1
|
Ahmed ZM, Alsahlawi H, Husain R. Septic arthritis of the wrist: A case of Parona space abscess in a rheumatoid arthritis patient with Charcot wrist. Radiol Case Rep 2024; 19:4248-4254. [PMID: 39135673 PMCID: PMC11318563 DOI: 10.1016/j.radcr.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 08/15/2024] Open
Abstract
Closed-space hand infections are considered an emergency requiring prompt management to avoid debilitating consequences and potential morbidity. Septic arthritis of the wrist is particularly uncommon in comparison to the large joints that are usually affected. We report a case of a 64-year-old female with known rheumatoid arthritis and neuropathic wrist, with superimposed septic arthritis of the wrist, complicated by abscess formation. Ultrasound and Magnetic resonance imaging revealed spread of infection to the midpalmar region and the space of Parona. Although collections in this space are extremely rare, if left untreated, they may lead to permanent disability. Incision and drainage of the abscess along with synovectomy of the affected wrist joint was performed. Streptococcus pneumoniae was the causative organism, despite the fact that Non-gonococcal and Staphylococcus aureus bacteria are the main causative agents of septic arthritis in adults.
Collapse
Affiliation(s)
| | - Huda Alsahlawi
- Diagnostic Radiology, Salmaniya Medical Complex, Rd No 2904, Manama, Bahrain
| | - Rola Husain
- Diagnostic and Interventional Radiology, Salmaniya Medical Complex, Rd No 2904, Manama, Bahrain
| |
Collapse
|
2
|
Sharma HA, McAlindon TE, Roberts MB, Haugen IK, Lo GH, Duryea J, Schaefer LF, Smith SE, Eaton CB, Driban JB. The natural history of marginal erosions in hands with and without osteoarthritis. Clin Rheumatol 2024:10.1007/s10067-024-07116-x. [PMID: 39172292 DOI: 10.1007/s10067-024-07116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION/OBJECTIVES Among people with or without hand osteoarthritis, we aimed to identify characteristics of people (e.g., age and gender) with marginal erosions (MEs). We also examined changes in MEs during 48 months. We described radiographic severity and progression among joints with MEs, changes in MEs, or central erosions (CEs). DESIGN We studied participants from the Osteoarthritis Initiative with baseline and 48-month hand radiographs. A radiologist and rheumatologist evaluated the radiographs for disease severity (Kellgren-Lawrence grades) and erosions (central or marginal), respectively. We used descriptive statistics to characterize participants and calculated frequencies at the joint level. RESULTS Of the 3558 participants, 89 had a ME at baseline. People with MEs were more often male, older, and ever (former and current) smokers than those without a ME. There was no difference in inflammatory biomarkers or the presence of hand pain between individuals with and without a baseline ME. Almost all hands had only one ME (80%), whereas only 50% of individuals with CEs had only one CE at baseline. Compared to CEs, MEs appeared more frequently in joints without osteoarthritis (54% vs. < 1%). Approximately 18% of joints with an ME progressed in Kellgren-Lawrence grade versus 4% without ME. Among the joints with an ME at baseline, 10% resolved by 48 months. Less than 0.1% of joints developed a new ME. CONCLUSION MEs appear to be distinct from CEs. MEs are predominantly present in males, isolated to one specific joint without osteoarthritis within a hand, and possibly predictive of radiographic progression. Key Points • Marginal erosions appear to be distinct from central erosions. • Most marginal erosions occur in joints without radiographic osteoarthritis. • Radiographic progression but not hand pain is more common in joints with a marginal erosion than without one.
Collapse
Affiliation(s)
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA, USA
| | - Mary B Roberts
- Center for Primary Care and Prevention, Kent Hospital, Pawtucket, RI, USA
- Brown University School of Public Health, Providence, RI, USA
| | - Ida K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Grace H Lo
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Medical Center, Houston, TX, USA
| | - Jeffrey Duryea
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lena F Schaefer
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stacy E Smith
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Charles B Eaton
- Center for Primary Care and Prevention, Kent Hospital, Pawtucket, RI, USA
- Brown University School of Public Health, Providence, RI, USA
| | - Jeffrey B Driban
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA.
| |
Collapse
|
3
|
Ulijn E, den Broeder N, Ten Cate D, van Overdijk K, Demirel H, Landewé R, van Herwaarden N, den Broeder A. Limited Diagnostic and Prognostic Value of Routine Radiographs in Newly Presenting Arthritis Suspected of Rheumatoid Arthritis: A Retrospective Study. Arthritis Care Res (Hoboken) 2024; 76:497-502. [PMID: 37933435 DOI: 10.1002/acr.25271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/12/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Current recommendations suggest that patients with newly presenting arthritis suspected of rheumatoid arthritis (RA) should undergo routine radiographs of hands and feet (X-HF) as the presence of RA-associated erosions might be of diagnostic and prognostic value. Our objective was to investigate the prevalence, diagnostic, and prognostic value of RA-associated erosions seen on routine X-HF in a large, recent cohort of patients with newly presenting arthritis. METHODS A retrospective cohort study was performed between 2016 and 2019 in patients with newly presenting arthritis suspected of RA. Patients were included if arthritis was present at diagnosis, rheumatoid factor and anticitrullinated protein antibodies were measured, RA was noted in the differential diagnosis, and routine X-HF were conducted. Outcomes were the prevalence of one or more RA-associated erosion(s), and whether diagnostic or prognostic classification were changed by erosivity. Seronegative patients, patients without acute phase reactants, and patients with longer symptom duration were analyzed as subgroups. RESULTS RA-associated erosions were found in 32 of 724 patients (4.4%, 95% confidence interval [95% CI] 3.1-6.2). Erosions led to a change of diagnostic classification in two patients (0.3%, 95% CI 0.01-1.1) and changed prognostic classification in three patients (0.4%, 95% CI 0.1-1.3). Seronegative patients and patients without elevated acute phase reactants had significantly lower prevalence of erosions (χ2 9.4, P = 0.002, χ2 6.5, P = 0.01). Longer symptom duration was not associated with a different prevalence of erosions (χ2 0.4, P = 0.81). CONCLUSION The recommendation of conducting routine X-HF in patients with newly presenting arthritis suspected of RA might be reconsidered due to low prevalence of early erosive disease and lack of diagnostic and prognostic value.
