Diffuse pigmented villonodular synovitis: non-surgical management

Article Abstract:

Pigmented villonodular synovitis is a tumor or growth of the synovium (fluid-secreting lining of joints). The growth contains masses of hair-like extensions, or nodules, and are infiltrated with blood cells associated with tissue injury. The knee is most often affected, although the hip, elbow, ankle, or foot may be involved, and the affected joint is swollen, tender, and warm. Bone erosion can be observed by radiography (X-ray). Removal of diseased synovium by open surgery (rather than arthroscopy, or closed-joint surgery) is the accepted treatment; X-ray therapy and joint reconstruction may also be necessary. Pigmented villonodular synovitis does not recur after surgery in 54 percent of cases. In one group of 12 patients, 5 of 6 joints had long-term improvement when intra-articular (within the joint) yttrium radiotherapy was given within 6 months of the first recurrence after surgery. The remaining six patients were treated at longer intervals after surgery and required repeat injections. Similar experiences with other groups have been reported. Joint function ultimately depends on the extent of the disease and whether joint cartilage has been damaged (an irreversible process). The symptoms, final extent of damage, and response to treatment in patients with pigmented villonodular synovitis are widely variable. The results from patients, shown in the tables and figures, indicate that whether treatment consists of surgery, yttrium radiotherapy, or osmic acid (a caustic substance), no single treatment is particularly superior to another. Assessment of joint condition following treatment has been difficult, as usual indicators such as joint size, pain, and swelling with exercise are variable. Imaging procedures with and without contrast media are also useless, although magnetic resonance imaging has been helpful in distinguishing synovial tissue and synovial fluid. Due to the nature of this rare condition, surgeons usually see more cases than rheumatologists. However, more cases are being referred to rheumatologists in early stages due to early diagnosis with biopsy during arthroscopic surgery. Before treatment of pigmented villonodular synovitis can be improved, careful studies of affected patients are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Cases, Yttrium, Injections, Intra-articular

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Polymyalgia rheumatica and rheumatoid arthritis of the elderly: a clinical, laboratory, and scintigraphic comparison

Article Abstract:

Polymyalgia rheumatica is characterized by severe pain and stiffness in muscles involving mainly the shoulder girdle and pelvic girdle, without permanent weakness or atrophy and occurs in patients over 50 years old. Morning stiffness, fever, and malaise may also occur, and these or other symptoms contribute to easy confusion between this and other disorders. Criteria have been established to aid in distinguishing polymyalgia rheumatica from rheumatoid arthritis, which is also common in older patients. Recently, the two diseases have been thought to represent different aspects of a single disorder. To better distinguish the two conditions, 16 patients with polymyalgia rheumatica and 23 patients with rheumatoid arthritis of the elderly were evaluated. Patients in the two groups were matched for age. Both groups tended to be anemic, with low levels of hemoglobin (the oxygen-carrying protein in red blood cells). Patients with rheumatoid arthritis had significantly higher blood levels of rheumatoid factor (an antibody made by the body against a protein structure common to all antibodies) and ceruloplasmin (a copper-transporting protein). Also in these patients, two measures of the presence of systemic or inflammatory disease, the erythrocyte sedimentation rate and C-reactive protein, correlated significantly. In addition, blood levels of hemoglobin correlated significantly with iron levels and decreased with rises in the sedimentation rate. Patients with polymyalgia rheumatica more often had upper arm tenderness on both sides. Imaging studies of the shoulder joint were not helpful in distinguishing between the two diseases. The study indicates that upper arm tenderness, and normal levels of ceruloplasmin and lack of rheumatoid factor are most useful for identifying patients with polymyalgia rheumatica. (Consumer Summary produced by Reliance Medical Information, Inc.)

Rheumatoid arthritis, Collagen diseases

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Polymyositis, not polymyalgia rheumatica

Article Abstract:

Polymyositis is a disease of connective tissue whose cause is unknown and which is characterized by muscle degeneration with muscle weakness and pain, pain in several joints, dermatitis, swelling, and inflammation. Polymyalgia rheumatica, also poorly understood, is characterized by pain affecting the shoulders and hips, absence of inflammatory arthritis, no signs of muscle disease, and prompt response to low doses of steroids. It is important to distinguish between the two disorders to optimize treatment and prognosis, and usually this is not a problem. Muscle weakness and dysphagia (difficulty swallowing) often mark polymyositis, but when the muscle weakness is not conspicuous, it may be difficult to differentiate the two. Four cases seen in one year by a rheumatologist in which the initial - and incorrect - diagnosis was polymyalgia rheumatica are described. Three of the four cases initially had muscle pain and stiffness, but not weakness. These cases initially and partially responded to steroid therapy, but symptoms persisted and weakness developed, so that patients were then referred to specialists. Tests of muscle function were not ordered initially in three of the four patients. Polymyositis is rare compared with other musculoskeletal disorders that produce similar symptoms. It is associated with a higher risk of underlying malignancy, and treatment may require higher doses of steroids or other medication to suppress immune function. These cases illustrate the need for a full examination to distinguish between muscle stiffness and weakness and to evaluate levels of muscle-specific enzymes, so that these similar diseases may be differentiated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Polymyositis

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