1
|
Zivadinovic JD, Stojanovic MM, Stosic MD, Zivadinovic AR, Jankovic R, Gmijovic MD, Golubovic I, Stosic B, Ignjatovic NS, Stojanovic MP. Subcutaneous and Intraosseous Fat Necrosis Associated with Chronic Pancreatitis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060802. [PMID: 35744065 PMCID: PMC9227301 DOI: 10.3390/medicina58060802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
Background: Extra-abdominal manifestations of fat necrosis, like subcutaneous fat necrosis, polyarthritis, and polyserositis may appear with an occurrence rate of about 0.8%, wherein intraosseous fat necrosis is a more rare complication of pancreatitis, with few reports in English literature. Case report: A 34-year-old male with a 15-year-history of alcohol abuse was hospitalized several times in the last few years because of attacks of relapsed chronic pancreatitis. After the last attack, pancreatitis came in a stable state (“burned out”) with no symptoms and signs of the disease. The patient had been free of symptoms for 28 months since the last admission when he came with sub-febrile temperature, huge pain, swelling, and erythema in the area of the left lateral malleolar region with propagation in the foot. Blood biochemistry was normal. Conventional radiography showed multiple sites of osteolysis in the left calcaneus. Images on multislice computed tomography (MSCT) with 3D reconstruction revealed hypodense focuses that corresponded to osteonecrosis areas and bone marrow edema in the left calcaneus. Conclusions: The possibility of intraosseous fat necrosis should be considered in situations of unexplained polyarthritis or panniculitis, particularly in individuals with alcohol abuse or pancreatic disease.
Collapse
Affiliation(s)
- Jelena D. Zivadinovic
- Clinic for Aneasthesiology and Intensive Therapy, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.S.); (R.J.); (B.S.)
- Correspondence:
| | - Marko M. Stojanovic
- Gastroenterology and Hepatology Clinic, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia;
| | - Marija D. Stosic
- Clinic for Aneasthesiology and Intensive Therapy, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.S.); (R.J.); (B.S.)
| | - Aleksandar R. Zivadinovic
- Clinic for Gynecology and Obstetrition, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia;
| | - Radmilo Jankovic
- Clinic for Aneasthesiology and Intensive Therapy, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.S.); (R.J.); (B.S.)
| | - Marko D. Gmijovic
- Digestive Surgery Clinic, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.G.); (I.G.); (N.S.I.); (M.P.S.)
| | - Ilija Golubovic
- Digestive Surgery Clinic, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.G.); (I.G.); (N.S.I.); (M.P.S.)
| | - Biljana Stosic
- Clinic for Aneasthesiology and Intensive Therapy, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.S.); (R.J.); (B.S.)
| | - Nebojsa S. Ignjatovic
- Digestive Surgery Clinic, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.G.); (I.G.); (N.S.I.); (M.P.S.)
| | - Miroslav P. Stojanovic
- Digestive Surgery Clinic, University Clinical Center Nis, University of Nis, 18000 Nis, Serbia; (M.D.G.); (I.G.); (N.S.I.); (M.P.S.)
| |
Collapse
|
2
|
Dieker W, Derer J, Henzler T, Schneider A, Rückert F, Wilhelm TJ, Krüger B. Pancreatitis, panniculitis and polyarthritis (PPP-) syndrome caused by post-pancreatitis pseudocyst with mesenteric fistula. Diagnosis and successful surgical treatment. Case report and review of literature. Int J Surg Case Rep 2017; 31:170-175. [PMID: 28152495 PMCID: PMC5288313 DOI: 10.1016/j.ijscr.2017.01.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/15/2017] [Accepted: 01/16/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Pancreatitis, panniculitis and polyarthritis syndrome is a very rare extra-pancreatic complication of pancreatic diseases. PRESENTATION OF CASE While in most cases this syndrome is caused by acute or chronic pancreatitis, we report a case of a 62-year-old man presenting with extensive intraosseous fat necrosis, polyarthritis and panniculitis caused by a post-pancreatitis pseudocyst with a fistula to the superior mesenteric vein and extremely high blood levels of lipase. This became symptomatic 2.5 years after an episode of acute pancreatitis and as in most cases abdominal symptoms were absent. Treatment by surgical resection of the pancreatic head with the pseudocyst and mesenteric fistula led to complete remission of all symptoms. DISCUSSION A review of the literature revealed that all publications are limited to case reports. Most authors hypothesize that an unspecific damage can cause a secretion of pancreatic enzymes to the bloodstream leading to a systemic lipolysis and fat tissue necrosis, especially of subcutaneous tissue, bone marrow, inducing panniculitis, polyarthritis and osteonecrosis. Even if caused by an acute pancreatitis abdominal symptoms are often mild or absent in most cases leading to misdiagnosis and poor prognosis. CONCLUSION While symptomatic treatment with NSAR and cortisone showed poor to moderate response, causal treatment can be successful depending on the underlying pancreatic disease.
