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At least 1,189 records · Page 66Linked to original sources
PubMed1988

Skeletal disease, arthro-osteitis, in adult patients with pustulosis palmoplantaris.

A follow-up study of 13 patients with pustulosis palmoplantaris (PPP) and skeletal disease is reported. A prolonged and fluctuating course occurred in all patients. Nine patients had anterior chest wall involvement with erosions or ankylosis of the sternoclavicular, first sternocostal and/or manubriosternal joint together with sclerosis and often hyperostosis of adjacent bones, ossification/calcification of the first costal cartilage, and in 7 patients of the costoclavicular ligament. Spinal involvement in the form of spondylodiscitis, sclerosis of vertebral bodies, syndesmophytes, paravertebral ossifications and/or spondyloarthritis occurred in 11 patients, three of whom also had involvement of the sacroiliac joints. One patient had sclerosis of a pubic and ischial bone. Peripheral arthritis or tenosynovitis occurred in 5 patients, two of whom had signs of enthesopathy, and one also erosions. The presence of a distinct PPP syndrome is suggested.

Adult↗
PubMed1999

[Spinal manipulation--treatment associated with a high risk of complications].

The article consists in a review of injuries for which claims were submitted to one or another of three insurance companies during a two-year period, and which had arisen in conjunction with manipulation of the cervical spine (n = 21), thoracic spine (n = 6), lumbar spine (n = 13), or the sacro-iliac joint (n = 14). Cervical spine manipulation had caused injury of the vertebral artery with resulting paralysis in three cases, and cervical disc herniation in three cases. Lumbar spine manipulation had caused disc herniation in six patients, of whom three had severe persistent problems. Of the 14 patients who had undergone manipulation of the sacroiliac joint, six had disc herniation which was operated with varying outcome. One patient with a compression fracture of an osteoporotic L3 vertebra developed paraparesis.

Adult↗
PubMed1983

[Inflammatory arthritis and osteoarthritis in palmoplantar pustulosis. Case report and review of the literature].

The case of a 46-year-old woman, who had pustulosis palmaris three years ago, and who has been experiencing inflammatory arthritis of the manubriosternal joint for two years with intermittent exacerbations, is reported. The negative bacteriologic investigations and the failure of antibiotic therapy have established that the condition is aseptic. Among patients with a history of palmo-plantar pustulosis, approximately 10% have aseptic inflammatory arthritis or osteitis, most commonly in the anterior chest wall. Other sites are the sacroiliac joints and the spine, where radiological features mimic ankylosing spondylitis, and peripheral joints. Laboratory anomalies are not specific, and HLA B27 antigen is not associated with this syndrome. The course of the arthritis, with exacerbations and remissions, is generally benign. The relationship of this syndrome to psoriatic arthritis is unclear. Non-steroidal antirheumatic drugs are the most effective agents.

Adult↗
PubMed1988

Risk factors for urethral injuries in men with traumatic pelvic fractures.

Urethral injuries are commonly associated with pelvic fractures. The prompt recognition and appropriate management of these injuries may significantly impact subsequent morbidity, yet few studies have addressed the identification of the risk factors for urethral injury in men with pelvic fractures. We reviewed retrospectively the records of 405 men with pelvic fractures seen at our medical center, including 21 (5 per cent) with urethral injuries. Of the 21 men 14 (67 per cent) had fractures involving a pubic ramus and a sacroiliac joint, and 12 (57 per cent) had no physical signs (blood at the urethral meatus, perineal hematoma or a high-riding prostate) that would suggest a urethral injury. The likelihood for the presence of physical signs is directly related to the interval since injury. We believe that men with the combination of rami fractures and sacroiliac disruption should undergo retrograde urethrograms before urethral instrumentation, and that physical signs are unreliable indications for urethral injuries, especially soon after the injury.

Fractures, Bone↗
PubMed1998

The bullhead sign: scintigraphic pattern of sternocostoclavicular hyperostosis and pustulotic arthroosteitis.

