Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arthritis: reliability in a multireader longitudinal study.
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OBJECTIVES: To describe a novel scoring system for the assessment of tenosynovitis by magnetic resonance imaging (MRI) in patients with rheumatoid arthritis, and assess its intra- and inter-reader reliability in a multireader, longitudinal setting. METHODS: Flexor and extensor tenosynovitis were evaluated at the level of the wrist in 10 different anatomical areas, graded semi-quantitatively from grade 0 to 3 (total score 0-30), based on the maximum width of post-contrast enhancement within each anatomical area on axial T1-weighted MR images. Ten sets of baseline and 1-year follow-up MR images of the wrists of patients with rheumatoid arthritis with early and established disease were scored independently by four readers twice on 2 consecutive days. Intra- and inter-reader agreements were evaluated. RESULTS: The intrareader intraclass correlation coefficients (ICCs) were high for status scores (median ICCs 0.84-0.88) and slightly lower for change score (0.74). The smallest detectable difference (SDD) in % of the maximum score was 11.2-11.5% for status scores and 13.3% for change scores. Inter-reader single-measure ICCs were acceptable for both status scores (median 0.73-0.74) and change scores (0.67), while average-measures ICCs were very high for both status and change score (all > or =0.94). The median scoring time per patient (baseline and follow-up images) was 7 min (range 3-10). CONCLUSIONS: The introduced tenosynovitis scoring system demonstrates a high degree of multireader reliability, is feasible, and may be used as an adjuvant to the existing OMERACT RAMRIS score, allowing improved quantification of inflammatory soft tissue changes in patients with rheumatoid arthritis. (+info)
Heterophil function in healthy chickens and in chickens with experimentally induced staphylococcal tenosynovitis.
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Heterophil function was evaluated in 16 healthy chickens and in 46 chickens with experimentally induced staphylococcal tenosynovitis. In paired blood samples, heterophils from chickens with tenosynovitis had a significant increase in adherence, chemotaxis, phagocytosis, and bacterial killing of Staphylococcus aureus compared to heterophils from healthy chickens. The percent adherence of heterophils to nylon fiber columns increased significantly from a 78.4% mean +/- 6.6% standard deviation to 87.6% +/- 3.2% after induction of staphylococcal tenosynovitis. Heterophil movement following in vitro exposure to saline or endotoxin was increased in chickens with tenosynovitis; 3 +/- 1 heterophils/0.25 mm2 to 10 +/- 6 heterophils/0.25 mm2 and 136 +/- 29 heterophils/0.25 mm2 to 340 +/- 74 heterophils/0.25 mm2, respectively. Endotoxin-activated serum was chemoattractive for heterophils from all chickens. Flow cytometry was used to define the heterophil population on light scatter histograms, evaluate individual cell phagocytosis of latex beads, and quantitate the number of beads phagocytosed per heterophil. When incubated with increased numbers of beads, only heterophils from chickens with tenosynovitis phagocytosed higher numbers of beads. At heterophil to bead ratios of 1:10, the percentage of heterophils that phagocytosed beads increased from baseline values of 37.8% +/- 9.0% to post-infection values of 67.3% +/- 7.5%. Using 1:20 heterophil to bead ratios, heterophil phagocytosis increased from 38.7% +/- 9.9% to post-infection values of 79.8% +/- 7.3%. Heterophils from all chickens were able to phagocytose and kill log phase staphylococcal bacteria. After phagocytosis, the heterophils from chickens with staphylococcal tenosynovitis rapidly decreased the number of viable bacterial colony forming-units per milliliter by approximately one log.(ABSTRACT TRUNCATED AT 250 WORDS) (+info)
Evidence for a different anatomic basis for joint disease localization in polymyalgia rheumatica in comparison with rheumatoid arthritis.
