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To determine the forms and characteristics of rheumatic diseases whose initial presentation mimics septic arthritis. Retrospective study of 398 patients hospitalized between 1979 and 2005 for arthritis diagnosed and treated as sep...
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To determine the forms and characteristics of rheumatic diseases whose initial presentation mimics septic arthritis. Retrospective study of 398 patients hospitalized between 1979 and 2005 for arthritis diagnosed and treated as septic. In 10 cases, initial presentation of a rheumatic disease was highly suggestive of septic arthritis, and the patient was treated as such. Three had rheumatoid arthritis, 3 spondyloarthropathies, 2 unclassified rheumatic diseases, 1 Wegener granulomatosis and 1 cytosteatonecrosis. Mean time to diagnosis of rheumatic arthritis was 6 months. There were 7 males and 3 females aged from 15 to 77 years. Six had fever, and 3 had leucocytosis. Average ESR was 68 mm/1 h, and C-reactive protein was above 100 mg/l in 6 patients. Five patients had radiological signs suggestive of septic arthritis. Joint fluid count was above 100,000 WBCs/mm3 in 2/5. Synovial biopsy suggested septic arthritis in 5 out of 6. These cases of pseudoseptic arthritis were indistinguishable from true septic arthritis. Follow-up is required in septic arthritis with negative culture findings to exclude rheumatic disease.
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We present the case of a 61-year-old female with an acute onset of polyarthritis involving the wrists, hands, knees, and ankles. Associated systemic symptoms included fever, weight loss, and lymphadenopathy. Serologic workup revea...
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We present the case of a 61-year-old female with an acute onset of polyarthritis involving the wrists, hands, knees, and ankles. Associated systemic symptoms included fever, weight loss, and lymphadenopathy. Serologic workup revealed positive rheumatoid factor (RF) and anti-cyclic citrullinated protein (anti-CCP) antibodies. Radiograph imaging of her bilateral hands and wrists showed erosive joint disease and lymph node, and bone marrow biopsy confirmed a diagnosis of T cell lymphoblastic leukemia. Our case demonstrates a unique clinical phenotype of paraneoplastic arthritis and is only the second reported case of RF, anti-CCP-positive arthritis related to a hematological malignancy. We review the only three published cases of seropositive paraneoplastic arthritis. In each case, systemic symptoms or a poor response to steroid treatment triggered additional workup. These cases highlight the importance of careful clinical assessment and vigilance to rule out secondary causes of inflammatory arthritis, even in patients with seropositive erosive arthritis.
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Purpose of review Improvements in medications, implant design, and arthroscopic techniques have changed the available treatment options for the arthritic patient. The purpose of the present review is to explore recent developments...
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Purpose of review Improvements in medications, implant design, and arthroscopic techniques have changed the available treatment options for the arthritic patient. The purpose of the present review is to explore recent developments and publications discussing the management of elbow arthritis. Recent findings New medications have greatly reduced the role of surgery in the management of rheumatoid arthritis. Effective arthroscopic treatments are being developed for elbow arthritis, but it is difficult for more than a few surgeons to gain sufficient experience with these complex technical procedures. Several new concepts have influenced total elbow prostheses. Summary The management of elbow arthritis is based on the type of arthritis and patient factors. The majority of operative treatments are palliative or reconstructive. As with arthritis in other joints, there is a stepladder of treatment options from nonspecific analgesia to arthroscopic or open debridement, interpositional arthroplasty, and ending with prosthetic arthroplasty, which is best reserved for relatively infirm and low-demand patients.
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Die septische Arthritis ist immer eine interdisziplinäre Herausforderung an Rheumatologen und Chirurgen. Eine entsprechend der gängigen Klassifikationen eingeleitete Behandlung muss stadienadaptiert sein und möglichst schnell e...
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Die septische Arthritis ist immer eine interdisziplinäre Herausforderung an Rheumatologen und Chirurgen. Eine entsprechend der gängigen Klassifikationen eingeleitete Behandlung muss stadienadaptiert sein und möglichst schnell erfolgen, da der Zeitfaktor das entscheidende prognostische Kriterium darstellt. Unbehandelt und bei zu spätem Therapiebeginn resultieren irreversible Gelenkschädigungen, Funktionsdefizite und ein Anstieg der Letalität. Besonders bei der akuten Gelenkinfektion sichern der klinische Befund, die laborchemischen Infektparameter und das Gelenkpunktat in den meisten Fällen die schnelle Empyemdiagnose. Chronische septische Arthritiden können dagegen erhebliche Probleme in der Diagnostik machen, in diesen Fällen kommen weiterführende bildgebende Diagnostikmethoden zum Einsatz. Besondere klinische Relevanz hat die Berücksichtigung der Vorbehandlung, Infektausdehnung und Gelenkschädigung. Nach einer evtl. antibiotischen Vorbehandlung ist als definitive Therapie stets eine operative Behandlung mit Einsatz arthroskopischer und offen chirurgischer Techniken in Abhängigkeit des Infektstadiums notwendig. Beide Operationstechniken haben vergleichbare Therapieerfolge. Wichtig ist die operative Radikalität beim Entfernen des infizierten Gewebes. Adjuvante und unterstützende Therapien sind die lokale und systemische Antibiotikabehandlung. Um Funktionsdefizite zu vermeiden, sollte eine intensive frühzeitig einsetzende Physiotherapie durchgeführt werden.
