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

Variable pathologies are subsumed under the term "synovial disease", including common pathologies such as rheumatoid arthritis. While formerly radiologists had to rely on conventional radiographs and bone scintigraphy with their inherent problems in visualizing soft tissue, noninvasive imaging of the synovium has recently improved substantially with the technical development of MRI and (Doppler) ultrasound. These imaging modalities allow differentiation of characteristic pathologic features based on a profound knowledge of normal anatomy and pathophysiology.
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PMID:Pathophysiology and imaging in inflammatory and blastomatous synovial diseases. 1207 16

Although MR imaging has been increasingly recognized as a useful tool in the diagnosis of early rheumatoid arthritis (RA) and in the assessment of disease activity, these applications have not yet been usually included in the routine management of this condition. Our goal is to review the current role of MRI in the everyday clinical management of patients with RA. The usefulness of MRI in the evaluation of articular and para-articular changes in specific locations, mainly the craniocervical region and the temporomandibular joint, are reviewed. Clinical problems derived from local extra-articular involvement, such as tenosynovitis, "rice-bodies" bursitis, and Baker's cyst rupture, are also described. Finally, we also review the value of MRI in evaluation of some complications of RA such as tendinous rupture, osteonecrosis, stress fracture, and septic arthritis/osteomyelitis.
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PMID:MR imaging assessment of clinical problems in rheumatoid arthritis. 1211 Oct 74

We present the case of a patient with long-standing rheumatoid arthritis and an acute onset of total dysfunction of the posterior tibial tendon. On MRI, a rupture of the tendon was apparent. Intraoperatively, however, massive tenosynovitis with stricture of the tendon was identified as the cause of posterior tibial tendon dysfunction. This case illustrates a pitfall in MRI imaging with potential diagnostic and therapeutic consequences.
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PMID:Posterior tibial tendon dysfunction and MR imaging in rheumatoid arthritis. 1212 Sep 10

Hip arthroplasty has become a common and still increasing procedure for the treatment of osteoarthritis, advanced head necrosis, post-inflammatory arthritis or rheumatoid arthritis. Radiography is the most important imaging modality for monitoring the normal, asymptomatic hip arthroplasty. Radiographs are obtained at the end of a surgical treatment, to exclude complications like fracture or component misplacement. In the follow-up radiographs are used for the diagnosis of loosening and infection of the hip arthroplasty as well as soft tissue ossification. Together with the history and clinical information, the analysis of morphological findings allows to find the grade of loosening. MRI has been advocated in the diagnosis of infection, in particular in the localisation of soft tissue involvement. Imaging, especially by radiographs, is used for the evaluation of the normal and complicated follow-up of hip arthroplasty.
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PMID:[Diagnostic imaging in hip prostheses]. 1214 8

We present the case of a 40-year-old man with rheumatoid arthritis who had a painless left inguinal mass. Sonographic examination revealed a large soft tissue mass with mixed internal echotexture and regular borders extending inside the pelvis and into the proximal portion of the thigh. Sonography also showed communication between the bursa of the iliopsoas muscle and the hip cavity, with intra-articular synovitis and erosion of the ileum. Giant iliopsoas bursitis secondary to hip involvement in rheumatoid arthritis was diagnosed on the basis of the sonographic findings. This diagnosis was confirmed by MRI.
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PMID:Giant iliopsoas bursitis: sonographic findings with magnetic resonance correlations. 1221 Apr 63

Tumor Necrosis Factor alpha (TNF) as proinflammatory cytokine plays in the pathogenesis of many diseases an important role. In psoriasis and in psoriatic arthritis TNF is up-regulated in the skin lesion and in the synovitis. Recent trials showed that the blockade of TNF with the chimeric antibody infliximab is able to improve both, the skin lesions and the synovitis of the joints. In psoriasis in 82% of patients treated with infliximab achieved an over 75% response in the PASI index. In Psoriatic arthritis the skin improvement was correlating with the reduction of synovitis and in a small MRI controlled study all patients achieved an ACR 20 response within 10 weeks. Patients with psoriatic arthritis, who have been included in spondylarthopathy trials showed similar improvement rates. In all trials unexpected safety problems have not been reported, but the trials have been small in population and short in duration. Infliximab was used between 5 and 10 mg/kg at week 0, 2, 6 and every 8 week. It some trials the retreatment periods varied. In contrast to the treatment of rheumatoid arthritis with infliximab methotrexate was not always used as comedication. In some cases infliximab has been used in combination with other DMARDs but no trial did evaluate the combination treatment vs. the monotherapy.
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PMID:Infliximab for psoriasis and psoriatic arthritis. 1246 61

