Synovial cysts in rheumatoid disease

Severe Sub-Acromial Bursitis with Rice Bodies in a Patient with Rheumatoid Arthritis: A Case Report and Review of Literature

Multiple rice body formation is a rare presentation of chronic sub-acromial bursitis secondary to extensive underlying rheumatoid arthritis, sero-negative inflammatory arthritis or tuberculous joints. Although there is usually an accompanying inflammatory arthropathy, it can occur in the absence of any underlying systemic disorder. We report a case of five years old neglected rice body deposition in shoulder in a 54-years old lady diagnosed to be having rheumatoid arthritis. After initial investigations, arthroscopic removal of rice bodies with bursa excision relieved the symptoms. The underlying rheumatic condition continued its course, generally sparing the involved shoulder joint. We suggest thorough examination for systemic rheumatologic disease in patients diagnosed with such lesions.

Synovial cysts of the hip

Background:

Synovial cysts of the hip are relatively rare lesions comparing to other joints. Patients are usually asymptomatic, but in some cases symptoms such as pain and/or compression of vessels or nerve could be present. Purpose of the study was to define clinical features and optimal management of synovial cyst of the hip joint through an accurate review of the literature.

Methods:

We present three consecutive cases treated with three different therapeutic strategies: surgical excision, wait-and-see and needle aspiration. An accurate review of the literature has been performed to identify patients who had been treated for synovial cyst of the hip.

Results:

Due to the rarity of the disease, there are no significant data in literature supporting the gold standard of treatment. Treatment of the synovial cyst depends on their size, symptoms and comorbidities.

Conclusions:

Most of the Authors recommend surgical treatment for symptomatic synovial cysts and needle aspiration as an option treatment in asymptomatic patients without vessel or nerve compression. In patients that referred symptoms in correspondence with the hip joint, not strictly related with radiograph findings, a CT or MRI examinations should be performed to exclude possible differential diagnosis. (www.actabiomedica.it)

Giant, completely calcified lumbar juxtafacet cyst: report of an unusual case

Study Design Case report. Objective To report the case of one patient who developed a giant, completely calcified, juxtafacet cyst. Methods A 57-year-old woman presented with a 2-year history of progressively worsening lower back pain, left leg pain, weakness, and paresthesias. Imaging showed a giant, completely calcified mass arising from the left L5-S1 facet joint, with coexisting grade I L5 on S1 anterolisthesis. The patient was treated with laminectomy, excision of the mass, and L5-S1 fixation and fusion. Results The patient had an uncomplicated postoperative course and had complete resolution of her symptoms as of 1-year follow-up. Conclusions When presented with a solid-appearing, calcified mass arising from the facet joint, a completely calcified juxtafacet cyst should be considered as part of the differential diagnosis.

Multiple rheumatoid bursal cysts that were finally effectively treated by combining surgical resection and sclerotherapy

A 71-year-old male who had been diagnosed with rheumatoid arthritis 3 years previously developed multiple subcutaneous cysts on his buttock, elbow, knee, hand and back. The diameters of the cysts were 10-15 cm. The characteristic fluid and pathology of the cysts led to the diagnosis of multiple rheumatoid bursal cyst (MRBC). The patient was keen to treat the cyst on his buttock as it hampered his sitting position. However, it resisted several kinds of sclerotherapies, including absolute alcohol, OK-432, minocycline and dexamethasone. When the cyst grew further, it was resected surgically; however, the cyst recurred immediately. It was finally brought under control by injecting it with OK-432. The thick cyst wall, which resisted the various sclerotherapies, was removed surgically, and a new capsule developed inside the cavity; adding a sclerotant to newly made thin capsule made us possible to treat this resistant large bursal cyst.

[Tuberculous rice body synovitis of the shoulder joint]

The clinical presentation of synovitis with rice bodies is found in a few systemic diseases as accompanying manifestations within joints or joint-associated bursa. A 79-year old patient was examined, who had complained of pain and swelling in the left shoulder for a long time. Sonography identified multiple spindle-shaped joint bodies within the joint effusion. MRI showed a large amount of so-called rice bodies with joint effusion in the shoulder and a massive destruction of the rotator cuff of the left shoulder. The histological examination showed a tuberculosis-specific inflammatory response with giant cells and epithelioid granulomas and molecular biological detection of Mycobacterium tuberculosis. Within a few months after surgical removal of the rice bodies from the joint space and the bursa a relapse occurred with repeated synovial effusion followed by a renewed surgical removal of the joint bodies. We describe the rare case of a patient with unilateral musculoskeletal manifestation of tuberculosis presented as synovitis of the left shoulder and the adjacent bursa with rice bodies and accelerated growth trend without coexisting active tuberculosis or tuberculosis in the previous history. Furthermore, a brief summary of the literature is given.

