Advances in Haemophilic Hip Joint Arthropathy
K. Mohan Iyer in Hip Joint in Adults: Advances and Developments, 2018
Haemophilia is a hereditary X-linked recessive condition affecting males. Haemophilic arthropathy can manifest as a monoarticular or oligoarticular condition affecting large joints. The pathophysiological mechanisms of haemophilic arthropathy affecting the hip joint have not been accurately identified. The Arnold-Hilgartner classification is a plain radiograph grading system for haemophilic arthropathy. Working in close collaboration with a haematology team to establish the factor replacement regime, tailored to the individual patient's needs, prior to orthopaedic surgery is recommended. Specialist haemophilia nurses can play a vital role in managing patients in the orthopaedic ward during the preand postoperative periods. Preoperatively, routine haematological and biochemical analysis should be performed. In addition to thorough preoperative medical preparation of the patient, considerable attention should be given to surgical preparation. Complications from joint replacement surgery can be classified as operative and postoperative. The benefits of pain relief and improved function provided by total joint replacement make the procedure the most successful orthopaedic operation for managing chronic haemophilic arthropathy.
Orthopaedics
Kristen Davies in Core Conditions for Medical and Surgical Finals, 2020
Osteoarthritis (OA) is a disorder characterised by the progressive loss of articular cartilage and remodelling of the underlying bone and formation of osteophytes, which most commonly affects the knees, hips and small joints of the hands. OA is the most common arthropathy and is a leading cause of pain and disability in the UK. The prevalence of OA of the knees, hips and hands increases with age. The pathogenesis of OA is more complicated than a wear-and-tear phenomenon but this is how patients often perceive it. Research suggests that chondrocytes in articular cartilage are activated by an unknown trigger and release enzymes that break down the cartilage and expose the underlying bone. The classic examination findings for a hip fracture are pain in the affected hip, inability to weight bear on the affected leg, limited range of hip movement and the affected leg being shortened and externally rotated.
Rheumatoid Arthritis
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
Rheumatoid factor (IgM) is found in 70%. The classical pattern is of a symmetrical arthropathy involving the interphalangeal joints, the metacarpophalangeal joints, the wrists, and feet. Laxity of the atlanto-axial joint ligaments with erosion of the odontoid peg may result in subluxation during flexion, with the possibility of cord compression. Twenty-five per cent of rheumatoid arthritis sufferers have cervical instability but only 7% have clinical signs. The lower cervical vertebrae may be fused leading to fixed flexion. Cricoarytenoid involvement may cause hoarseness, stridor and airway obstruction. Involvement of the temporomandibular joint may limit mouth opening. Rheumatoid arthritics must be fully assessed to exclude the above problems. Investigations should be tailored to the clinical findings. Regional anaesthesia should be considered but maybe difficult to perform in view of deformed anatomy. A difficult intubation must be anticipated and fibreoptic intubation considered.
Synovium and cartilage biomarkers in hemophilic arthropathy
Published in Expert Review of Hematology, 2016
Some promising cartilage and synovium biomarkers are at various stages of development and awaiting further validation in larger patient populations with osteoarthritis (OA). Various reports have shown increased levels of inflammatory biomarkers, both locally (synovial fluid) and systemically (serum and plasma) in such patients. The clinical value of these parameters in combination with imaging biomarkers in order to predict early onset and the burden of OA is being investigated. This review article aims to describe the potential usefulness of synovial and cartilage biomarkers for the diagnosis and prognosis of hemophilic arthropathy (HA) by using the existing literature on OA as an applicable model. A systematic review found that serum cartilage oligomeric matrix protein (sCOMP) is elevated in patients with knee OA and is sensitive to OA disease progression.
Arthroplasty for severe deforming arthropathy in overlap syndrome of systemic lupus erythematosus and anti-Jo-1 antibody positive dermatomyositis
Published in Modern Rheumatology Case Reports, 2018
Kenjiro Fujimura, Hiromichi Mitsuyasu, Motoko Ishida, Koji Sakuraba, Masataka Nakamura, Tomoya Miyamura, Satoshi Kamura, Eiichi Suematsu, Hisaaki Miyahara
We experienced a rare case of severe contractured and flexed metacarpophalangeal joint (MPJ) arthropathy in a patient with overlap syndrome of systemic lupus erythematosus and dermatomyositis. The patient was a 60-year-old female with high anti-nuclear antibody and anti-Jo-1 antibody titers whose hands had gradually deformed without arthralgia during the past 6 years. Both hands were extremely contractured; in particular, the right hand had dislocations of the second to fifth MPJs, ankyloses of some proximal interphalangeal and distal interphalangeal joints, and z-shaped deformity of the thumb. We performed thumb arthroplasty and artificial joint replacement of the second to fifth MPJs of the dominant right hand. These operations enabled improvement of the patient’s ability to perform daily activities, with an improvement from 1.125 to 0.625 of the Japanese version of the Stanford Health Assessment Questionnaire score. Although surgery to treat contractured deformities can only partially recover the functional ability, it also has indications for arthroplasties.
A case of cutaneous polyarteritis nodosa with elevated serum interleukin-6 levels complicated by leg arterial stenosis and destructive arthropathy of the left ankle
Published in Modern Rheumatology, 2014
Yoshiro Horai, Ayuko Tokuyama, Remi Sumiyoshi, Yoshikazu Nakashima, Takahisa Suzuki, Akitomo Okada, Shin-ya Kawashiri, Kunihiro Ichinose, Yasumori Izumi, Taiichiro Miyashita, Mami Tamai, Satoshi Yamasaki, Hideki Nakamura, Tomayoshi Hayashi, Tomoki Origuchi, Atsushi Kawakami
We report a case of a 60-year-old female with cutaneous polyarteritis nodosa (CPN) of the left ankle, accompanied by elevated serum interleukin (IL)-6 levels. Computed tomographic angiography revealed severe narrowing of medium-sized arteries in her left leg. Destructive arthropathy in the left ankle was identified by X-ray and magnetic resonance imaging. This is the first Japanese case of severe CPN complicated by destructive arthropathy. Quantification of serum IL-6 might be useful in diagnosis and evaluation of CPN.
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