Despite frequent involvement, the rheumatoid shoulder is neglected in operative treatment of the upper extremities. The slow course of omarthritis, the compensation mechanism of scapulothoracic motion and neighbouring joints as well as dominating disabilities of the lower extremities and the rheumatoid hand are possible explanations. The pattern of destruction of the rheumatoid shoulder is characterized by progressive joint and soft tissue deterioration. Soft tissue involvement determines the course of the shoulder joint. The subacromial space is a common and early site for rheumatoid involvement, often leading to bursitis, tenosynovitis of the biceps tendon and rotator cuff rupture. Sonography and MRI enable the early detection of subacromial and glenohumeral pathology before deterioration is visible radiologically. Surgical intervention in patients with rheumatoid arthritis of the shoulder is based on the degree of radiological destruction according to Larsen, the natural course of the shoulder joint and the soft-tissue condition. The goals of surgery are to relieve pain, increase motion and restore shoulder function. Surgery should be carried out early in the course of the disease, thus determining the long-term prognosis and the remaining surgical options. Depending on the pattern of destruction of the rheumatoid shoulder, the options for treatment can be divided into early and late procedures.Joint-preserving surgery is indicated in the early stages of radiological destruction according to Larsen classification O-III, whereas the late stages of destruction (Larsen IV-V) require reconstructive surgery. The introduction of arthroscopic and semiarthroscopic techniques has improved the acceptance of early synovectomy for the rheumatoid shoulder, but there is still a place for open synovectomy in patients with extensive soft-tissue repair and bone-remodelling procedures. Arthroscopic and open synovectomy are supplementary and noncompetitive surgical procedures for the rheumatoid shoulder. With proceeding bone and soft-tissue destruction corresponding to Larsen stage IV and V, synovectomy is not successful and reconstructive surgery is necessary. Resection-interposition-arthroplasty (RAIP) remains a controversial alternative to arthroplasty in young patients with sufficient bone stock and a reconstructable rotator cuff. The success of cup-replacement will additionally restrict the indications for RAIP. RIAP remains a possible salvage procedure after aseptic and septic loosening of shoulder arthroplasty. Glenohumeral replacement arthroplasty has become the procedure of choice in reconstructive surgery of the shoulder. The severity of soft-tissue and bone destruction determines the choice of shoulder prosthesis. Current modular shoulder systems with increased numbers of humeral-head stem combinations are calculated to achieve a better adjustment of the soft-tissue tension and to optimize the adaptation between head geometry and the natural shape of the glenoid.The surrounding soft-tissue structure, especially the condition of the rotator cuff, is very important for the functional recovery after shoulder arthroplasty. We prefer a hemiarthroplasty of the rheumatoid shoulder joint to avoid critical glenoid fixation. Patients with irreparable rotator cuff tears and severe glenohumeral arthritis remain a difficult challenge in shoulder surgery and the ideal procedure has not yet been found.Pain relief and a modest increase in active motion are the main goals in operative treatment. Bipolar shoulder arthroplasty represents an adequate alternative to currently favoured hemiarthroplasty in patients with cuff-deficient shoulders.
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PMID:[Differential therapy for the rheumatoid shoulder]. 1248 39

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. The results of CE PDUS and dynamic MRI were closely related: RESE in joints with CE PDUS signal was significantly higher than in joints without CE PDUS signal (Mann-Whitney test, p<0.001). Among the patients with pre-contrast PDUS signal no statistically significant difference in RESE values was found between joints with and without post-contrast flow-signal increase. No correlation was found between clinical examination and CE PDUS. Based on comparisons with dynamic contrast-enhanced MRI, PDUS appears to be reliable for assessment of synovitis in RA MCP joints. Intravenous contrast injection may provide additional information in selected cases but did not in the present study increase the sensitivity of the method.
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PMID:Contrast-enhanced power Doppler ultrasonography of the metacarpophalangeal joints in rheumatoid arthritis. 1281 18

Anterior tibial compartment syndrome was developed due to pyomyositis in a 33-year-old male patient with rheumatoid arthritis while receiving steroid therapy during the follow-up period. The preoperative physical examination, laboratory findings, MRI images, intraoperative observation and postoperative histopathological examinations confirmed the association with pyomyositis. The surgical drainage and antibiotic treatment were effective, and in the follow-up period, neuromuscular dysfunctions disappeared completely within 6 months. The patient has been asymptomatic for 4 years of follow-up. To date, anterior tibial compartment syndrome due to pyomyositis in a case with rheumatoid arthritis has not been reported.
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PMID:Anterior tibial compartment syndrome due to the pyomyositis in a patient with rheumatoid arthritis. A case report. 1263 25

Bilateral rupture of the patellar tendons is a rare lesion, usually associated with systemic diseases such as systemic lupus erythematosus, rheumatoid arthritis, chronic renal failure and others. It is extremely rare in a healthy individual, with fewer than 15 cases described. A case of a 32-year-old male with no known history of systemic disease or knee problems is presented. Physical examination, xrays and MRI demonstrated bilateral rupture of the patellar tendons. The tendons were repaired using a nonabsorbable suture reinforced with two titanium anchors fixed to each patella, and a quadriceps tendon flap. The evolution was satisfactory, with both knees recovering a full range of motion in a four-month period.
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PMID:Spontaneous bilateral patellar tendon rupture in an otherwise healthy patient. A case report. 1266 99


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