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Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Three months after a 79-year-old male patient had received a right cemented total knee arthroplasty, pain, swelling and a reduced range of motion were noted after an extended walk. Physical examination by the orthopedic surgeon showed joint effusion. Subsequent computed tomography showed a correct implant position without any signs of loosening. Diagnostic joint aspiration and microbiological analysis showed no signs of infection. Scintigraphy was suggestive of local synovitis. Thus, synovitis caused by ‘excessive walking’ was diagnosed, and oral diclofenac was prescribed. However, the patient complained of increasing pain, and presented with local eczema of the right knee a few weeks later. Patch tests were positive to gentamicin and neomycin, but an antibiotic-free bone cement had been used for the operation. However, it was found that, while performing the diagnostic joint aspiration, the orthopedic surgeon had injected gentamicin solution to prevent infection. Taking this detail into account, the authors diagnosed ‘synovitis and allergic contact dermatitis’ resulting from intra-articular gentamicin application. In the course of the next 10 months, the patient’s symptoms, including his eczema, completely resolved (50).
Effects of treatment on bone and bone marrow
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Lia A Moulopoulos, Vassilis Koutoulidis
Ischaemic lesions occur more often in bones with fatty marrow (because of the scarce vascular supply). The term avascular necrosis has been used for epiphyseal osteonecrosis while ischaemic lesions of the metaphyses and diaphyses of long bones are referred to as bone infarcts (Figure 40.6). The majority of imaging studies on osteonecrosis focus on the femur. The typical MRI appearance of osteonecrosis is that of a low intensity rim surrounding fatty marrow on T1-weighted images (T1WI); this rim is hyperintense on fat-suppressed T2WI (Figure 40.7). The double-line sign (two concentric rims on non-fat suppressed images) consists of an outer dark line of serpiginous shape, which is produced by reactive sclerosis at the interface of the lesion with the healthy marrow, and a bright inner line, at the periphery of the ischaemic marrow, corresponding to either an area of hyperaemia or to a chemical-shift artefact (32). Bone marrow oedema in osteonecrosis is not found at the early stages of the disease as previously believed; actually, it rarely occurs without the presence of the double-line sign (33). During the early stages of osteonecrosis, articular cartilage is not involved because it is not supplied by vessels. A subchondral fracture is a late finding of the disease and presents with increased signal on T2WI (the so-called crescent sign) (Figure 40.8). Recognition of the presence of osteonecrosis before the occurrence of a subchondral fracture is important for the success of conservative treatment. A joint effusion is often observed and is usually associated with pain.
The Hip
Published in Louis Solomon, David Warwick, Selvadurai Nayagam, Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Louis Solomon, David Warwick, Selvadurai Nayagam
During the acute stage of bone infection x-rays may show slight lateral displacement of the femoral head, suggesting the presence of a joint effusion. Ultrasound scans also will help to reveal a joint effusion. In children the epiphysis may become necrotic and later appear unusually dense or ‘fragmented’ on x-ray. In adults the defining feature is rapidly progressive erosion of the articular surfaces.
Modelling disease risk for amyloid A (AA) amyloidosis in non-human primates using machine learning
Published in Amyloid, 2019
Eric T. Leung, Michael J. Raboin, Jessica McKelvey, Adam Graham, Anne Lewis, Kamm Prongay, Aaron M. Cohen, Amanda Vinson
Another major risk factor for AA amyloidosis in macaques, reactive arthritis or chronic polyarthritis is an inflammatory, non-infectious arthritis that often follows enteric and urogenital infections [40–42]. Clinically, it is characterized by an acute onset of lameness and joint swelling one to two months following an episode of enteric disease. Stifles, elbows, tarsal and interphalangeal joints are most commonly affected, and there is marked joint effusion with mature neutrophils and fibrin, as well as synovitis and enthesitis. Also included in musculoskeletal abnormalities, osteoarthritis in NHPs encompasses a group of degenerative joint diseases of unknown cause characterized by progressive change in the articular cartilage and subchondral bone. While originally considered non-inflammatory, human osteoarthritis is now recognized to include a significant inflammatory component mediated by cytokines and chemokines that are produced by, or act upon, synoviocytes and chondrocytes, which induce matrix metalloproteinases and other proteinases involved in the degradation of cartilage [43].
Is synovitis detected on non-contrast-enhanced magnetic resonance imaging associated with serum biomarkers and clinical signs of effusion? Data from the Osteoarthritis Initiative
Published in Scandinavian Journal of Rheumatology, 2018
LA Deveza, VB Kraus, JE Collins, A Guermazi, FW Roemer, MC Nevitt, DJ Hunter
The main advantage of establishing an association between biochemical markers and synovitis on MRI is that if they were associated, there would be a serum marker to be used as a surrogate of synovitis in future clinical research. This is likely to be more readily accessible and affordable than MRI and not as operator dependent as ultrasound (15). Similarly, clinical assessment of effusion has been used in trials to screen for the presence of knee joint effusion (16–18) but there is a lack of studies examining the diagnostic performance of these clinical tests against MRI or ultrasound (19).
A case of Löfgren’s syndrome evaluated by imaging modalities: musculoskeletal ultrasound, MRI and PET-CT
Published in Modern Rheumatology Case Reports, 2020
Tomohisa Uchida, Keita Fujikawa, Akira Kondo, Akinari Mizokami, Kazuhiro Kurohama, Masahiro Nakashima, Atsushi Kawakami, Katsumi Eguchi
Few reports have described the imaging findings of Löfgren’s syndrome using MSUS or MRI [3–6]. In a pioneering study published in 1992, Kellner et al. evaluated ankle by using MSUS; the predominant abnormalities were hypoechogenic structures within the subcutis and periarticular tissues in the majority of cases (83.3%) [3]. Le Bras et al. employed high-resolution MSUS and found that periarticular involvement was the most common abnormality by B-mode imaging; they found subcutaneous oedema in 23 of 25 patients (92%) and tenosynovitis in 14 of 36 patients (38.8%) [4]. In addition, the abnormalities by PD imaging were PD signals of the soft tissue (subcutaneous tissues and tendons) in 7 of 36 patients (19.4%) and intraarticular PD signals in 2 of 36 patients (5.6%) [4]. In a study by Goussault et al. the most common abnormal finding on B-mode imaging of ankle joint was subcutaneous oedema [26 of 26 patients (100%)] followed by tenosynovitis [22 of 40 patients (55%)] and joint effusion [10 of 40 patients (25%)]; the less common findings on PD imaging were tenosynovitis (27.5%) and synovitis (7.5%) [5]. Anandacoomarasamy et al. performed MRI evaluation of ankle joint of four patients and found significant subcutaneous oedema and small amounts of tenosynovial and joint fluid in all patients; none of the patients showed signs of synovitis [6]. To the best of our knowledge, no previous reports have described PET-CT evaluation of articular involvement. In the present case, PET-CT depicted FDG accumulation primarily in subcutaneous and periarticular lesions such as tendon and muscle lesions around the knee and ankle joints. Our findings in conjunction with previous reports indicate that periarticular and subcutaneous inflammation rather than synovial inflammation is the cause of articular manifestations in Löfgren’s syndrome. It was suggested that joint effusion is probably a reactive phenomenon mediated by periarticular and subcutaneous inflammation [4]. MSUS, MRI and PET-CT findings in the present case support this theory. However, the hypothesis that the pathological process in Löfgren’s syndrome starts in the subcutaneous tissue and later extends to the adjacent joint has not been proven; thus, further investigation is needed.