Collapse
Affiliation(s)
- Wulf Dieker
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Johannes Derer
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Thomas Henzler
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Alexander Schneider
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Felix Rückert
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Torsten J Wilhelm
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Bernd Krüger
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| |
Collapse
|
3
|
Ferri V, Ielpo B, Duran H, Diaz E, Fabra I, Caruso R, Malave L, Plaza C, Rodriguez S, Garcia L, Perez V, Quijano Y, Vicente E. Pancreatic disease, panniculitis, polyarthrtitis syndrome successfully treated with total pancreatectomy: Case report and literature review. Int J Surg Case Rep 2016; 28:223-226. [PMID: 27736709 PMCID: PMC5065631 DOI: 10.1016/j.ijscr.2016.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/10/2016] [Accepted: 09/10/2016] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Pancreatic disease can be complicated by extrabdominal manifestations such as panniculitis and polyarthritis. The symptomatic triad comprising pancreatic disease, panniculitis and polyarthritis is also known as PPP syndrome and is characterized by severe chronic sequels and high mortality rate. We describe a case of PPP syndrome successfully treated with spleen preserving total pancreatectomy; in addition we performed a literature review. PRESENTATION OF CASE A 67 years old male presented panniculitis and polyarthritis without clinical abdominal symptoms. Clinical presentation, laboratory values and radiological findings demonstrated an acute pancreatitis and a pancreatic cancer was suspected; failure of conservatory treatments and high suspicious of malignancy led to perform a spleen preserving total pancreatectomy. Finally histological examination excluded a pancreatic cancer and confirmed a chronic pancreatitis. Patient was discharged with complete resolution of the extrabdominal disease. DISCUSSION In literature only 64 cases of PPP syndrome have been reported. Abdominal symptoms do not often appear at presentation and diagnosis may be delayed. Panniculitis develope in any part of the body but especially on the distal parts of the lower extremities, around the ankles and pretibial regions of the legs. Between osteo-articular manifestations polyarthritis is the most common one, although oligoarthritis, and monoarthritis in have been reported. CONCLUSION PPP syndrome is a rare disease with a high mortality rate. A timely diagnosis and an aggressive treatment may improve the prognosis of this condition.
Collapse
Affiliation(s)
- Valentina Ferri
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain.
| | - Benedetto Ielpo
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Hipolito Duran
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Eduardo Diaz
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Isabel Fabra
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Riccardo Caruso
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Luisi Malave
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Carlos Plaza
- Division of Anatomic Pathology, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Silvia Rodriguez
- Division of Reumathology Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Lina Garcia
- Diviasion of Nuclear Medicin, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Virginia Perez
- Division or Radiology, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Yolanda Quijano
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| | - Emilio Vicente
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, Madrid, Spain
| |
Collapse
|
4
|
Polyarthritis and pancreatic panniculitis associated with pancreatic carcinoma: review of the literature. J Clin Rheumatol 2015; 20:433-6. [PMID: 25417680 DOI: 10.1097/rhu.0000000000000181] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pancreatic disorders, such as chronic or acute pancreatitis, and carcinoma may be infrequently accompanied or preceded by panniculitis or polyarthritis. This triad is known in the literature as the pancreatitis, panniculitis, and polyarthritis syndrome. Although the pancreatic disease of pancreatitis, panniculitis, and polyarthritis syndrome usually includes pancreatitis, here we review the literature with report of 1 additional case of polyarthritis and panniculitis occurring in the presence of pancreatic carcinoma. Given that the diagnosis is often difficult when abdominal symptoms are absent, knowledge of the association between panniculitis and polyarthritis with pancreatic disease may lead to a prompt diagnosis and management. The histopathology of the skin lesions can be a valuable clue for focusing attention to a pancreatic disease.
