Septic complications involving hand and wrist in patients with pre-existing rheumatoid arthritis: The role of magnetic resonance imaging and sonography

Bortolotto, Chandra; Gregoli, Bettina; Coscia, D.; Draghi, Ferdinando

doi:10.1016/j.jus.2012.03.004

Cited by 9 publications

(4 citation statements)

References 15 publications

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“…The main site of inflammation is the synovial membrane, which becomes abnormally thickened, thus forming the so‐called synovial pannus . Synovitis involves not only joints but also tendon sheaths, and it may result in structural articular and periarticular damage in the long term . Tenosynovitis of the hand and wrist has been estimated to develop in up to 95% of patients with rheumatoid arthritis and most often affects the extensor carpi ulnaris tendon .…”

Section: Tendinopathy In Inflammatory Rheumatic Diseasesmentioning

confidence: 99%

Sonography of Non‐neoplastic Disorders of the Hand and Wrist Tendons

Gitto

Draghi

2017

J of Ultrasound Medicine

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Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis.

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Section: Tendinopathy In Inflammatory Rheumatic Diseasesmentioning

confidence: 99%

Sonography of Non‐neoplastic Disorders of the Hand and Wrist Tendons

Gitto

Draghi

2017

J of Ultrasound Medicine

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“…After injection of contrast medium, usually a T1w sequence with fat suppression is repeated, using the most significant plane. 21 Magnetic resonance may be used to establish or confirm the diagnosis of psoriatic arthritis, determine the extent of disease, monitor activity, and damage and assess therapeutic efficacy. 22 All changes associated with psoriatic arthritis, namely enthesitis, synovitis, and tenosynovitis, can be seen by MRI.…”

Section: Psoriatic Arthritis: X-ray and Magnetic Resonance Imagingmentioning

confidence: 99%

“…Magnetic resonance imaging protocols have several variants, but an unchangeable core sequence is always acquired, consisting of at least one T1w sequence and two high intrinsic contrast sequences (T2 or proton density weighted sequence with fat suppression or inversion recovery) on two perpendicular planes. After injection of contrast medium, usually a T1w sequence with fat suppression is repeated, using the most significant plane 21 …”

Section: Main Textmentioning

confidence: 99%

Psoriatic arthritis: Ultrasound peculiarities with particular emphasis on enthesitis

Draghi

Ferrozzi

Ballerini

et al. 2022

J of Clinical Ultrasound

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The prevalence of psoriatic arthritis among patients with psoriasis has a marked variability with ethnic and geographic variations. Inflammatory changes associated with psoriatic arthritis include bone erosion, tenosynovitis, and synovial hypertrophy, but enthesitis is considered the hallmark. Both X‐ray and magnetic resonance imaging (MRI) are usefull in the diagnosis of psoriatic arthritis, but ultrasonography is the best imaging modality to assess entheses. Ultrasound findings of enthesitis include a loss of the regular fibrillar architecture, hypoechoic thickening, hypervascularization of tendons, ligaments, and joint capsules at their bony attachment, bony changes (including irregularities and erosions). Ultrasound has also proved the ability to detect inflammatory subclinical findings and to be useful in the follow‐up of therapies.

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“…Immunocompromised patients, such as those with HIV infection, 9,10 inflammatory arthropathy, [11][12][13] organ transplantation, 14 or active malignancy, 15 may be more susceptible to infections, including septic arthritis, and may have altered clinical presentation due to underlying immune dysfunction. Malignancy, immunosuppressed states, and inflammatory arthropathy, for example, can cause chronic inflammation, altering the serum WBC, %PMNs, ESR, and CRP values.…”

mentioning

confidence: 99%

Assessment for Septic Arthritis in Immunocompetent and Immunocompromised Patients: A Single-Institution Study

Brown

Samade

Turnquist

et al. 2021

J Am Acad Orthop Surg

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Introduction: Prompt diagnosis of septic arthritis is imperative to prevent irreversible joint damage. Immunocompromised patients are at an increased risk of septic arthritis as well as secondary systemic infection. Our aims were to identify features predictive of septic arthritis and to determine whether these features differed between immunocompetent and immunocompromised patients.Methods: A single institution retrospective cohort study was performed of 173 immunocompetent and 70 immunocompromised patients who underwent aspiration or arthrotomy for suspected septic arthritis from 2010 to 2018. Demographic data, symptoms, laboratory values, and imaging findings were recorded. Multiple variable logistic regression models were used to assess for predictive factors for septic arthritis in both cohorts. Results were reported as odds ratios, 95% confidence intervals, and P values.Results: In the regression analysis, independent predictive factors for septic arthritis in immunocompetent patients were younger age (P = 0.004), presence of radiographic abnormalities (P = 0.006), and Creactive protein (CRP) (P , 0.001). For immunocompromised patients, only CRP was an independent continuous predictive factor (P = 0.008) for septic arthritis. A risk stratification tool for predicting septic arthritis in immunocompetent patients using age ,55 years, CRP .100 mg/dL, and presence of radiographic abnormalities was developed. A similar tool was created using CRP .180 mg/dL and radiographic abnormalities in immunocompromised patients.Discussion: Differences in predictive factors for septic arthritis between immunocompromised and immunocompetent patients suggest dissimilar clinical presentations. The developed risk stratification tools allow one to predict the likelihood of septic arthritis in both groups. This may permit more accurate selection of patients for surgical intervention in the setting of insufficient data from synovial aspiration.

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Septic complications involving hand and wrist in patients with pre-existing rheumatoid arthritis: The role of magnetic resonance imaging and sonography

Cited by 9 publications

References 15 publications

Sonography of Non‐neoplastic Disorders of the Hand and Wrist Tendons

Sonography of Non‐neoplastic Disorders of the Hand and Wrist Tendons

Psoriatic arthritis: Ultrasound peculiarities with particular emphasis on enthesitis

Assessment for Septic Arthritis in Immunocompetent and Immunocompromised Patients: A Single-Institution Study

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