Multiple extra-articular synovial cysts complicated with rheumatoid arthritis

Multiple extra-articular synovial cysts (MESC) are rarely complicated with various rheumatic diseases. We here first report a rheumatoid arthritis (RA) patient with MESC, which were extensively analyzed by a series of imaging techniques including fluorine-18-2-fluoro-D: -glucose positron emission tomography ((18)F-FDG-PET), magnetic resonance imaging (MRI), and ultrasonography. FDG uptakes in joint lesions with MESC were much higher than those reported in typical lesions of RA, suggesting that marked joint inflammation is implicated in the development of MESC.

A mutilating arthropathy, "rhupus hands" associated with multiple synovial cysts in a patient with systemic lupus erythematosus

"Rhupus hands" is a phrase coined to describe one of the deforming arthropathies associated with systemic lupus erythematosus (SLE), because the clinical features are indistinguishable from those of rheumatoid arthritis. Herein, we report a case of rhupus hands with multiple synovial cysts arising in a 60-year-old woman with SLE.

Intraspinal synovial cyst communicating with the C1-C2 facet joints and subarachnoid space associated with rheumatoid atlantoaxial instability

STUDY DESIGN

The first case of intraspinal synovial cyst communicating with the C1-C2 facet joints and subarachnoid space associated with rheumatoid atlantoaxial instability is presented.

OBJECTIVES

To describe the diagnosis and successful treatment of a synovial cyst of the C1-C2 junction in a patient with rheumatoid arthritis and atlantoaxial instability.

SUMMARY OF BACKGROUND DATA

Intraspinal synovial cysts of the C1-C2 junction are extremely rare. Neither association with rheumatoid atlantoaxial instability nor communication with the C1-C2 facet joints and the subarachnoid space has been previously reported in a synovial cyst of the C1-C2 junction.

MATERIALS AND METHODS

The clinical and radiologic features of a 71-year-old woman with a symptomatic synovial cyst of the C1-C2 junction with rheumatoid atlantoaxial instability are detailed. Posterior atlantoaxial fusion alone was performed.

RESULTS

Preoperative magnetic resonance images demonstrated a large cystic mass around the dens, compressing the spinal cord. The mass was of low signal intensity on T1-weighted images, was of high signal intensity on T2-weighted images, and was enhanced marginally with gadolinium-DTPA on T1-weighted images. Computed tomograms performed after myelography disclosed the cyst around the dens communicating with the subarachnoid space and the C1-C2 facet joints. Spontaneous regression of the cyst was identified on the magnetic resonance images 3 months after surgery. One year after surgery, myelopathic symptoms were improved.

CONCLUSION

An intraspinal cyst communicating with the C1-C2 facet joints and subarachnoid space associated with rheumatoid atlantoaxial instability was reported. Computed tomograms after myelography were useful in delineating the relationships among the synovial cyst, facet joints, and the subarachnoid space. Spontaneous regression of the cyst and clinical improvement were achieved by C1-C2 posterior fusion alone.

Synovial cysts and ganglia: the value of magnetic resonance imaging

Synovial and ganglion cysts commonly present in close proximity to joints and skeletal structures in rheumatic disorders. Familiarity with the presentation of these soft tissue masses can facilitate timely diagnosis and effective management, thus avoiding costly and potentially high-risk procedures to patients. Management usually consists of local, nonsurgical approaches. A patient with chronic joint deformities and clinical features primarily consistent with mixed connective tissue disease is described. Multiple localized masses developed at her right elbow and were identified on T2-weighted magnetic resonance imaging as multiloculated cysts that dissected from the elbow joint. The cysts were treated successfully by needle aspiration and intraarticular corticosteroid injection. The clinical associations, diagnosis, treatment, and management of synovial cysts and ganglions are reviewed.