Collapse
|
5
|
Courtney P, Doherty M. Joint aspiration and injection and synovial fluid analysis. Best Pract Res Clin Rheumatol 2013; 27:137-69. [PMID: 23731929 DOI: 10.1016/j.berh.2013.02.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. This chapter addresses (1) the indications, technical principles, expected benefits and risks of aspiration and injection of intra-articular corticosteroid and (2) practical aspects relating to SF analysis, especially in relation to crystal identification. Intra-articular injection of long-acting insoluble corticosteroids is a well-established procedure that produces rapid pain relief and resolution of inflammation in most injected joints. The knee is the most common site to require aspiration although any non-axial joint is accessible for obtaining SF. The technique involves only knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used, it is very safe. Analysis of aspirated SF is helpful in the differential diagnosis of arthritis and is the definitive method for diagnosis of septic arthritis and crystal arthritis. The gross appearance of SF can provide useful diagnostic information in terms of the degree of joint inflammation and presence of haemarthrosis. Microbiological studies of SF are the key to the confirmation of infectious conditions. Increasing joint inflammation associates with increased SF volume, reduced viscosity, increasing turbidity and cell count and increasing ratio of polymorphonuclear:mononuclear cells, but such changes are non-specific and must be interpreted in the clinical setting. However, detection of SF monosodium urate and calcium pyrophosphate dihydrate crystals, even from un-inflamed joints during intercritical periods, allows a precise diagnosis of gout and calcium pyrophosphate crystal-related arthritis.
Collapse
Affiliation(s)
- Philip Courtney
- Department of Rheumatology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
| | | |
Collapse
|
6
|
Ike RW, Bole GG. Pseudoseptic arthritis due to acute lipoarthrosis in a systemic lupus erythematosus patient with osteonecrosis. ACTA ACUST UNITED AC 2009; 61:1130-2. [PMID: 19644908 DOI: 10.1002/art.24693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Robert W Ike
- Rheumatology Division, Taubman Center, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
| | | |
Collapse
|
7
|
Courtney P, Doherty M. Joint aspiration and injection and synovial fluid analysis. Best Pract Res Clin Rheumatol 2009; 23:161-92. [PMID: 19393565 DOI: 10.1016/j.berh.2009.01.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. This chapter addresses: (1) the indications, the technical principles and the expected benefits and risks of aspiration and injection of intra-articular corticosteroid; and (2) practical aspects relating to SF analysis, especially in relation to crystal identification. Intra-articular injection of long-acting insoluble corticosteroids is a well-established procedure that produces rapid pain relief and resolution of inflammation in most injected joints. The knee is the most common site to require aspiration, although any non-axial joint is accessible for obtaining SF. The technique requires a knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used, it is very safe. Analysis of aspirated SF is helpful in the differential diagnosis of arthritis and is the definitive method for diagnosis of septic arthritis and crystal arthritis. The gross appearance of SF can provide useful diagnostic information in terms of the degree of joint inflammation and presence of haemarthrosis. Microbiological studies of SF are the key to the confirmation of infectious conditions. Increasing joint inflammation is associated with increased SF volume, reduced viscosity, increasing turbidity and cell count, and increasing ratio of polymorphonuclear: mononuclear cells, but such changes are non-specific and must be interpreted in the clinical setting. However, detection of SF monosodium urate and calcium pyrophosphate dihydrate crystals, even from un-inflamed joints during intercritical periods, allow a precise diagnosis of gout and of calcium pyrophosphate crystal-related arthritis.
Collapse
|
8
|
Narváez J, Bianchi MM, Santo P, de la Fuente D, Ríos-Rodriguez V, Bolao F, Narváez JA, Nolla JM. Pancreatitis, panniculitis, and polyarthritis. Semin Arthritis Rheum 2008; 39:417-23. [PMID: 19070353 DOI: 10.1016/j.semarthrit.2008.10.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 09/10/2008] [Accepted: 10/01/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Lobular panniculitis, together with polyarthritis and intraosseous fat necrosis, may occasionally complicate pancreatic disease. This triad is known in the literature as the pancreatitis, panniculitis, and polyarthritis (PPP syndrome). We describe a case of the PPP syndrome and review the available literature to summarize the clinical characteristics of patients with this condition. METHODS A patient with the PPP syndrome, with evidence of extensive intraosseous fat necrosis in the joints involved revealed by magnetic resonance imaging, is described and the relevant literature based on a PubMed search from 1970 to February 2008 is reviewed. The keywords used were pancreatitis or pancreatic disease, panniculitis, arthritis, and intraosseous fat necrosis. RESULTS Including our case, 25 well-documented patients with the PPP syndrome have been reported. Our patient had few abdominal symptoms despite high serum levels of pancreatic enzymes. In our review of the literature, almost 2/3 of patients had absent or mild abdominal symptoms, leading to misdiagnosis. The delay in diagnosis and specific treatment of the underlying pancreatitis worsens the prognosis of this condition, which has a mortality rate as high as 24%. In nearly 45% of the patients, the arthritis follows a chronic course with a poor response to nonsteroidal anti-inflammatory drugs and corticosteroids, and the rapid development of radiographic joint damage. CONCLUSION Certain forms of pancreatic disease can very occasionally cause arthritis and panniculitis. Although uncommon, physicians should be alert to the possible presence of this syndrome for 2 reasons: first, unrecognized pancreatic disease can be fatal if not treated promptly; second, to avoid inappropriate and risky therapy to improve joint symptoms.