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OBJECTIVE: The anatomic basis for joint disease localization in polymyalgia rheumatica (PMR) is poorly understood. This study used contrast-enhanced and fat suppression magnetic resonance imaging (MRI) to evaluate the relationship between synovial and extracapsular inflammation in PMR and early rheumatoid arthritis (RA). METHODS: Ten patients with new-onset PMR and 10 patients with early RA underwent dynamic contrast-enhanced MRI and conventional MRI of affected metacarpophalangeal (MCP) joints. Synovitis and tenosynovitis were calculated based on the number of enhancing voxels, initial rate of enhancement, and maximal enhancement of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). Periarticular bone erosion and bone edema were scored according to the OMERACT (Outcome Measures in Rheumatology Clinical Trials) scoring system in both groups. The degree of extracapsular Gd-DTPA enhancement was assessed in both conditions using semiquantitative scoring. RESULTS: No significant differences were seen in the volume of synovitis (P = 0.294), degree of flexor tenosynovitis (P = 0.532), periarticular erosions (P = 0.579), or degree of bone edema (P = 0.143) between RA and PMR joints. However, despite comparable degrees of synovitis, the proportion of MCP joints showing extracapsular enhancement was higher in the PMR group (100%) than in the RA group (50%) (P = 0.030). One PMR patient, but none of the RA patients, had bone edema at the capsular insertion. CONCLUSION: Despite degrees of synovitis and tenosynovitis comparable with those in RA, PMR-related hand disease is associated with prominent extracapsular changes, suggesting that inflammation in these tissues is more prominent than joint synovitis, which is common in both conditions. This suggests that the anatomic basis for joint disease localization differs between RA and PMR. (+info)
Finger tendon disease in untreated early rheumatoid arthritis: a comparison of ultrasound and magnetic resonance imaging.
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OBJECTIVE: To investigate the frequency and distribution of finger tenosynovitis in patients with early, untreated rheumatoid arthritis (RA) using gray-scale ultrasound (US) and magnetic resonance imaging (MRI). METHODS: Fifty patients underwent US and MRI of metacarpophalangeal (MCP) joints 2-5. Twenty healthy controls underwent US only. Flexor and extensor involvement was documented for each joint. Intrareader reliability (IRR) was calculated by rereading static images. RESULTS: Flexor tenosynovitis was found in 57 (28.5%) of 200 joints in 24 (48%) of 50 patients on US compared with 128 (64%) of 200 joints in 41 (82%) of 50 patients on MRI. Periextensor tenosynovitis was found in 14 (7%) joints in 9 (18%) patients on US compared with 80 (40%) joints in 36 (72%) patients on MRI. No controls had imaging tenosynovitis. Using MRI as the gold standard, the sensitivity, specificity, and negative and positive predictive values for US were 0.44, 0.99, 0.49, and 0.98, respectively, for flexor tenosynovitis and 0.15, 0.98, 0.63, and 0.86 for extensor tenosynovitis, respectively. The IRR was 0.85 and 0.8 for US and MRI, respectively. The most frequently involved joints on US and MRI were the second and third MCP joints. CONCLUSION: This is the first study to compare US and MRI for the detection of tenosynovitis in the fingers of patients with early untreated RA. Tenosynovitis was found to be common using both modalities, with MRI being more sensitive. A negative US scan does not exclude inflammation and an MRI should be considered. Further work is recommended to standardize definitions and image acquisition for both US and MRI images. (+info)
Hand and wrist problems in general practice--patient characteristics and factors related to symptom severity.
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OBJECTIVES: Hand and wrist problems are common, but little is known about characteristics of patients consulting the general practitioner (GP) for these problems. The objectives are: (i) to describe wrist and hand problems presented to the GP in terms of severity of symptoms, and their impact on physical, emotional and social functioning; (ii) to describe patient and disease characteristics across different diagnostic categories; and (iii) to study factors related to the severity of hand or wrist problems. METHODS: Patients consulting their GP with hand or wrist problems were sent a questionnaire containing questions on socio-demographic variables, characteristics of the complaint, physical activity and psychosocial factors. The GP recorded information on symptoms, signs and medical diagnosis. We studied the cross-sectional association between a variety of factors and severity of hand or wrist problems, using the Symptom Severity Scale as the outcome measure. RESULTS: Mean age of the 267 participants was 49.3 yrs and 74% were female. The three most frequently recorded diagnoses were osteoarthritits (17%), tenosynovitis (16%) and nerve entrapment (12%). The characteristics of patients varied slightly across diagnostic categories. Patients who did not have paid work, had longer duration of symptoms, diagnosis of entrapment, higher pain intensity, higher body mass index and higher scores on worrying reported significantly higher scores on severity of hand or wrist problems (P-value <0.10). CONCLUSION: Primary care patients with hand or wrist problems report pain and reduced function. Impact on other aspects of perceived health is limited. Severity seems to be associated with socio-demographic, physical and psychosocial factors, more than with medical diagnosis. (+info)
Tuberculous pyomyositis of the thigh masquerading as malignancy with concomitant tuberculous flexor tenosynovitis and dactylitis of the hand.
