The incidence and clinical characteristics of peripheral arthritis in polymyalgia rheumatica and temporal arteritis: a prospective study of 231 cases.
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OBJECTIVE: To evaluate the incidence and characteristics of peripheral arthritis in polymyalgia rheumatica and temporal arteritis, and to ascertain the incidence of rheumatoid arthritis among such cases. Patients and methods. In total, 231 patients were selected from a prospective population-based study. All patients were clinically examined on several occasions and followed until cessation of therapy and permanent disease remission. RESULTS: Of the 231 cases, 38.5% presented peripheral arthritis either at diagnosis or during the disease course. At diagnosis, peripheral arthritis was not observed among patients with temporal arteritis. Peripheral arthritis occurring during the disease course was more often polyarticular and needed additional treatment more frequently than joint inflammation presenting at diagnosis. Only one case had distal pitting oedema. Rheumatoid arthritis developed in 4.8% of the cases and exclusively among patients with polymyalgia rheumatica. CONCLUSION: Aetiopathogenic differences may exist between polymyalgia rheumatica and temporal arteritis as peripheral arthritis and the development of rheumatoid arthritis were observed among the former patient group only. (+info)
Radiographic joint space in rheumatoid glenohumeral joints. A 15-year prospective follow-up study in 74 patients.
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OBJECTIVE: To evaluate radiographically the glenohumeral (GH) joint space in patients with long-term rheumatoid arthritis (RA). METHODS: A cohort of 74 patients with RA were followed prospectively for 15 yr. At the end point, 148 shoulders were radiographed using a standard method. The GH joint space was examined from the radiographs using a method developed previously for population studies; the joint space was measured at three different sites and the average of the three measurements, the integral space, was calculated. Destruction of the GH joints was assessed with the Larsen method on a scale of 0-5 and compared with the joint space measurements. RESULTS: The mean GH joint space in RA patients was 3. 1 (S.D. 3.3), range -17.3 to 5.7 mm; 2.7 mm (S.D. 4.5) in men and 3. 2 mm (S.D. 2.8) in women. The mean of the affected joints (Larsen grades 2-5), 1.7 mm (S.D. 4.5), was notably narrower than the mean 4. 4 mm (S.D. 0.6) of the non-affected (Larsen grades 0-1) joints. Pathological GH joint space, less than 2 mm, was found in five (15%) of 36 joints in men and in 14 (13%) of 112 joints in women. All the joints graded as Larsen 4 and 5 (n = 17) fulfilled this pathological criterion. Joint space narrowing was associated [r = - 0.66, 95% confidence interval (CI): -0.56 to -0.75] with increasing destruction (Larsen grading) of the joint. The narrowing was significant between non- (Larsen 0, 1), moderately (Larsen 2, 3) and severely (Larsen 4, 5) affected joints (P < 0.001). However, a remarkable step in this process occurred between Larsen grades 3 and 4 when the mean joint space diminished from 3.1 to 0.3 mm. CONCLUSIONS: Joint space narrowing is a frequent consequence of GH joint rheumatoid affection. However, joint space narrowing is a late phenomenon occurring not until after marked erosive destruction, which should be noted when using the Larsen method for GH joints. (+info)
Magnetic resonance arthrography of the acetabular labrum. Macroscopic and histological correlation in 20 cadavers.
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We studied the sensitivity and specificity of magnetic resonance arthrography (MRa) for the diagnosis of lesions of the acetabular labrum in 20 cadaver hips. The MRa results were compared with macroscopic and histological findings. We found that the labrum could be satisfactorily delineated by MRa and that large detachments could be identified satisfactorily. The diagnosis of small detachments and degeneration of the labrum was less reliable. (+info)
In vivo kinematics of total knee arthroplasty. Concave versus posterior-stabilised tibial joint surface.
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We studied the kinetics of the knee in 20 patients (22 knees) 12 months after total knee arthroplasty (TKA), by using three-dimensional radiostereometry and film-exchanger techniques. Eleven knees had a concave (constrained) tibial implant and 11 a posterior-stabilised prosthesis. Eleven normal knees served as a control group. In the posterior-stabilised knees there was less proximal and posterior displacement of the centre of the tibial plateau during extension from 45 degrees to 15 degrees, with a decrease in the anterior translation of the femoral condyles of 4 mm at 45 degrees. There was less internal tibial rotation and increased distal positioning of the centre of the tibial plateau with both designs when compared with the normal knees, and in both the centre of the plateau was displaced posteriorly by more than 1 cm. Increased AP translation has been recorded in all prosthetic designs so far studied by radiostereometry. The use of a posterior-stabilised design of tibial insert could reduce this translation but not to that of the normal knee. (+info)
Antineutrophil cytoplasmic antibodies in patients with early rheumatoid arthritis: an early marker of progressive erosive disease.