OBJECTIVE: The purpose of this retrospective study was to examine the value of whole-body nuclear medicine imaging and to evaluate the typical scintigraphic pattern of sternocostoclavicular hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO). In this entity the correct diagnosis is frequently missed because of uncharacteristic changes in other imaging modalities. MATERIALS AND METHODS: Forty-nine patients (age range 15-65 years old, mean age 36 years) with sternocostoclavicular hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO) were examined with whole-body scintigraphy and conventional radiography. RESULTS: Forty-three of 49 patients with SCCH/PAO showed a characteristic "bullhead"-like high tracer uptake of the sternocostoclavicular region with the manubrium sterni representing the upper skull and the inflamed sternoclavicular joints corresponding to the horns (= bullhead sign). Scintigraphy revealed additional skeletal manifestations (spondylitis, sacroiliitis, osteitis) in 33 of 49 patients with SCCH and/or PAO. CONCLUSIONS: Bone scintigraphy is the imaging modality of choice for the diagnosis of skeletal involvement in PAO. Nuclear medicine reveals unexpected locations and shows the typical pattern of focal hot spots of the spine, sacroiliac joints and/or appendicular skeleton in the large majority of cases in combination with a bullhead-like tracer uptake of the sternocostoclavicular region. The bullhead sign is the typical and highly specific scintigraphic manifestation of SCCH and PAO in radionuclide bone scans and helps to avoid unnecessary biopsies.

Adolescent↗
PubMed1990

[Multicentric reticulohistiocytosis (lipoid dermato-arthritis). A radiologic study of 3 cases].

The authors report their experience with 3 cases of multicentric reticulohistiocytosis observed over 6 years of outpatient radiological practice. The condition presents with the following radiological patterns: 1) clear-cut erosions of the articular surfaces, especially in the distal interphalangeal joints of the hands and in the metatarso-phalangeal joints of the feet, with symmetrical distribution (not necessarily); 2) osteolytic punched-out areas in the epiphyseal spongiosa, ranging in size from 1 mm to over 1 cm; 3) no osteoporosis, no osteo-proliferative or periosteal reactions, not even in the presence of large osteoarticular destructions; 4) frequent atlanto-epistropheal subluxation; 5) articular ankylosis at the sacroiliac joints only. The association of the above patterns and the relatively benign clinical course distinguish multicentric reticulohistiocytosis from rheumatoid arthritis, psoriasis arthritis, erosive osteoarthritis, and gout. A reliable diagnosis can be suggested on the basis of radiological findings alone, even before cutaneous or mucosal lesions appear--which are, at any rate, not sure to appear and typical of nails only. An unquestionable diagnosis can be made at histology of synovial and/or cutaneous nodules. Multicentric reticulohistiocytosis is considered an uncommon condition (nearly 100 cases in international literature to 1989); the authors believe it to be commoner though often misdiagnosed as a "variant of rheumatoid arthritis".

Adult↗
PubMed1998

Fibroblasts from mice with progessive ankylosis proliferate excessively in response to transforming growth factor-beta 1.

BACKGROUND: Murine progressive ankylosis (MPA) is a spontaneous arthropathy that produces ankylosis of peripheral and spinal joints in mice homozygous for the gene ank. This animal model bears a striking resemblance clinically, radiographically, and histologically to ankylosing spondylitis. Phosphocitrate (PC) is the only treatment known to significantly delay disease progression in MPA. Transforming growth factor-beta (TGF-beta) is important for both developmental bone formation and fracture healing, and has been detected in biopsy specimens from sacroiliac joints of patient with ankylosing spondylitis. We hypothesized that TGF-beta might be involved in the pathogenesis of MPA. METHODS: We compared the proliferative response of resting fibroblasts from normal and MPA mice to TGF-beta 1 as measured by 3H-thymidine incorporation and the effect of PC on that response. Cells were cultured with 10% serum as a positive control. The mouse fibroblast cell line, BALB/3T3, controlled for culture conditions. RESULTS: MPA and normal fibroblasts responded similarly to serum. MPA fibroblasts proliferated significantly better in TGF-beta 1 than the poorly responsive normal mouse fibroblasts. PC, at 10(-3) mol/L, inhibited the TGF-beta 1-induced proliferation of MPA and 3T3 cells, but had no effect on normal fibroblasts. CONCLUSIONS: MPA fibroblasts proliferate excessively to TGF beta 1 in vitro. This effect could be caused by altered TGF receptors, changes in signal transduction, or impaired inhibition of the TGF-beta signal. This excessive response is blocked by PC. These results give further clues as to how PC inhibits the progression of ankylosis in MPA.

3T3 Cells↗
PubMed1995

Bacterial infections: osteoarticular brucellosis.

