The development of multiple large tophi in patients with gout is rare. We report magnetic resonance (MR) and histological features of large subcutaneous tophi in a 32-year-old male patient with no known arthritis. His subcutaneous lesions were confused with a neoplastic process, evaluated by MR imaging, and surgically excised after biopsy. The honeycomb-like appearance on the gadolinium-enhanced images may reflect the characteristic multilobular structure of the tophi composed of avascular urate deposits and surrounding vascularized granulation tissue.
Objective: Early and accurate evaluation of the presence and activity of synovitis is extremely important in the diagnosis and treatment of rheumatoid arthritis. Myeloid related protein 8/14 (MRP8/14), also known as calprotectin or S100A8/A9 is considered as a sensitive marker for local inflammatory activity in rheumatoid arthritis. The aim of this study is to demonstrate the efficacy of MRP8/14 as a marker of disease activity in RA. Methods: Thirty-one patients with diagnosis of RA who received treatment without biological drugs at our institution were included in this study. Serum MRP8/14, CRP and MMP-3 were tested in all patients. Disease activity was evaluated using DAS28-CRP and SDAI. Ultrasonography was performed on the wrists and MCP joints of both hands using semi-quantitative scale of power Doppler signal. The sum of scales in joints was calculated as the PD score. The correlation of MRP8/14 with serum biomarkers, disease activity and ultrasonography examination was investigated. Result: Serum MRP8/14 was strongly correlated with CRP (r = 0.63) and MMP-3 (r = 0.69). A correlation was observed between serum MRP8/14 and DAS28-CRP (r = 0.53) and SDAI (r = 0.66). No significant correlation was found between PD scores and MRP8/14. Conclusion: This study demonstrated that MRP8/14 is correlated with evaluated disease activity and markers of serum inflammatory response in patients not using biological drugs. MRP8/14 is considered an effective new method for objective evaluation of synovitis in RA.
Objective: Nalebuff's type I deformity of the rheumatoid thumb, which is the most common thumb deformity with rheumatoid arthritis, can be classified into three stages according to the range of motion of the thumb. However, a functional assessment for each stage has never been undertaken. Methods: The ranges of motion of the thumb metacarpophalangeal and interphalangeal joints were evaluated to determine Nalebuff's clinical stage, and both the Modified Kapandji Index (MKI) and the simple test for evaluating hand function (STEF) were used to evaluate hand function in 32 rheumatoid arthritis patients with type I deformity. We assessed hand function in each stage, and examined the relationship between the three clinical stages and dysfunction of the hand. Results: The scores for both MKI and STEF were significantly reduced in parallel with advancing stage of thumb deformity. Conclusion: Nalebuff's staging system is also useful for reflecting the level of thumb function.
The development of multiple large tophi in patients with gout is rare. We report magnetic resonance (MR) and histological features of large subcutaneous tophi in a 32-year-old male patient with no known arthritis. His subcutaneous lesions were confused with a neoplastic process, evaluated by MR imaging, and surgically excised after biopsy. The honeycomb-like appearance on the gadolinium-enhanced images may reflect the characteristic multilobular structure of the tophi composed of avascular urate deposits and surrounding vascularized granulation tissue.
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