Quickly progressive amyotrophy of the thigh: An unusual cause of rapid chondrolysis of the knee

Abstract

While rapidly destructive OA is more recognized in hip, we report the case of a 50-year-old woman who presented a rapid chondrolysis in the patellofemoral joint in a context of rapid loss of muscular strength. She had arthralgia, myalgia and proximal muscular deficit of the limbs. Creatine phospho kinase level was elevated and electromyogram exam showed a myogenic syndrome. Neither immune nor visceral disease was highlighted. As we suspected a polymyositis, we started corticosteroids and physiotherapy, then methotrexate and intravenous immunoglobulin. Concomitantly to the worsening of the muscular deficit and atrophy of hamstrings, she developed a persistent and disabling knee pain. Initial radiographs and magnetic resonance imaging (MRI) showed only a patellofemoral dysplasia and tiny cartilage damages. Because of aggravation of myalgia, we treated by mycophenolate mofetyl then rituximab. One year later, the knee remained painful and swollen. MRI showed signs of advanced osteoarthritis including an important loss of cartilage with an atrophy of hamstrings. Several articular corticosteroids injections were done. In the same time, the evolution of the muscular disease was unusual. Another histological analysis of muscle has highlighted a genetic myopathy due to mutation of calpain. Immunosuppressive treatments were stopped and a total joint replacement was performed. We show for the first time a case of rapid chondrolysis of patellofemoral joint related to a severe genetic myopathy.

Muscle and Osteoarthritis Joint Status: Current Research Highlights and Their Implications

“…However, whether these findings are attributable to the presence of either pre existing muscle pathology and /or an alteration in afferent input to the central nervous system and long term adaptations that may prove detrimental to articular cartilage in vulnerable joints such as the knee is impossible to establish. Although Ferrari, et al [50] found concomitantly worsening of the muscular deficit and atrophy of hamstrings led to persistent and disabling knee pain associated with osteoarthritic joint damage, in a patient with progressive amyotrophy, whether this occurs in osteoarthritis cases more generally over time is also not known.…”

Hydrogels for the Application of Articular Cartilage Tissue Engineering: A Review of Hydrogels

“…Articular cartilage injury does not heal instantly, unfortunately, and the methods for articular cartilage repair are few. Slight cartilage damage can be treated by strengthening the surrounding muscles by physiotherapy, and pain and swelling can be reduced by anti-inflammatory drugs [30][31][32]. However, if the cartilage injury is more serious, surgical treatment may be considered.…”

Hydrogels as a Replacement Material for Damaged Articular Hyaline Cartilage

“…In addition, with age, the pore area at the surface of the bone, such as the femur, is known to increase [36], decreasing the overall fracture strength and increasing the susceptibility for the cartilage to wear. Other causes of articular cartilage damage include infections and diseases such as septic arthritis [37,38] and myopathy [39]. …”

“…It is important that whichever treatment is used, the joint must maintain the freedom of movement that would be expected [40]. When the cartilage damage or arthritis is mild, physiotherapy can be used to strengthen the surrounding muscles, in conjunction with anti-inflammatory drugs to reduce pain and swelling [39,41,42]. Regular exercise has also been observed to control mild symptoms [43].…”