Osteoarticular brucellosis has been documented extensively from the Middle East and Spain in the last 5 years, but it has only been reported infrequently from the UK and USA. Brucella melitensis from goat and sheep is the most frequently isolated organism. Peripheral articular pain, particularly of the large joints, is the commonest osteoarticular manifestation, while effusions that seldom yield organisms on culture, also occur frequently. Sacroiliitis which most frequently is unilateral, often presents acutely and dramatically with severe pain that is poorly localized to the lower back and buttock, leading to difficulty in walking and even standing. Tapping the heel and springing the sacrum is probably the best way of localizing the pain to the sacroiliac joint in this acute stage. Lack of awareness of this pattern of presentation could lead to misdiagnosis. Spondylitis is the third major manifestation of osteoarticular brucellosis. It occurs in older patients and is insidious and chronic in onset and course. The lumbar spine is most frequently involved, although cervical involvement is frequently associated with more complications, particularly compressive neurological deficits. Osteomyelitis occurs unusually. Several large series have been reported among children. In them peripheral large joint involvement in association with systemic features predominate while sacroiliitis may occur unusually. Plain X-rays often demonstrate vertebral damage, involving the upper anterior margin most frequently. CT scans define better vertebral damage that is characterized by bony sclerosis and the less frequently encountered extradural extension and para-vertebral abscess formation. Technetium bone scan is the most sensitive technique for detecting acute sacroiliitis and other sites of early osteoarticular involvement. A four-fold rise in Brucella agglutination titre is the most frequently utilized diagnostic aid. A 6 week culture in a CO2-enriched medium is recommended for growing Brucella. Tetracycline or doxycycline 200 mg per day for 6 weeks is the mainstay of most medical treatment schedules. Combination with streptomycin for 3 weeks or rifampicin for 6 weeks is recommended, to reduce significantly the failure and relapse rate. Spinal involvement is associated with an increased failure and relapse rate while they occurred least among those with no osteoarticular involvement. Surgical intervention to stabilize the spine and relieve neurological compression may become necessary. With the use of these various measures, the outlook for complete recovery is good.

Adult↗
PubMed1980

Prospective evaluation of sacroiliac scintigraphy in chronic inflammatory back pain.

To assess the usefulness in screening for sacroiliitis of a wide band profile cut which included the entire sacroiliac (SI) joint, 34 patients with chronic inflammatory back pain (IBP) underwent sacroiliac joint scintigraphy with 99mTc-methylene diphosphonate while receiving no antiinflammatory therapy. The sacroiliac joint to sacrum (SIJ/S) ratios in those with back pain differed significantly from the ratios of an age-matched control group. However, 12 of the 34 patients with inflammatory back pain had normal or equivocal sacroiliac radiographs and 4 of 12 had normal SIJ/S ratios. All 4 were HLA-B27 positive, had diminished lumbar movement, and required antiinflammatory medication; 2 had diminished chest expansion; 1 has developed iritis. We conclude that this technique is not a reliable screening procedure. Therapy with antiinflammatory drugs was associated with a significant decrease in the SIJ/S ratios in 19 of the 34 who were reimaged.

Adolescent↗
PubMed1987

[Clinico-laboratory, immunologic and radionuclide joint indices in psoriatic arthropathy].

A juxtaposition between the clinical-laboratory, immunologic and radionucleotide articular parameters was performed in 50 patients with psoriatic arthropathy, distributed according to the incidence of X-ray manifestations. The late and moderate changes in ESK, leukocytes, fibrinogen, DPA and phosphatasemia do not characterize the severity of the disease. A tendency to hyperuricemia and hypercalcemia is established in the period of arthralgia before the X-ray image for bone-tissue damage. The genetic HLA-B27 predetermination plays a certain role for the more frequent involvement of the spine and sacroiliac joints in the pathological process. The disturbances in the immune system are manifested with increased number of early T-lymphocytes, FcG-receptor lymphocytes, complement (C3b)--receptor lymphocytes and spontaneously blast-transformed cells. The increasing IgG content correlates with the accumulation of macromorphological X-ray images and with the index of mineral metabolism from the articular study with 99MTc-pyrophosphate. The changes in the pertechnetium index for articular vascularization are quantitatively insignificant and do not allow the joining of the psoriatic arthropathy to the group of primary synoviarthritis. The accumulation of technetium pyrophosphate in the articular structures is asymmetric, focal and precedes the changes in the X-ray image.

Adult↗
PubMed2004

Chiropractic management of hip pain after conservative hip arthroplasty.