Collapse
Affiliation(s)
- Evy Ulijn
- Sint Maartenskliniek, Nijmegen, the Netherlands
| | | | | | | | | | - Robert Landewé
- Amsterdam Medical Center (AMC), Amsterdam, and Zuyderland Medical Center, Heerlen, the Netherlands
| | | | | |
Collapse
|
4
|
Patel J, Tai R, Sereni C, Joshi G. Hydroxyapatite deposition disease, an overlooked differential diagnosis in the emergency department: a case series and review of literature. Emerg Radiol 2024; 31:229-238. [PMID: 38358564 DOI: 10.1007/s10140-024-02212-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
Hydroxyapatite crystal deposition disease (HADD) poses diagnostic challenges in the emergency department (ED) as it may clinically present similarly to infection and other musculoskeletal conditions. Misdiagnosis often leads to unnecessary treatments and resource over-utilization. This review article provides an overview of HADD in seven patients who presented to the ED secondary to an acute presentation of this disease process. HADD is a prevalent pathology, which commonly involves the shoulder, followed by the hip, elbow, wrist, and knee. Predisposing risk factors, such as diabetes and certain genetic factors, have also been identified. Clinical history and imaging, particularly radiographs, play a vital role in diagnosing HADD, with characteristic calcification patterns observed in different stages of the disease. Conservative nonsurgical therapy is the mainstay of treatment, providing effective symptom relief in over 90% of cases. By recognizing HADD as a crucial differential diagnosis for patients with acute or chronic pain, healthcare resource utilization can be optimized, leading to improved patient care in the ED.
Collapse
Affiliation(s)
- Jay Patel
- University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA, 01655, USA.
| | - Ryan Tai
- Division of Musculoskeletal Imaging, University of Massachusetts Medical School/Memorial Health Care, 55 Lake Avenue, North, Worcester, MA, 01655, USA
| | - Christopher Sereni
- Division of Musculoskeletal Imaging, University of Massachusetts Medical School/Memorial Health Care, 55 Lake Avenue, North, Worcester, MA, 01655, USA
| | - Ganesh Joshi
- Division of Musculoskeletal Imaging, University of Massachusetts Medical School/Memorial Health Care, 55 Lake Avenue, North, Worcester, MA, 01655, USA
| |
Collapse
|
5
|
Pooyan A, Alipour E, Azhideh A, Chalian M. Editorial on Special Issue "Skeletal Radiology". Diagnostics (Basel) 2023; 13:2396. [PMID: 37510140 PMCID: PMC10378053 DOI: 10.3390/diagnostics13142396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Musculoskeletal (MSK) disorders are among the top five contributors to disability-adjusted life years (DALYs) worldwide [...].
Collapse
Affiliation(s)
- Atefe Pooyan
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA 98105, USA
| | - Ehsan Alipour
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA 98105, USA
| | - Arash Azhideh
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA 98105, USA
| | - Majid Chalian
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA 98105, USA
| |
Collapse
|
6
|
Sanghavi N, Korem S, Dey S, Wasserman A, Ash J. Dual-Energy Computed Tomography (DECT) Resolves the Diagnostic Dilemma in an Atypically Presenting Case of Gout. Cureus 2023; 15:e38247. [PMID: 37252479 PMCID: PMC10225115 DOI: 10.7759/cureus.38247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Gout is a common inflammatory arthropathy that presents as acute monoarthritis, most commonly of the first metatarsophalangeal (MTP) joint. Chronic polyarticular involvement may lead to confusion with other inflammatory arthropathies, including rheumatoid arthritis (RA). A thorough history, physical examination, synovial fluid analysis, and imaging are keys to establishing a correct diagnosis. Although a synovial fluid analysis remains the gold standard, the affected joints may be difficult to access by arthrocentesis. In cases where a large monosodium urate (MSU) crystal deposition is in the soft tissues - the ligaments, bursae, and tendons, it becomes a clinical impossibility. In such cases, dual-energy computed tomography (DECT) can assist in differentiating gout from other inflammatory arthropathies, including RA. Additionally, DECT can perform quantitative analysis of tophaceous deposits and, therefore, assess response to treatment.
Collapse
Affiliation(s)
- Nirali Sanghavi
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | | | - Subo Dey
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | - Amy Wasserman
- Rheumatology, Westchester Medical Center, Valhalla, USA
| | - Julia Ash
- Rheumatology, Westchester Medical Center, Valhalla, USA
| |
Collapse
|