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The clinical features of 19 patients who had arthritis and leukemia were reviewed and compared with those without arthritis. There was leukemic arthritis (characterized by absence of other evident causes and response to chemothera...
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The clinical features of 19 patients who had arthritis and leukemia were reviewed and compared with those without arthritis. There was leukemic arthritis (characterized by absence of other evident causes and response to chemotherapy) in 14, septic arthritis in 4, and hemarthrosis in 1. Among those with leukemic arthritis, there was acute leukemia in 11 and chronic leukemia in 3. The arthritis presented before, simultaneously with, and after the diagnosis of leukemia in 5,4, and 5 cases, respectively. Acute symmetrical polyarthritis mimicking rheumatoid was the most common presentation. The knee, wrist, and ankle were most commonly involved. A degree of pain, which was out of proportion to the degree of inflammation, could be seen occasionally. Synovial fluid blast cells were identified in 33% of cases. The leukemic arthritis responded well to chemotherapy. Septic arthritis was an initial presentation of leukemia in 2 patients. There was no significant difference in hematologic parameters or in mortality rate between those with and without arthritis.
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Background: No microorganism is identified in 7-35% of cases of septic arthritis. The diagnosis is, therefore, only presumptive. We reviewed our cases of septic arthritis in adult native joints to determine the frequency of negati...
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Background: No microorganism is identified in 7-35% of cases of septic arthritis. The diagnosis is, therefore, only presumptive. We reviewed our cases of septic arthritis in adult native joints to determine the frequency of negative cultures, disease characteristics and the frequency of misdiagnosis of septic arthritis. Methods: This retrospective study included all patients admitted to our department from 1979-2005 with arthritis, diagnosed and treated as septic. Results: No microorganism was isolated from synovial fluid or blood samples from 74 out of 398 (19%) patients with presumed septic arthritis. Patients without microorganisms were younger (54 vs 62 years), less likely to have risk factors for septic arthritis (31% vs 41%) and had lower mortality (0 vs 5%) than patients with positive cultures. Long-term outcome was known for 48 patients. A retrospective analysis of all data and long-term outcome concluded that septic arthritis was probable in 18 patients and improbable in 13. Ten of the latter developed rheumatic disease after a mean time of 6 months: rheumatoid arthritis (n= 3), spondyloarthropathies (n= 3), unclassified rheumatic disease (n= 2), Wegener granulomatosis (n= 1) and cytosteatonecrosis (n= 1). Fever and signs of inflammation were more frequent and synovial fluid cell counts were higher in patients with improbable septic arthritis. Conversely, radiological signs were more common in patients with probable septic arthritis. Conclusion: At least 14% of patients diagnosed with septic arthritis with negative bacteriological results subsequently develop rheumatic disease. This pseudoseptic arthritis is indistinguishable from true septic arthritis. When no microorganism is identified, the diagnosis remains presumptive and follow-up is necessary to screen for other diseases, especially rheumatic diseases.
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Mit Certolizumab pegol (CDP870) steht seit Oktober 2009 ein neuer TNF-α-Blocker zur Behandlung der rheumatoiden Arthritis zur Verfügung. Durch eine Modifizierung des Antikörperfragments durch das Anhängen von Polyethylenglykol...
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Mit Certolizumab pegol (CDP870) steht seit Oktober 2009 ein neuer TNF-α-Blocker zur Behandlung der rheumatoiden Arthritis zur Verfügung. Durch eine Modifizierung des Antikörperfragments durch das Anhängen von Polyethylenglykol (PEG) konnte im Tierversuch ein besseres Eindringen in entzündliches Gewebe nachgewiesen werden. In zwei individuellen Patientenkasuistiken konnte bei therapierefraktären Arthritiden eine Remission unter dem pegylierten Certolizumab erreicht werden.
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Objective. To conduct a systematic review and quality appraisal of quality measures for inflammatory arthritis, including rheumatoid arthritis (RA), spondyloarthritis, psoriatic arthritis (PsA), and juvenile idiopathic arthritis (JIA).
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Die Differenzialdiagnose von Arthritiden und anderer Erkrankungen, die mit Gelenkbeschwerden einhergehen, ist oft selbst für erfahrene Radiologen schwierig. Dennoch gibt es einfache Zeichen, die den ausschlaggebenden Hinweis zur ...
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Die Differenzialdiagnose von Arthritiden und anderer Erkrankungen, die mit Gelenkbeschwerden einhergehen, ist oft selbst für erfahrene Radiologen schwierig. Dennoch gibt es einfache Zeichen, die den ausschlaggebenden Hinweis zur Diagnosestellung geben können. In enger Zusammenarbeit mit den klinisch tätigen Kollegen kann der Radiologe so wichtige therapierelevante Hinweise geben. Dieser Artikel bündelt klassische radiologische Bildbefunde und Tipps für die sichere Befundinterpretation.
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