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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Articular complications seem to be very common in patients under chronic dialysis, where they currently constitute the main limitation to the long-term functional prognosis. Carpal tunnel syndrome is often bilateral and severe; after 8 to 10 years of haemodialysis, it is usually associated with local deposits of amyloid substance. Treatment must be undertaken early and it is surgical. Arthropathies due to microcrystalline deposits take various forms, the most frequent being acute periarticular attacks related to apatite crystals. Septic arthritis is a frequent complication, dangerous in such patients, and which must be considered in every case of acute or subacute arthritis. Chronic arthropathies affect more than one half of the patients who have been under dialysis for more than 10 years. The most common are arthralgias of the shoulders often associated with pain in other joints, restricted joint movements and synovial thickening notably in the wrists, small finger joints and knees; radiology shows subchondral cavities betraying the presence of the cervical spine, are fairly frequent in patients under long-term haemodialysis. The pathogenesis of these complications is not yet fully understood, and several factors may be involved. Anatomically, carpal tunnel syndrome and chronic arthropathies are associated with articular deposits of a very special amylose consisting of beta-2 microglobulins.
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PMID:[Rheumatologic complications and amyloidosis in dialysis patients]. 218 42

Degenerative arthrosis is perhaps the most common debilitating disease of performance horses. Treatment should be based upon a knowledge of the anatomy and physiology of normal joints and upon an understanding of the processes of degeneration and repair. These topics are briefly reviewed. Although rest is probably, the most beneficial therapy, physical and pharmaceutical treatments are often employed in an effort to speed recovery. The effects and relative benefits of intrasynovial injections of corticosteroids, hyaluronica cid, and Arteparon are considered in detail. Although local corticosteroid therapy is inexpensive and is effective in reducing lameness caused by degenerative joint disease, it is rarely indicated. Septic arthritis and "steroid arthropathy" are two serious sequelae. Whereas the incidence of the former may be avoided through careful technique, the latter effect is inherent in the action of the drug. The accelerated rate of joint destruction observed in steroid arthropathy is due to suppression of chondrocyte metabolism and thus the processes of cartilage maintenance and repair. Hyaluronic acid is present in the synovial fluid and within the matrix of cartilage. The commercial preparation is no approved for use in the United States, but it is commonly obtained from other countries. Although hyaluronate apparently does not function in the lubrication of cartilage surfaces, it may improve lubrication of soft tissues thus decreasing resistance to joint movement and lessening pain. Reports substantiate the effectiveness of hyaluronic acid in treating early cases of degenerative arthrosis despite the fact that the drug does not significantly promote cartilage healing. Arteparon, a polysulfated glycosaminoglycan, has been used in Europe for two decades in the treatment of degeneration joint disease and is currently being tested in this country. The drug is deposited within diseased cartilage and improves the functional properties of the cartilage as well as stimulates cartilage metabolism.
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PMID:Corticosteroid and hyaluronic acid treatments in equine degenerative joint disease. A review. 703 40

Septic arthritis of the hip is uncommon in the school-age child. Presenting signs may be subtle and consequently may delay the diagnosis. This case report deals with a ten-year-old child who presented with an eight-day history of pain in the inner thigh associated with decreased range of motion of her hip, fever, and an inability to bear weight. Radiographic findings included demineralization of the femoral head. Initial laboratory findings showed leukocytosis and a sharply elevated Westergren sedimentation rate. Joint fluid Gram stain showed gram-positive cocci. Blood culture and joint culture grew Staphylococcus aureus. Therapy involved immediate operative drainage of purulent joint fluid, immobilization of the joint, and intravenous antibiotic therapy. Initial antibiotics were chosen based on synovial fluid Gram stain and the age of the patient. During therapy with antistaphylococcal penicillin, the patient developed a drug induced neutropenia.
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PMID:Septic hip in a child. 721 1

Toxic synovitis, an acute inflammatory condition of the hip, is the most common cause of limp and acute pain of the hip in children under 10 years of age. Usually, the synovitis and joint effusion are present unilaterally. The etiology of the condition is unknown, although in a few cases a recent history of an upper respiratory tract infection may be present. The child with toxic synovitis may complain of a limp and pain in the hip, the anteromedial aspect of the thigh, and the knee. The white cell count and erythrocyte sedimentation rate may be slightly elevated, as is the body temperature. Ultrasound is recommended as the primary imaging tool in the diagnosis and treatment of toxic synovitis. Septic arthritis, Perthes disease, and osteomyelitis are a few of the differential diagnoses that the practitioner should consider. Most cases can be managed with bed rest at home and administration of a nonsteroidal anti-inflammatory medication. Follow-up care should occur 2 weeks after diagnosis to ensure there is no recurrence of the joint effusion or progression to avascular necrosis. Radiographs of the hip should be repeated at 1 month and 3 months to complete the patient follow-up.
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PMID:Toxic synovitis of the hip in children. 759 30

