological and radiologic classification systems adopted by the authors. To assess the incidence of cervical rheumatoid arthritis and the integrated role of different imaging techniques in its diagnosis, 38 consecutive patients (29 women and 9 men) with rheumatoid arthritis according to the American Rheumatism Association criteria were examined. The average age was 60 years (range: 27-70 years) with a mean disease duration of 6.6 years (range: 6 months-25 years). All the patients underwent conventional radiography of the cervical spine, unenhanced Computed Tomography (CT) of the craniocervical junction and unenhanced and Gadolinium-enhanced Magnetic Resonance Imaging (MRI) of the cervical spine. Cervical spine involvement was demonstrated in 25/38 (66%) patients 20 women and 5 men, with an average age of 57 years and a mean disease duration of 8.5 years. In 13 of them (mean disease duration: 12.7 years), the diagnosis was made with radiography which showed atlantoaxial and subaxial subluxations and/or erosions. Of the 12 patients with negative conventional radiography (mean disease duration: 2.5 years), 4 were identified with both CT and MRI (synovial pannus and erosions). 3 with MRI only (joint effusion/hypervascularized synovial pannus), and 5 exhibited questionable CT findings which were clarified only by MR demonstration of inflammatory tissue contiguous to suspicious irregularities of the cortical bone of the odontoid process. 52% (13/25) of cervical rheumatoid arthritis patients were identified with plain radiographs, 68% (17/25) with CT and 100% (25/25) with MRI. Our preliminary data show that a specific tool for the diagnosis is recommended even in the early disease phases since rheumatoid arthritis commonly affects the craniocervical junction. Studying the craniocervical region is clinically difficult, and diagnostic imaging assessment is essential. Conventional radiography allowed to detect more than half the patients with cervical rheumatoid arthritis, but only in advanced disease stages. On the contrary, MRI had the unique potential of direct and detailed synovial visualization, thus permitting the diagnosis of cervical involvement even in the early phases of the inflammatory process, when CT findings were still negative or questionable.
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PMID:[Integrated role of computerized tomography and magnetic resonance imaging in identifying the early changes in rheumatoid arthritis of the craniocervical junction]. 938 Aug 62

Bilateral rupture of the quadriceps tendon is a rare injury. It usually occurs in obese older patients. Other predisposing factors are long-term chronic renal failure, gout, rheumatoid arthritis, diabetes mellitus, hyperparathyroidism and abuse of anabolic steroids. The most common cause of bilateral rupture is a sudden violent contraction of the quadriceps muscles with the knees semiflexed and the feet fixed. Examination reveals bilateral joint effusion, palpable or visible suprapatellar gaps, and an inability to extend both knees and lift the straight legs. Often the diagnosis is missed, and diagnostic confusion with other causes of inability to use the legs happens. We report one case of simultaneous bilateral rupture where treatment was delayed for several weeks because of diagnostic confusion.
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PMID:[Simultaneous bilateral rupture of the quadriceps tendon]. 962 90


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