Collapse
Affiliation(s)
- Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
Synovial fluid (SF) accumulates in the joint cavity in different conditions; this review outlines the data from those analyses that help in their differential and definitive diagnosis. The gross appearance of the fluid can provide a quick bedside orientation with regard to the amount of inflammation present in the joint: totally transparent SF originates in non-inflammatory conditions--of which osteoarthritis is the most common--and the amount of turbidity grossly relates to the amount of inflammation. Most turbid to purulent fluids usually come from infected joints, but exceptions are not uncommon. The white cell count offers quantitative information, but the boundaries between non-inflammatory and inflammatory SF and between this and septic fluid are very hazy and figures have to be interpreted in the clinical setting. Detection and identification of monosodium urate (MSU) and calcium pyrophosphate dihydrate (CPPD) crystals allow a precise diagnosis of gout and CPPD crystal-related arthropathy. Only one in five CPPD crystals have sufficient birefringence for easy detection and they are easily missed if searched for only using a polarised microscope. Instructions for beginners are given. Proper microbiological studies of the SF is the key to the diagnosis of infectious conditions.
Collapse
Affiliation(s)
- Eliseo Pascual
- Rheumatology Section, Hospital General Universitario de Alicante, Calle Maestro Alonso 109, Alicante 03010, Spain.
| | | |
Collapse
|
10
|
Soojian MG, Tejwani N. Chylous Knee Effusion: Is It Septic Arthritis? A Case Report and Review of Literature. ACTA ACUST UNITED AC 2004; 57:1121-4. [PMID: 15580045 DOI: 10.1097/01.ta.0000124267.54630.0f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael G Soojian
- Department of Orthopaedics, NYU-Hospital for Joint Diseases, New York, New York 10016, USA
| | | |
Collapse
|
11
|
Rodriguez M, Lopez GL, Prieto P, Fernandez L, Willisch A, Arce M. Massive subcutaneous and intraosseous fat necrosis associated with pancreatitis. Natural evolution of the radiographic picture. Clin Rheumatol 1997; 16:199-203. [PMID: 9093803 DOI: 10.1007/bf02247850] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 44-year-old man developed high fever, polyarthralgias, erythematous tender nodules and plaques on feet, ankles, knees and dorsum of the hands, as well as swelling of ankles and several joints of hands and feet. Laboratory evaluation showed high serum pancreatic amylase and lipase. Histological study of a subcutaneous nodule demonstrated fat necrosis. X-ray examination revealed numerous lytic lesions involving cancellous and cortical bone in phalanges, metacarpals, radius, tibia, tarsus and metatarsals, with areas of widened bone. The patient never referred any abdominal symptom. He evolved favourably within the following months. A year later, resolution of most of the bone lesions was observed.
Collapse
Affiliation(s)
- M Rodriguez
- Rheumatology, Internal Medicine and Radiology services, Complejo Hospitalario Cristal-Piñor, Orense, Spain
| | | | | | | | | | | |
Collapse
|
12
|
Lin YL, Lin MT, Huang GT, Chang YL, Chang H, Wang SM, How SW. Acute pancreatitis masquerading as testicular torsion. Am J Emerg Med 1996; 14:654-5. [PMID: 8906763 DOI: 10.1016/s0735-6757(96)90081-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 40-year-old man presented with fat necrosis of scrotum as the complication of acute pancreatitis. Excessive fluid accumulation in the pancreas and the extrapancreatic spaces, including around the spermatic cord, was seen on computed tomography. Surgical specimen showed typical fat necrosis of tunica vaginalis and the spermatic cord. After the surgery, pain of the testicle subsided completely, without recurrence. From the clinical presentation alone, it had been difficult to differentiate this patient's condition from torsion of the spermatic cord.