Septic arthritis is a synovial infection of bacterial origin. Such a diagnosis, suggested by pain and diminished resistance to infection, should be confirmed by puncture of the joint effusion. The condition calls for emergency hospitalisation and treatment in a surgical unit. Treatment should include draining and cleaning of the joint, immobilization at least in the early stages, and double parenteral antibiotic administration. Clinical, radiological and laboratory follow-up (CRP and ESR) should be pursued. Detection of the responsible germ is often difficult and requires great care in sampling and analysis. The frequency of Haemophilus in children under 4 years of age requires adaptation of antibiotic therapy. In newborns, diagnosis is often difficult and delayed, explaining the frequency of sequelae in this age group. The only important prognostic factor is the interval before beginning treatment.
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PMID:[Septic arthritis in children]. 785 26

Septic arthritis (SA) in intravenous abusers is reviewed in the English literature from 1966-1992 with the purpose of registration of the bacteriological development, localization of the infected joints, clinical information and laboratory data. Eighty-three publications are available for the review. We have registered 270 joint infections caused by 264 bacteria in 257 intravenous drug abusers with SA. Since 1985 there has been a change in joint localization and bacteriology. A possible explanation is considered. Diagnosis and treatment is difficult, because of the unstable life-style and frequent compliance problems in intravenous drug abusers. SA should be considered in patients with known intravenous drug abuse, uncharacteristic pain and symptoms of osteoarticular infection. SA is often accompanied by fever, leucocytosis and elevated sedimentation rate. Bacteriological diagnosis is achieved by joint aspiration and/or blood culture. Tc-99m-MDP-(technetium-99m-methylene diphosphonate)-bone scintigraphy should be performed on joints suspected of infection which are difficult to aspirate. With adequate antibiotic treatment the prognosis is good, and the mortality is insignificant.
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PMID:[Septic arthritis in intravenous drug abuse]. 805 69

Transient synovitis is the most common cause of acute hip pain in children three to 10 years of age. Children with this condition typically present with hip pain for one to three days, accompanied by limping or the refusal to bear weight. Transient synovitis has an uncertain etiology and remains a diagnosis of exclusion. First, septic arthritis must be ruled out, since femoral head destruction, degenerative arthritis and permanent deformity can occur if septic arthritis is not treated promptly. Septic arthritis should be suspected in a patient with severe pain or spasm on hip movement or palpation, a temperature higher than 37.5 degrees C (99.5 degrees F) and an erythrocyte sedimentation rate of 20 mm per hour or greater. Hip aspiration is the diagnostic procedure of choice if septic arthritis is suspected. Treatment of transient synovitis consists of bed rest and nonsteroidal anti-inflammatory drugs, with regular temperature checks to exclude the onset of fever. If significant pain and limping persist seven to 10 days after the initial presentation, the patient should be reevaluated.
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PMID:Transient synovitis of the hip in children. 885 81

Septic arthritis of the hip joint is a condition that can often lead to partial or complete destruction of the hip joint, causing severe functional disability. Reports in the literature indicate that optimal management of these patients is unclear. Our report presents a follow-up of 37 patients (44 hips) who had septic arthritis during infancy or childhood. In general, patients at follow-up had a poor anatomical appearance radiographically, although pain and activity restriction were minimal. Results suggest that surgical efforts should be directed primarily at correcting limb length discrepancy and malalignment of the mechanical axes. In general, patients with a hip deformity of type I-III had a good functional outcome, whereas patients with hip deformity type IV with an instable hip joint had an unsatisfactory outcome. Any indication for hip replacement in these patients should be based not only on radiological findings, but also on the functional situation.
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PMID:[Late sequelae of coxitis in infants]. 944 92

The neonate is unable to relate specific complaints of pain and may not exhibit the usual signs of illness or infection. Septic arthritis of the hip is a surgical emergency in the neonate, and it should be considered in any irritable or ill child who has a high index of suspicion. Prompt diagnosis and immediate treatment are necessary. Nearly all babies undergo routine examination of the hip for dysplasia. It is recognized that limitation of abduction of the hip in the neonate may not represent developmental dysplasia of the hip but may represent other etiologies, such as fracture, infection, congenital anomaly, or tumor. The following case report illustrates the importance of careful clinical evaluation of an apparent asymptomatic neonate.
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PMID:Fortuitous diagnosis of iliac osteomyelitis: septic arthritis of the hip in the neonate. 988 89

Septic arthritis of the posterior lumbar joints is extremely rare in comparison with spondylodiscitis which is much more common. We report a case of an 86-year-old women with septic arthritis of the left L4-L5 lumbar facet joint associated with endocarditis. Arthritis diagnosis was made on CT scan and MRI, infection by Staphyloccocus aureus was proved by blood cultures. Heart growth was seen by echocardiography. Twenty-three cases were reported in the literature. Clinical and biological data failed to discriminate between facet joint septic arthritis and spondylodicitis. Diagnosis is established on imaging findings, computed tomography and magnetic resonance imaging, completed by blood cultures and, if they are negative, by aspiration-biopsy. Appropriate antimicrobial therapy is usually successful. Some back pain generally persists. In conclusion, lumbar pain with fever without spondylodiscitis is suggestive of septic arthritis of a lumbar facet joint. Epiduritis associated in 60% patients requires rapid treatment.
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PMID:[Septic arthritis of a lumbar facet joint. A case report]. 1147 78


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