OBJECTIVES: To describe a case involving postsurgical hip pain that was successfully treated with a combination of chiropractic manipulation of the lumbar and pelvic region and low-tech rehabilitation 14 months postsurgery. CLINICAL FEATURES: A 45-year-old man had pain and difficulty with walking. He was diagnosed with bilateral avascular necrosis at the femoral heads. He had successful right hip arthroplasty (HA) surgery at the time of the original diagnosis and had 2 previous surgeries to the left hip joint to treat avascular necrosis, with the latter being hip arthroplasty. He had a chief complaint of left hip pain that radiated down the lateral thigh to the knee with a "clicking" of the hip noted at end range abduction and adduction, as well as an altered gait pattern associated with dysfunction of the left hip. INTERVENTION AND OUTCOME: He was treated with chiropractic manipulative therapy of the lumbar and sacroiliac joints and a rehabilitation program that consisted of in-office and home exercise programs. The patient experienced a decrease in the pain and an improvement in the flexibility and strength that led to an improved gait pattern and decreased pain. Outcomes were measured through active range of motion comparisons and use of the Harris Hip Scale Evaluation. CONCLUSIONS: Treatment of hip pain through chiropractic manipulation and rehabilitation is described. The patient had increases in active ranges of motion and Harris Hip scores. Additional studies should be done to evaluate the effects of chiropractic manipulations on patient outcomes following such surgeries.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

The HLA B27 antigen-spondylarthropathy association. Impact on clinical expression.

To determine the impact of the HLA B27 antigen on the expression of spondylarthropathies, we conducted a retrospective cross-sectional study of the 116 spondylarthropathy patients whose HLA B27 phenotype was determined during a stay in the Morvan Hospital rheumatology department, Brest, France, between January 1, 1986, and December 31, 1994. Age at disease onset was younger in the HLA B27-positive patients (31.5 +/- 14 years versus 40 +/- 15 years; p = 0.008), who were more likely to have buttock pain (odds ratio, 4.84; p < 0.001) and roentgenographic evidence of sacroiliitis (odds ratio, 5.34; p < 0.001) and less likely to have psoriasis (odds ratio, 0.15; p < 0.0001), as compared with their HLA B27-negative counterparts. Peripheral arthritis occurred in similar proportions of patients with and without the HLA B27 antigen. Presence of HLA B27 was of little value for the diagnosis of spondylarthropathy in patients with inflammatory joint disease involving peripheral joints (sensitivity 50%, specificity 92%, positive predictive value 53%, negative predictive value 91%). Higher mean values of the erythrocyte sedimentation rate (40.3 versus 30.6 mm/h; p < 0.05) and serum C-reactive protein level (29.8 versus 16.8 mg/L, p < 0.005) were seen in patients with the HLA B27 antigen. Our data from patients with any form of spondylarthropathy show that the HLA B27 antigen is associated with earlier-onset disease, involvement of the sacroiliac joints and more severe inflammation.

Adult↗
PubMed2006

[Imaging methods in rheumatology: imaging in psoriasis arthritis (PsA)].

Conventional radiography is still the standard method of imaging in PsA since it displays many joints at the same time, thereby allowing different types of joint involvement to be recognized. Moreover, thanks to the high resolution of radiography, bony changes in a single joint are depicted in a brilliant way. Several features of psoriatic arthritis allow the distinction from rheumatoid arthritis, including the frequent involvement of the distal interphalangeal joints, asymmetry of joint involvement, axial involvement of finger joints, oligoarticular involvement; however, symmetric polyarthritis is also possible. At the level of the single joint, there are signs of severe destructive changes potentially leading to mutilation and at the same time signs of periostal bone proliferation and ankylosis may be present. Bony proliferation and/or osteolysis are not restricted to the joint region but can affect also the total phalanx with bone apposition or concentric osteolysis which may lead to a complete disappearance of phalanxes. For purposes of quantification of radiographic changes scoring methods are used that were originally developed for rheumatoid arthritis. So far, there is only one validated scoring method that was specifically designed for PsA and that takes into account both features of PsA, damage as well as proliferation of bone. In contrast to conventional radiography, MRI and sonography are able to visualize inflammatory processes within the soft tissue (joint capsules, tendon sheaths, tendon insertions, etc.), allowing an estimation of disease activity. Scintigraphy is nonspecific and can only be used to detect clinically silent inflammatory spots. The relatively frequent spinal (axial) involvement is similar to that seen in ankylosing spondylitis. However, unilateral sacroiliitis, asymmetry of syndesmophytes and development of parsyndesmophytes may distinguish PsA from ankylosing spondylitis. While conventional radiography demonstrates the bony consequences of inflammation in the spine, MRI also shows the active inflammatory changes in sacroiliacal joints and vertebrae.

Arthritis, Psoriatic↗
PubMed2002

Development of a radiographic index to assess the tarsal involvement in patients with spondyloarthropathies.

