Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders最新文献

{"title":"Application Value of Blood Routine-Derived Indices for the Evaluation of Disease Activity in Systemic Lupus Erythematosus.","authors":"Ming Li, Yunfei Li, Lijun Pang, Junjie Chen, Shuangshuang Shang, Chuanbing Huang","doi":"10.1177/11795441261436819","DOIUrl":"https://doi.org/10.1177/11795441261436819","url":null,"abstract":"<p><strong>Background: </strong>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple organ systems, characterized by heterogeneous pathogenesis, diverse clinical manifestations, prolonged disease course, and substantial morbidity and mortality.</p><p><strong>Objectives: </strong>This study aimed to systematically evaluate the clinical value of 11 hematological indices derived from routine blood tests in assessing disease activity in patients with SLE.</p><p><strong>Design: </strong>This retrospective observational study analyzed the correlation between hematological biomarkers and clinical disease activity indicators in enrolled patients. Receiver-operating characteristic (ROC) curves were employed to evaluate the predictive efficacy of each indicator for disease activity, while binary logistic regression analysis was used to identify independent risk factors influencing disease activity.</p><p><strong>Methods: </strong>Clinical and laboratory data from 100 patients with SLE were retrospectively analyzed. Associations between blood routine-derived indices and disease activity were assessed. Receiver-operating characteristic curves were used to evaluate the predictive performance of these indices for SLE activity, and binary logistic regression analysis was conducted to identify independent risk factors.</p><p><strong>Results: </strong>Compared with healthy controls, patients with SLE exhibited significantly higher levels of platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), aggregated inflammatory systemic index (AISI), derived neutrophil-to-lymphocyte ratio (dNLR), neutrophil-to-lymphocyte-platelet ratio (NLPR), monocyte-to-lymphocyte ratio (MLR), and RDW/PLT ratio (RPR) (all <i>P</i> < .05), whereas HGB/RDW ratio (HBR) was significantly lower. Disease activity was positively correlated with SIRI, SII, AISI, PLR, NLR, dNLR, NLPR, and MLR (<i>P</i> < .05 or <i>P</i> < .01), while mean platelet volume-to-platelet ratio (MPR) and RPR showed significant negative correlations with disease severity. The ROC analysis demonstrated that SIRI, SII, AISI, PLR, NLR, dNLR, NLPR, MLR, RPR, and a combined predictive model effectively discriminated active disease, with the combined model yielding the highest area under the curve (AUC). Among individual indices, SII and NLR showed the strongest predictive performance.</p><p><strong>Conclusion: </strong>Blood routine-derived inflammatory indices, particularly SII and NLR, are effective tools for evaluating disease activity in SLE. After adjustment for potential confounders, elevated SII was identified as an independent risk factor for increased disease activity, highlighting its potential clinical utility in routine assessment of patients with SLE.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"19 ","pages":"11795441261436819"},"PeriodicalIF":1.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interleukin-6 as a Marker of Joint Damage in Osteoarthritis: A Study of Its Pro-inflammatory Impacts.","authors":"Dwitya Elvira, Dela Hangri Jalmas","doi":"10.1177/11795441261436818","DOIUrl":"https://doi.org/10.1177/11795441261436818","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis (OA) is a degenerative joint disease characterized by a complex pathophysiology involving inflammatory biomarkers.</p><p><strong>Objectives: </strong>The current study aimed to investigate the correlation between interleukin-6 (IL-6) serum levels and joint space narrowing (JSN) in patients with knee OA.</p><p><strong>Design: </strong>A total of 46 patients clinically diagnosed with knee OA were included in this study.</p><p><strong>Methods: </strong>Joint space narrowing was measured using radiographic examinations, whereas blood serum levels of IL-6 were quantified using enzyme-linked immunosorbent assay. Statistical analysis was performed to determine the relationship between IL-6 and JSN.</p><p><strong>Results: </strong>The average level of IL-6 was 117.61 (67.05) ng/mL, with JSN measurement of 1.76 (1.31) mm. An inverse correlation found between IL-6 levels and the size of the gap joints in patients with knee OA (<i>r</i> = -.298; <i>P</i> = .044).</p><p><strong>Conclusion: </strong>An inverse correlation exists between IL-6 levels and joint impairment in knee OA, suggesting that inflammation plays a crucial role in the progression of the disease.