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Synovial Hypertrophy (synovial + hypertrophy)

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Medical Sciences	100%

Selected Abstracts

A new magnetic resonance imaging scoring method for assessment of haemophilic arthropathy

HAEMOPHILIA, Issue 4 2004
B. Lundin
Summary., In a European multicentre study, 39 ankles in 28 haemophilic boys were investigated by magnetic resonance imaging (MRI). A new MRI score was developed in the format A(e:s:h) for evaluating haemophilic arthropathy. This scheme provides high resolution and allows separation of different pathological components. The factor A is calculated as the sum of scores for subchondral cysts (maximum value 6), irregularity/erosion of subchondral cortex (maximum 4) and chondral destruction (maximum 6); e, s and h, respectively, represent effusion/haemarthrosis, synovial hypertrophy and haemosiderin deposition, and they are separately evaluated on a scale of 0,4. Working independently, two radiologists scored the 39 ankles twice using both this new ,European' scoring method and a previously published ,Denver' scoring scheme. Final classification was achieved by consensus. The reproducibility of the readings was assessed, and for both scoring methods the results indicated good or moderate intraobserver agreement, and good, moderate or fair interobserver agreement. These findings suggest that MRI can be useful for semiquantitative evaluation of haemophilic arthropathy, providing the examination is performed according to an appropriate protocol, and the images are evaluated by specially trained radiologists. [source]

Rapidly destructive arthropathy of the hip in haemophilia

HAEMOPHILIA, Issue 1 2001
N. Ishiguro
The aetiology of rapidly destructive arthropathy is still being debated. We report a 48-year-old male haemophiliac who exhibited hip arthropathy that was similar to rapidly destructive arthropathy. The hip joint was destroyed 6 months after the onset of symptoms. Results of clinical and laboratory examinations did not show any features of neuropathic, inflammatory or septic arthropathy, except for coagulopathy. Magnetic resonance imaging revealed an expansive joint capsule with synovial proliferation in the affected hip joint. Total hip arthroplasty was carried out successfully with total resection of the synovial tissue and joint capsule. A histological examination revealed bone necrosis, nonspecific inflammation, haemosiderosis and synovial hypertrophy. The recurrent bleeding into the hip joint induced pronounced inflammation with synovial proliferation and acute destruction of bony tissue. [source]

Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug,induced clinical remission: Evidence from an imaging study may explain structural progression

ARTHRITIS & RHEUMATISM, Issue 12 2006
A. K. Brown
Objective More timely and effective therapy for rheumatoid arthritis (RA) has contributed to increasing rates of clinical remission. However, progression of structural damage may still occur in patients who have satisfied remission criteria, which suggests that there is ongoing disease activity. This questions the validity of current methods of assessing remission in RA. The purpose of this study was to test the hypothesis that modern joint imaging improves the accuracy of remission measurement in RA. Methods We studied 107 RA patients receiving disease-modifying antirheumatic drug therapy who were judged by their consultant rheumatologist to be in remission and 17 normal control subjects. Patients underwent clinical, laboratory, functional, and quality of life assessments. The Disease Activity Score 28-joint assessment and the American College of Rheumatology remission criteria, together with strict clinical definitions of remission, were applied. Imaging of the hands and wrists using standardized acquisition and scoring techniques with conventional 1.5T magnetic resonance imaging (MRI) and ultrasonography (US) were performed. Results Irrespective of which clinical criteria were applied to determine remission, the majority of patients continued to have evidence of active inflammation, as shown by findings on the imaging assessments. Even in asymptomatic patients with clinically normal joints, MRI showed that 96% had synovitis and 46% had bone marrow edema, and US showed that 73% had gray-scale synovial hypertrophy and 43% had increased power Doppler signal. Only mild synovial thickening was seen in 3 of the control subjects (18%), but no bone marrow edema. Conclusion Most RA patients who satisfied the remission criteria with normal findings on clinical and laboratory studies had imaging-detected synovitis. This subclinical inflammation may explain the observed discrepancy between disease activity and outcome in RA. Imaging assessment may be necessary for the accurate evaluation of disease status and, in particular, for the definition of true remission. [source]

Jaccoud's arthropathy in systemic lupus erythematosus: Differentiation of deforming and erosive patterns by magnetic resonance imaging

ARTHRITIS & RHEUMATISM, Issue 1 2003
Benedikt Ostendorf
Objective To evaluate alterations of the soft tissues, tendons, and bones as detected by magnetic resonance imaging (MRI) in patients with systemic lupus erythematosus (SLE),associated arthritis of the finger joints. Methods Both hands of 14 patients with SLE of various activities and durations and with arthritis and/or deformities of the finger joints were examined by MRI and conventional radiography. Coronal T1-weighted spin-echo (with and without gadolinium contrast), axial T2-weighted turbo spin-echo, coronal fat-suppressed short tau inversion recovery, and 3-dimensional double-echo steady-state sequences were acquired and analyzed, and the findings were compared with those from conventional radiographs. Results MRI detected periarticular capsular swelling in all 14 patients, joint effusion in 7, edematous tenosynovitis in 6, proliferative tenosynovitis (flexor and/or extensor tendons) in 4, and intraarticular signs of synovial membrane hypertrophy in 10 patients, 9 of whom showed enhancement after administration of contrast medium. Bony erosions were identified in 8 patients by MRI; conventional radiography missed these erosions in 2 of the 8 patients. Four of the 14 patients were designated as Jaccoud's arthropathy index,positive, and all 4 showed severe edematous tenosynovitis and capsular swelling, but no signs of bony erosions despite longstanding disease (mean 21.5 years). Four of the 10 patients with mild deformity exhibited prominent soft tissue pathology, with minimal destruction of bone; the other 6 patients had bony alterations that resembled rheumatoid arthritis. Conclusion In SLE patients with arthritis of the finger joints, MRI detects characteristic signs of soft tissue pathology (e.g., capsular swelling, edematous and proliferative tenosynovitis, synovial hypertrophy) and bony alterations (e.g., erosions, some of which are missed by conventional radiography). MRI thus helps to distinguish different types of lupus arthritis/Jaccoud's arthropathy, which allows more differentiated treatment strategies and monitoring. [source]