Giant synovial cysts

Giant synovial cysts (GSC) are large, well-defined cavities, containing synovial fluid and lined by a synovium-like membrane, which extend for a variable distance outside the joint cavity. We are reporting 15 cases of GSC of various joints. Rheumatoid arthritis is the most common disease process reported in association with GSC. We suggest that trauma may be a more important cause of GSC than has previously been described. Arthrography and ultrasonography are both helpful in diagnosing these large cysts, especially in the knee to aid in differentiating GSC from thrombophlebitis.

Synovial cyst presenting as forearm mass

A 43-year-old man with rheumatoid arthritis that involved primarily the hands and feet was seen at Veterans Administration Wadsworth Medical Center, Los Angeles, for a painless mass on the left forearm. An antecubital synovial cyst was diagnosed on the basis of results of ultrasonography and arthrography. Arthrocentesis of the elbow joint yielded 5 ml of serous fluid. Intraarticular injection of a corticosteroid resulted in complete resolution of the mass within three days, thus surgery was avoided.

Grey scale ultrasonography and arthrography in evaluation of popliteal cysts

Ultrasonography will reliably detect popliteal cysts of clinically significant size and improvements in ultrasound imaging have enhanced the value of ultrasound in relation to arthrography in the assessment of cyst rupture. Forty-eight knees in 25 patients suspected of having a popliteal cyst were examined by ultrasonography followed immediately by arthrography. Popliteal cysts were demonstrated in 40% (19/48) by ultrasound and in 46% (22/48) by arthrogram. Arthrography detected small cysts not seen with ultrasound, but altrasonic scanning showed cysts which did not fill on arthrography. A ruptured cyst or deep venous thrombosis was suspected in 10 patients. Rupture was confirmed in two patients by arthrography, in both of whom soft tissue changes and attenuation of the distal margin of the cysts were shown by ultrasound.

Synovial cysts in juvenile rheumatoid arthritis

In a case of juvenile rheumatoid arthritis with large synovial cysts, cyst fluid aspiration was performed to relieve pain, but recurrence was prevented with salicylate therapy alone. The mechanism of formation of synovial cysts is discussed.

Wrist arthrography: review and comparison of normals, rheumatoid arthritis and gout patients

Bilateral wrist arthrograms performed on a randomly selected population of 100 adult males revealed an unexpected high prevalence of communications among the three wrist compartments. These findings warrant reassessment of wrist arthrographic criteris for synovial involvement of rheumatoid arthritis. Midcarpal joint extension correlated with increasing age and occupational trauma, suggesting a degenerative or "wear and tear" mechanism in the breakdown of the delicate interosseous intercarpal ligaments. Such extension was also found to a greater than expected frequency in gout. Radioulnar joint extension correlated with acute trauma secondary to wrist sprains or fractures, presumably through tears in the tough triangular fibrocartilage. Such extension was also found to a greater than expected frequency in RA. While midcarpal extension and inferior radioulnar extension correlate with gout and RA, respectively, their occurrence in a random adult male population is so frequent (as is three compartment communication) as to obviate their diagnostic value. However, synovial corrugation and lymphatic visualization were seen only in the wrists of patients with diagnosed inflammatory arthritic conditions and may have potential diagnostic significance. Selected anthropometric variables were analyzed by age in this randomly selected adult male population and compared with the gouty and RA patient groups. Significant continuously decreasing grip strength and hand mineralization occurred with age, which was opposite to the trend for osteoarthrosis. The hematocrit, erythrocyte sedimentation rate, and serum uric acid were impressively stable until the ninth or older decades, at which time a significant increase in sedimentation rate and decrease in hematocrit were found.

Detection of synovial cysts by transmission-emission scintigrams following intra-articular 169Yb-DTPA

A new simple and safe technique for the detection of synovial cysts is described. This investigation employs combined transmission-emission scintigraphy following intra-articular injection of 169Yb-DTPA. Twenty-two joints were investigated in 18 patients. A high degree of correlation was found between clinical findings and the results of this investigation. The major advantages of this method are low local radiation to synovial linings, adequate visualisation of periarticular soft tissue, and small volumes required for intra-articular injection.

Rheumatoid plantar synovial cysts

A patient is described with rheumatoid arthritis and a painful synovial cyst, which originated from a metatarsophalangeal joint and presented as a swelling on the plantar surface of the foot. The cyst was successfully excised.

Protective value of synovial cysts in rheumatoid knees

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