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Multifocal involvement of the skeleton is extremely rare, with tuberculous pyomyositis and tenosynovitis of the wrist being uncommon presentations of skeletal tuberculosis (TB). We present an immunocompetent 68-year-old woman with concomitant presentation of these uncommon forms of extrapulmonary TB heralded by tuberculous pyomyositis. Tuberculous pyomyositis can often masquerade as malignancy, leading to misdiagnosis and patients being mistakenly referred to oncologists for management. This delayed the institution of appropriate drug therapy. Similarly, because of its rarity, tuberculous tenosynovitis may be overlooked as a cause of chronic tenosynovitis. In the absence of pathognomonic imaging findings, the diagnosis ultimately rests on histopathological and microbiological confirmation. This case highlights the importance of maintaining a high index of suspicion of the protean manifestations of extrapulmonary TB, not only in high-risk populations, but in immunocompetent individuals as well. It also illustrates the advantage of a clinically-directed multidisciplinary approach in early recognition and treatment of this entity. (+info)
A mass lesion of the wrist: a rare manifestation of tuberculosis.
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The worldwide reemergence of tuberculosis is significant. In particular, the incidence of extrapulmonary tuberculosis is increasing. But tuberculous tenosynovitis is rare and may be overlooked as a cause of chronic tenosynovitis. Here, we present a case of a 24 year-old man with a mass lesion on the flexor side of the right wrist. Laboratory findings were generally negative, except for the acceleration of the erythrocyte sedimentation rate, and the tuberculosis skin test was strongly positive. Magnetic resonance imaging (MRI) of the mass lesion of the wrist revealed tenosynovitis. We performed open biopsy and mycobacterial cultures. Thus, we diagnosed the patient with tuberculous tenosynovitis. Tuberculous tenosynovitis is uncommon but should be kept in mind in cases of chronic tenosynovitis. (+info)
Sonographic features of soft tissue tumors in the hand and forearm.
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BACKGROUND: High-resolution sonography is well suited for screening soft tissue masses because of its safety, low cost, and real-time, dynamic imaging. The purpose of our study was to elaborate the preoperative sonographic features of soft tissue tumors of the hand and forearm and the corresponding histologic results. METHODS: Thirty-one soft tissue tumors of the hand and forearm were evaluated by ultrasound preoperatively. The mobility, consistency, echogenicity, margin, and color Doppler signal of each tumor were assessed. Dynamic study was also performed. The pathologic diagnosis was obtained after subsequent surgery. RESULTS: The pathologic diagnoses of these soft tissue lesions were lipoma (n = 6), ganglion cyst (n = 6), neurilemmoma (n = 3), neurofibroma (n = 3), giant cell tumor (n = 10), tenosynovitis (n = 2), and malignant lymphoma (n = 1). An adjacent tendon or communication duct extending to the joint space could be found in most giant cell tumors and ganglion cysts; a traceable nerve could be found in most nerve sheath tumors. All benign tumors appeared well-defined. The only malignant tumor appeared ill-defined without a color Doppler signal. CONCLUSION: Sonography enables a reliable diagnosis of the cystic or solid nature of soft-tissue lesions, accurate estimation of the volume, and precise three-dimensional localization of the abnormality. Examiners should perform a dynamic examination and trace the adjacent structure to obtain more diagnostic clues. (+info)