Sternoclavicular erosions in polymyalgia rheumatica.

Paice, Elisabeth W.; Wright, F.W.; Hill, Alan

doi:10.1136/ard.42.4.379

Cited by 34 publications

(12 citation statements)

References 9 publications

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“…A surprising finding was that MRI-determined erosion and bone edema were equally common in both groups, and indeed it has been recognized that PMR may on occasion exhibit radiographically detectable erosion (15). This likely reflects the fact that irrespective of the trigger, synovitis will lead to the same pattern of MRI-determined erosion and edema.…”

Section: Discussionmentioning

confidence: 88%

Evidence for a different anatomic basis for joint disease localization in polymyalgia rheumatica in comparison with rheumatoid arthritis

Marzo‐Ortega¹,

Rhodes²,

Tan³

et al. 2007

Arthritis & Rheumatism

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Objective. The anatomic basis for joint disease localization in polymyalgia rheumatica (PMR) is poorly understood. This study used contrast-enhanced and fat suppression magnetic resonance imaging (MRI) to evaluate the relationship between synovial and extracapsular inflammation in PMR and early rheumatoid arthritis (RA).Methods. Ten patients with new-onset PMR and 10 patients with early RA underwent dynamic contrastenhanced MRI and conventional MRI of affected metacarpophalangeal (MCP) joints. Synovitis and tenosynovitis were calculated based on the number of enhancing voxels, initial rate of enhancement, and maximal enhancement of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). Periarticular bone erosion and bone edema were scored according to the OMERACT (Outcome Measures in Rheumatology Clinical Trials) scoring system in both groups. The degree of extracapsular Gd-DTPA enhancement was assessed in both conditions using semiquantitative scoring.Results. No significant differences were seen in the volume of synovitis (P ‫؍‬ 0.294), degree of flexor tenosynovitis (P ‫؍‬ 0.532), periarticular erosions (P ‫؍‬ 0.579), or degree of bone edema (P ‫؍‬ 0.143) between RA and PMR joints. However, despite comparable degrees of synovitis, the proportion of MCP joints showing extracapsular enhancement was higher in the PMR group (100%) than in the RA group (50%) (P ‫؍‬ 0.030). One PMR patient, but none of the RA patients, had bone edema at the capsular insertion.Conclusion. Despite degrees of synovitis and tenosynovitis comparable with those in RA, PMR-related hand disease is associated with prominent extracapsular changes, suggesting that inflammation in these tissues is more prominent than joint synovitis, which is common in both conditions. This suggests that the anatomic basis for joint disease localization differs between RA and PMR.

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Section: Discussionmentioning

confidence: 88%

Evidence for a different anatomic basis for joint disease localization in polymyalgia rheumatica in comparison with rheumatoid arthritis

Marzo‐Ortega¹,

Rhodes²,

Tan³

et al. 2007

Arthritis & Rheumatism

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“…Several developed polyarthritis despite their receiving doses of corticosteroids usually sufficient to control all manifestations of uncomplicated polymyalgia rheurnatica syndrome. While joint scans, synovial biopsy, and joint fluid findings support the contention of an active inflammatory syncivitis underlying the clinical features of polymyalgia rheumatica, such joint involvement does not tend to lead to chronic joint changes (5)(6)(7)(8)(9)(10)(11)(12). Moreover, in only 2 of the 9 patients whose polyarthritis preceded symptoms of giant cell arteritis were symptoms of polymyalgia rheurnatica recognized, because the affected joints were predominantly peripheral.…”

Section: Ginsburg Et Almentioning

confidence: 96%

“…This latter condition may be due to a mild synovitis of the axial joints, particularly affecting the synovial tissues of the shoulder joints, hip joints, sternoclavicular joints, and other proximal structures (5)(6)(7)(8)(9)(10). While erosions of such joints occasionally have been noted on long-term followup, the synovitis of polymyalgia rheumatica has not been considered a destructive arthropathy (5,11,12). Recently, we treated several patients whose initial symptom of GCA was a peripheral polyarthritis clinically indistinguishable from rheumatoid arthritis.…”

mentioning

confidence: 99%

Seronegative polyarthritis in giant cell arteritis

Ginsburg

Cohen

Hall

et al. 1985

Arthritis & Rheumatism

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Nineteen of 520 patients with biopsy‐proven giant cell arteritis were found to have persistent seronegative, symmetric polyarthritis with a mean joint count of 20 (swollen plus tender). In 9 patients in the onset of polyarthritis occurred prior to the diagnosis of giant cell arteritis, 3 had simultaneous onset, and 7 developed polyarthritis within 3 years after the onset of giant cell arteritis. Ten of the 19 patients demonstrated radiographic features of joint space narrowing and/or erosions. In 1 patient in a synovial biopsy was performed, revealing marked multinucleated giant cell infiltration. A persistent seronegative polyarthritis, although uncommon in giant cell arteritis, may be its presenting symptom. Other symptoms of giant cell arteritis should be sought in patients who exhibit this feature, especially in those whose arthritis begins at age 50 or older.

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“…91,92 Deposits of amyloid (β 2 microglobulin) may be found in the sternoclavicular joints of patients with the systemic disease.…”

Section: Other Conditionsmentioning

confidence: 99%

Disorders of the sternoclavicular joint

Robinson

Jenkins

Markham³

et al. 2008

The Journal of Bone and Joint Surgery. British volume

145

118

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The sternoclavicular joint is vulnerable to the same disease processes as other synovial joints, the most common of which are instability from injury, osteoarthritis, infection and rheumatoid disease. Patients may also present with other conditions, which are unique to the joint, or are manifestations of a systemic disease process. The surgeon should be aware of these possibilities when assessing a patient with a painful, swollen sternoclavicular joint.

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Sternoclavicular erosions in polymyalgia rheumatica.

Cited by 34 publications

References 9 publications

Evidence for a different anatomic basis for joint disease localization in polymyalgia rheumatica in comparison with rheumatoid arthritis

Evidence for a different anatomic basis for joint disease localization in polymyalgia rheumatica in comparison with rheumatoid arthritis

Seronegative polyarthritis in giant cell arteritis

Disorders of the sternoclavicular joint

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