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"19 ","pages":"11795441261436818"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13049335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Sonographic Pattern of Late-Onset and Early-Onset Rheumatoid Arthritis: Comparative Study.","authors":"Nermeen Noshy Aziz, Rasha Mohamed Hassan, Rehab Ali Ibrahim, Naglaa Afifi, Rasha N Thabet","doi":"10.1177/11795441261429109","DOIUrl":"10.1177/11795441261429109","url":null,"abstract":"<p><strong>Background: </strong>Late-onset rheumatoid arthritis (LORA) poses a great challenge for physicians regarding diagnosis and treatment. The prognosis for LORA was better in some early research but worse in more recent trials.</p><p><strong>Objectives: </strong>The study aim was to compare the clinical, laboratory, and radiological characteristics assessed by musculoskeletal ultrasound (MSUS) of patients with LORA and early-onset rheumatoid arthritis (EORA) and to examine their associations with inflammation and treatment outcomes.</p><p><strong>Design: </strong>The study included 64 RA with EORA and 64 RA patients with LORA, fulfilling the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA.</p><p><strong>Methods: </strong>Medical history, Health Assessment Questionnaire Disability Index (HAQ-DI), DAS 28 score, laboratory investigations, and MSUS of both hands and wrist joints were done.</p><p><strong>Results: </strong>Female patients with EORA were more compared with those with LORA (89% vs 78.1%). Comorbidities were significantly more prevalent in the LORA group (28.12%) compared with the EORA group (10.9%) (<i>P</i> = .0143). A significant difference was also observed between the 2 groups regarding higher ESR values in LORA, with no significant difference detected in C-reactive protein (CRP) levels. Regarding joint involvement, shoulder, metatarsophalangeal (MTP), and knee joints were more frequently affected in LORA, with statistically significant differences (<i>P</i> < .0001, .0119, and .0285, respectively). The MSUS findings revealed higher gray-scale grades in patients with LORA, with significantly increased Doppler signal activity (<i>P</i> < .052), and a greater frequency of erosions compared with those with EORA. The mean HAQ-DI score was significantly higher in LORA than in EORA (<i>P</i> = .0004). Regarding treatment patterns, methotrexate (MTX) was more commonly prescribed in the EORA group (67.1%) compared with the LORA group (37.5%), whereas leflunomide was used more in LORA (68.75%) compared with EORA (46.8%), with statistically significant difference.</p><p><strong>Conclusions: </strong>Patients with LORA demonstrated more active synovitis and a higher frequency of erosions compared with those with EORA, despite the non-significant difference in DAS 28 scores. Moreover, patients with LORA exhibited a greater burden of comorbidities than those with EORA. Therefore, regular evaluation of inflammatory activity using MSUS, along with assessment of associated comorbid conditions, is recommended in patients with LORA.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"19 ","pages":"11795441261429109"},"PeriodicalIF":1.9,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Diagnosis of Rheumatoid Arthritis From Hand Radiographs Using Artificial Intelligence: A Retrospective Study.","authors":"Dilber Çetintaş, Gülhan Kılıçarslan, Türkan Tuncer, Derya Çetintaş","doi":"10.1177/11795441261429110","DOIUrl":"10.1177/11795441261429110","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is a chronic inflammatory disease that damages hand and wrist joints, leading to pain, disability, and reduced quality of life. Radiographic assessment plays a key role in diagnosis, but it is subjective and dependent on the clinician's experience. Deep learning-based systems offer the potential for faster, more objective, and more consistent evaluation.</p><p><strong>Objectives: </strong>This study aims to develop an attention-based deep learning model for the automated diagnosis of RA from hand and wrist radiographs and to demonstrate that high diagnostic performance can be achieved even with a limited data set.</p><p><strong>Design: </strong>Retrospective observational study evaluating an attention-based deep learning model for automated diagnosis of RA from hand and wrist radiographs.</p><p><strong>Methods: </strong>Radiographs from 311 RA patients and 259 healthy controls collected between September 2018 and September 2024 were analyzed. Individuals with other conditions causing hand deformities were excluded. The data set was divided into training (n = 325), validation (n = 142), and test (n = 50) sets. DenseNet121 and DenseNet169 architectures were combined with an attention mechanism to highlight RA-specific structural changes. Despite the relatively small data set, data augmentation and attention modeling were used to improve robustness.