Collapse
Affiliation(s)
- Y L Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei
| | | | | | | | | | | | | |
Collapse
|
13
|
Shbeeb MI, Duffy J, Bjornsson J, Ashby AM, Matteson EL. Subcutaneous fat necrosis and polyarthritis associated with pancreatic disease. ARTHRITIS AND RHEUMATISM 1996; 39:1922-5. [PMID: 8912516 DOI: 10.1002/art.1780391121] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M I Shbeeb
- Mayo Clinic and Foundation, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
14
|
Schumacher HR. Synovial irritants: crystals, microbes and others--their implications for diagnosis, pathogenesis and therapy. Ann Rheum Dis 1995; 54:516-8. [PMID: 7632099 PMCID: PMC1009915 DOI: 10.1136/ard.54.6.516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- H R Schumacher
- Medical Research Service, VA Medical Center, University, Philadelphia, PA 19104, USA
| |
Collapse
|
15
|
2nd International meeting on synovium cell biology, physiology and pathology. Canterbury, United Kingdom, 21-23 September 1994. Proceedings and abstracts. Ann Rheum Dis 1995; 54:501-28. [PMID: 7632095 PMCID: PMC1009911 DOI: 10.1136/ard.54.6.501-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
16
|
Tolin BS, Esterhai JL, Allan DA, Furth EE, Schumacher HR. Pancreatic osteoarthropathy with unusually destructive sequelae. Orthopedics 1993; 16:473-7. [PMID: 8493153 DOI: 10.3928/0147-7447-19930401-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- B S Tolin
- Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia
| | | | | | | | | |
Collapse
|
17
|
Wise CM, White RE, Agudelo CA. Synovial fluid lipid abnormalities in various disease states: review and classification. Semin Arthritis Rheum 1987; 16:222-30. [PMID: 3547659 DOI: 10.1016/0049-0172(87)90024-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Although lipids are not usually present in large quantities in normal synovial fluids or in the usual synovial fluid seen in most rheumatologic conditions, their presence in synovial fluid may have diagnostic importance. As summarized in Table 2, analysis of synovial fluids for lipid constituents is relatively simple. On standing or after centrifugation, significant amounts of lipids may layer out and be visible as a supernatant. On microscopic examination, lipid droplets are usually easily seen and should be stainable with appropriate dyes (oil red O or Sudan III or IV), or may occasionally be visualized as intracellular or extracellular inclusions by polarized microscopy. Small (0.5 to 2.0 microns) intracellular inclusions containing triglycerides may be seen in neutrophils from most synovial fluids, and are of no diagnostic importance. Cholesterol crystals may be readily recognized microscopically by their characteristic flat, plate-like appearance and notched corners Synovial fluid may also be analyzed for cholesterol and triglycerides in routine clinical laboratories, and free fatty acids and lipolytic enzymes in special lipid laboratories. The presence of massive increases in cholesterol associated with microscopically visible cholesterol crystals is usually associated with chronic RA, occasionally in the setting of super-imposed bacterial infection. The presence of gross or microscopic lipid droplets is usually associated with trauma and hemorrhagic effusions. When present in this setting, the clinician should entertain a high suspicion for a significant intraarticular injury, such as fracture, meniscal tear, or severe ligamentous injury. In addition, however, several instances of non-traumatic inflammatory effusions associated with intracellular and extracellular lipid droplets have been reported.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
|
18
|
Zimmermann-Górska I, Urbaniak M, Karwowski A. Coexistence of arthritis, subcutaneous fat necrosis, and pseudocyst of pancreas. Rheumatol Int 1986; 6:45-8. [PMID: 3787087 DOI: 10.1007/bf00270665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A 29-year-old woman was observed with subcutaneous fat necrosis, arthritis, and a giant pseudocyst of the pancreas. Surgical removal of the cyst resulted in a remission of the inflammatory process in the joints as well as within the subcutaneous tissue.
Collapse
|
19
|
White RE, Wise CM, Agudelo CA. Post-traumatic chylous joint effusion. ARTHRITIS AND RHEUMATISM 1985; 28:1303-6. [PMID: 4063005 DOI: 10.1002/art.1780281116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
20
|
|
21
|
Simkin PA, Brunzell JD, Wisner D, Fiechtner JJ, Carlin JS, Willkens RF. Free fatty acids in the pancreatitic arthritis syndrome. ARTHRITIS AND RHEUMATISM 1983; 26:127-32. [PMID: 6824511 DOI: 10.1002/art.1780260202] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Fat necrosis and arthritis occur in some individuals with pancreatitis. The intraarticular free fatty acid concentration was found to be markedly elevated in 2 patients with this pancreatitic arthritis syndrome. Injection of free fatty acids into rabbit knees reproduced the inflammatory synovial response including intracellular fat globules within leukocytes. Free fatty acids exceeding the available binding sites of albumin appear to mediate the extrapancreatic inflammatory manifestations of this syndrome.
Collapse
|
22
|
Phillips RM, Sulser RE, Songcharoen S. Inflammatory arthritis and subcutaneous fat necrosis associated with acute and chronic pancreatitis. ARTHRITIS AND RHEUMATISM 1980; 23:355-60. [PMID: 7362688 DOI: 10.1002/art.1780230316] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|