Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Anton C. de Groot in 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
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
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.
Patella fracture transverse
Alisa McQueen, S. Margaret Paik in Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Patella sleeve fractures account for approximately 50% of all patellar fractures and usually occur in patients between 8 and 12 years of age. The mechanism is an explosive acceleration with rapid quadriceps contraction while the knee is in flexion, resulting in avulsion of the periosteum, retinaculum, and cartilage from the patella. The lateral radiograph may show some swelling at the lower patellar pole and possibly a small bony fragment that has avulsed with the cartilage. Joint effusion is usually absent. MRI is critical for complete evaluation. Complications due to missed diagnosis or delay in presentation include avascular necrosis of inferior pole of the patella, patella alta, quadriceps wasting extensor lag, anterior knee pain, and ossification of the patellar tendon.
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].
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.
Prevalence of joint, entheseal, tendon, and bursal findings in young, healthy individuals by musculoskeletal ultrasound
Published in Scandinavian Journal of Rheumatology, 2023
JK Schreiner, D Scheicht, P Karakostas, F Recker, J Ziob, C Behning, P Preuss, P Brossart, VS Schäfer
Several studies have analysed ultrasound and magnetic resonance imaging (MRI) findings in healthy individuals, predominantly focusing on a smaller number of joints than our study (7, 20–22). In the tibiotalar joints of marathon runners, joint effusion was detected by ultrasound in 18.1% of the examined joints (23). These findings are comparable to our data demonstrating the presence of tibiotalar joint effusion in 14.7% of the examined joints (15/102; n = 11). Furthermore, both biceps tendon sheath effusion and effusion of the retrocalcaneal bursa were observed in a notable proportion of the participants (17.6%; n = 9) in our study. Fluid around the biceps tendon in healthy individuals was previously observed by Schmidt (24) in 27% in an older population, whereas the prevalence in our young study population appeared to be considerably lower, in 9.8% of the examined tendons (10/102; n = 9). In addition, Schmidt observed fluid in the retrocalcaneal bursae in 24%, which is higher than the prevalence of effusion in the retrocalcaneal detected in the present study (9.8%, 10/102; n = 9). It is uncertain whether the participants in the previous study performed sports activities before the ultrasound examination, as a renunciation of athletic activities was not required by Schmidt (24). This could explain the higher prevalence compared to our findings, as our participants were instructed not to engage in any sports activity for 48 h prior to the study to avoid the influence of physical exercise on ultrasound findings. There are no reference values for how long musculoskeletal ultrasound findings can be observed after physical activity, and thus how long participants should refrain from physical activity. None of the previous ultrasound studies asked their participants to renounce physical activity (6, 22, 25), even though an influence of physical activity on, for example, entheseal ultrasound findings was observed (25). Moreover, in the evaluation of factors associated with ultrasound findings, we observed an association between hours of sports activity per week and the presence of joint effusion in the knee joint. Joint effusion after sports activity has been studied previously, with different results. One study on 19 marathon runners and 19 controls identified increased fluid in the tibiotalar and talocalcaneal joint in 34% of the athlete group after performing a marathon and in 18% of the controls, on MRI (26). In contrast, an ultrasound study including marathon runners could not detect development or changes in joint effusion of the knee and tibiotalar joint (23).
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