OBJECTIVE: To develop and test an index to evaluate the radiographic changes that occur in the tarsus and adjacent areas of the foot in patients with spondyloarthropathies (SpA). METHODS: The spondyloarthropathy tarsal radiographic index (SpA-TRI) was developed in three consecutive steps: (a) detection of descriptors after reviewing 70 radiographic files; (b) descriptor gradation and subsequent modifications performed by a consensus committee, and (c) interobserver variability assessed by three blinded and independent observers on 272 radiographs: anteroposterior 118, lateral 90, oblique 64 from 121 patients with SpA, and intraobserver variability on 75 radiographs from 25 patients with SpA. Statistical analysis included percentage of agreement and kappa test. SpA-TRI score ranges from 0 to 4 (0=normal; 1=osteopenia or suspicious findings; 2=definite joint space narrowing, bony erosion(s), periosteal whiskering, or enthesophyte(s) in the plantar fascia or Achilleal tendon attachments; 3=para-articular enthesophyte(s); 4=bony ankylosis (joint space fusion or complete bridging)). RESULTS: Complete agreement for every evaluation was >40%, and discordance >1 grade was <15%. The kappa scores among the three observers were acceptable for all the single projections: oblique (0.52, 0.36, 0.35), lateral (0.50, 0.42, 0.56), and anteroposterior (0.40, 0.41, 0.21) views. The combination of lateral and oblique views achieved the highest concordance rates (0.72, 0.33, 0.66), surpassing that of the three projections altogether (0.34, 0.58, 0.37). In every case the concordance was comparable with that of sacroiliac joints (0.47, 0.41, 0.34); intraobserver concordance showed a similar trend. CONCLUSION: The SpA-TRI is an index that includes the most prominent features of tarsal disease and adjacent areas of the foot in SpA and grades them accordingly, it has an adequate reproducibility, and is suitable for use with two or more projections, preferably the combination of oblique and lateral.

Adolescent↗
PubMed1986

The association of obesity with joint pain and osteoarthritis in the HANES data.

Data from 4225 persons from the National Health and Nutrition Examination Survey (HANES) was used to determine whether obesity was associated with osteoarthritis (OA) or joint pain. Subjects were divided into four groups on the basis of sex and race. We found that obesity was associated with OA of the knee for each sex/race group (p less than 0.01). The association was strongest for women, and it was present even for subjects without evidence of knee pain on physical examination. Frame size was not significantly associated with OA of the knee. Relative weight was weakly associated with OA of the hips in white women and nonwhite men but not significantly associated with OA of the sacroiliac joint. Diabetes did not seem to be an important risk factor for OA. These results suggest that the additional mechanical stress resulting from obesity is the principal reason for the association between obesity and OA.

Adult↗
PubMed2006

Magnetic resonance--guided musculoskeletal interventional radiology.

As an imaging modality, magnetic resonance (MR) guidance has great potential to direct diagnostic and therapeutic procedures performed in the musculoskeletal region and influence patient management. MR-guided interventional procedures involving bone, soft tissue, intervertebral discs, and joints are safe and sufficiently effective for use in clinical practice. This article discusses and illustrates the procedural characteristics and techniques when performing MR-guided musculoskeletal interventions. Biopsy procedures are similar to other modalities for bone and soft tissue lesions. MR guidance is advantageous if the lesion is not visible by other modalities and for regions adjacent to hardware and implants, subselective targeting, intra-articular locations, and periarticular cyst aspiration. MR guidance has also been used for a host of spine injections and pain management procedures such as sacroiliac joint injections, discography, transforaminal epidural injection, selective nerve block, sympathetic block, celiac plexus block, and facet joint cryotherapy neurotomies. Future directions of clinical applications include tumor ablation and multimodality procedure suites. MR-guided musculoskeletal procedures will continue to be a growth area particularly for the diagnosis and treatment of bone and soft tissue neoplasia.

Humans↗
PubMed2006

[The reorienting subtalar arthrodesis].

The subtalar joint is part of what may be called the "lower ankle joint" and can be considered as the weight-bearing part of it. In the case of articular problems such as post-traumatic malunions or congenital abnormalities, a joint fusion limited to the subtalar joint can be indicated. Resection of the joint surfaces for accommodating the bones to achieve sound union results in a loss of height which must be considered and avoided. Fractures of the os calcis also often cause a loss of height of the hindfoot, together with a maloriented heel which is incompatible with functional and stable gait. The technique of fusion in those cases implements full liberation of the calcaneus from the talus for complete tridimensional reorientation which most often results in an equivalent empty space. It is then necessary to stabilize the reorientation achieved, most efficiently by an autologous tricortical bone block taken from the posterior iliac crest at the sacroiliac joint level. The optimal surgical approach is from posterolateral as described by Gallie.

Ankle Injuries↗