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OBJECTIVE: To evaluate the clinical associations of antineutrophil cytoplasmic antibodies (ANCA) in patients with early rheumatoid arthritis (RA), as well as the possible predictive role of ANCA. We also assessed the overlap of ANCA with other specific serologic markers of RA. METHODS: Eighty-two RA patients with symptoms for < or = 12 months were studied for the presence of ANCA by immunofluorescence and specific enzyme immunoassays. ANCA were determined and clinical, radiographic, and laboratory data were collected at study entry and later at 12, 36, 60, and 84 months. RESULTS: In 2 patients, the first serum samples (obtained at study entry) were no longer available for the determination of ANCA. Perinuclear ANCA (pANCA) were found in 40 patients (50%), and atypical cytoplasmic ANCA were found in 3 patients (4%) at study entry. Perinuclear ANCA-positive patients were significantly more frequently positive for rheumatoid factor (78%) than were ANCA-negative patients (54%) (P = 0.0297). Fifty-five percent of pANCA-positive patients and 22% of ANCA-negative patients were positive for antiperinuclear factor (P = 0.0044). Similarly, pANCA-positive patients had antikeratin antibodies more frequently than did ANCA-negative patients (35% versus 20%). During a 7-year followup, the progress of radiographic joint destruction, assessed with Larsen scores, was significantly more rapid in patients who were pANCA positive at study entry than in those who were ANCA negative (P = 0.0015). Also, the mean titer of pANCA at study entry was significantly higher in those patients who subsequently had advanced radiographic joint destruction at 60 and 84 months. The association of pANCA with rapid radiographic destruction in patients with early RA was further corroborated by a logistic regression analysis that selected pANCA positivity as an independent and statistically significant predictor of rapid radiographic joint destruction. CONCLUSION: In patients with early RA, pANCA are associated with specific serologic markers of RA and predict rapid radiographic joint destruction. (+info)
Computer-based methods for measuring joint space and estimating erosion volume in the finger and wrist joints of patients with rheumatoid arthritis.
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OBJECTIVE: This study was conducted 1) to determine the feasibility of using computer programs to measure radiographic joint space width and estimate erosion volume in the hands of patients with rheumatoid arthritis (RA), and 2) to compare the new computer-based methods with established scoring methods. METHODS: To measure the joint space width in the finger and wrist joints of RA patients, hand and wrist radiographic films were scanned using a tabletop scanner and analyzed with programs written using the "macro" capabilities of NIH Image software. Estimation of erosion volume was determined by utilizing gray-scale intensity to calibrate bone density units per mm3, which made possible comparisons between the erosions and noneroded, anatomically similar sites. RESULTS: In 3 sets of duplicate measurements of joint space width on 79, 48, and 48 finger and wrist joints, the mean absolute deviation from the mean of the 2 measurements was 0.036 mm (SD 0.034), 0.032 mm (SD 0.049), and 0.021 mm (SD 0.016), respectively. Joint space measurements and scoring of joint space narrowing both demonstrated a difference between active treatment and placebo in an old trial set on gold therapy (P = 0.03 and P = 0.01, respectively). Two repeated measurements of bone density units in the bones of 3 different hands differed from the mean of the measurement by 2.29-4.04%. In 2 experiments, estimates of erosion volume showed a greater difference between gold therapy and placebo than did erosion scores in the trial set (P = 0.049 and P = 0.016 versus P = 0.27). CONCLUSION: Computer-based methods for measuring finger and wrist joint spaces and estimating erosion volume in patients with RA agree with the results of radiographic scoring of erosions and joint space narrowing. (+info)
Lateral shelf acetabuloplasty in Perthes' disease. A review of the end of growth.
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The surgical treatment of Perthes' disease by femoral or innominate osteotomy is not as effective in those over the age of eight years as it is in the younger child. This has prompted the search for other types of management in those who are older. The preliminary results of the use of a lateral shelf acetabuloplasty for such cases have shown encouraging results at two years. The concern with such an operation is that it might interfere with the growth of the outer aspect of the acetabulum and so prejudice the long-term outcome. We describe a review at maturity of 26 children presenting with early disease after the age of eight years who were treated by lateral shelf acetabuloplasty. The results suggest that the outcome is improved; 22 of 27 hips were rated as Stulberg groups 1 to 3. Poor results occurred in children, particularly girls, presenting with Group-4 disease over the age of 11 years. (+info)
Soft-tissue interposition after closed reduction in developmental dysplasia of the hip. The long-term effect on acetabular development and avascular necrosis.
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We reviewed 98 children (133 hips) with developmental dysplasia of the hip who underwent arthrography immediately after closed reduction by overhead traction. We followed the patients to skeletal maturity to investigate whether soft-tissue interposition influences acetabular development and avascular necrosis over the long term. The shape of the limbus and the thickness of the soft-tissue interposition at the acetabular floor, as shown on arthrograms at the time of reduction, were not directly related to the final radiological results or to the incidence of avascular necrosis. Even if marked soft-tissue interposition was found on the initial arthrogram, spontaneous disappearance was noted in 71% up to the age of five years. The final radiological results showed no difference between those in which the interposition disappeared and those with none at the time of closed reduction. However, the requirement for secondary surgery at the age of five years was significantly higher in those with more than 3.5 mm of soft-tissue interposition. In the no-disappearance group (group C) further operation was necessary in 100% and the results were significantly worse at maturity according to Severin's classification. We suggest that the indications for open reduction should not be based solely on the arthrographic findings at the time of closed reduction. (+info)