</p><p><strong>Results: </strong>The proposed model achieved 88% accuracy, 84% precision, and 91% recall, demonstrating strong diagnostic capability with limited training data. Initial clinical testing suggests that the model can support radiologists by providing consistent and objective assessments.</p><p><strong>Conclusion: </strong>This attention-based deep learning approach shows promise as an effective, reliable, and efficient tool for the automated diagnosis of RA. The ability to achieve high performance with limited data highlights its potential for real-world clinical adoption, particularly in resource-constrained environments.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"19 ","pages":"11795441261429110"},"PeriodicalIF":1.9,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12966568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cough-Induced Groin Pain: Misleading Symptom or Diagnostic Key for Differential Diagnosis.","authors":"Seçil Yıldırım, Aylin Ayyıldız, Mustafa Hüseyin Temel, Fatih Bağcıer, Evrim Coşkun","doi":"10.1177/11795441261417711","DOIUrl":"10.1177/11795441261417711","url":null,"abstract":"<p><p>Groin pain that worsens with coughing is most commonly attributed to intra-abdominal pressure changes associated with inguinal or femoral hernias. However, musculoskeletal (MSK) disorders can mimic hernia-related symptoms and are often overlooked, leading to misdiagnosis, unnecessary imaging, and delayed treatment. Recognition of these alternative causes is essential for accurate diagnosis and appropriate management. We report the case of a 42-year-old male office worker with chronic right-sided groin pain persisting for 6 months. The pain was localized without radiation, aggravated by palpation, but not influenced by coughing or the Valsalva maneuver. Imaging studies including MRI of the hip, lumbar spine, and pelvis were unremarkable. On physical examination, a hypersensitive trigger point was identified in the pectineus muscle, with a pain pressure threshold (PPT) of 1.8 kg/cm² compared to 3.4 kg/cm² on the unaffected side. A diagnosis of pectineus myofascial pain syndrome was made. Ultrasound-guided dry needling was applied in three sessions over 2 weeks, resulting in an improvement of PPT to 3.2 kg/cm² and a reduction of the Visual Analog Scale (VAS) score from 7/10 to 2/10. This case emphasizes that not all groin pain provoked by coughing is hernia-related. Pectineus myofascial pain syndrome, although underrecognized, should be considered in the differential diagnosis. Early recognition of this condition can prevent unnecessary surgical referrals and facilitate timely effective treatment.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"19 ","pages":"11795441261417711"},"PeriodicalIF":1.9,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12873075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Immune-Inflammation Index as a Marker of Activity in Behcet's Uveitis.","authors":"Doaa Maamoun Ashour, Mohamed Rezk Mohamed, Nesrin Said Madkour, Rahma A Elziaty, Reem Mohsen, Marwa A Karim","doi":"10.1177/11795441251412830","DOIUrl":"10.1177/11795441251412830","url":null,"abstract":"<p><strong>Background: </strong>Behcet's disease (BD) is an immune-mediated disease with ocular involvement in ~70% cases. Clinical assessment of uveitis activity can be challenging in special situations. The Systemic Immune-Inflammation Index (SII), a novel biomarker, may aid assessment but remains unstudied in BD uveitis.</p><p><strong>Objective: </strong>To evaluate the levels of SII and other potential inflammatory biomarkers derived from full blood count (FBC) in patients with active uveitis in BD.</p><p><strong>Methods: </strong>This is a case-control study that included 3 groups; an active uveitis group with a confirmed diagnosis of BD, an inactive disease group with BD without any activity for at least 3 months, and a control group of age and sex-matched healthy adults. Full blood count was done for all participants from a venous sample. Neutrophil-lymphocyte ratio (NLR), Platelet-lymphocyte ratio (PLR), and SII (neutrophils × platelets/lymphocytes) were calculated and compared between the groups.</p><p><strong>Results: </strong>58 subjects were enrolled; 24 patients with BD and current active uveitis, 15 patients with inactive BD, and 19 healthy matched volunteers. The NLR and PLR were significantly higher in the active uveitis group than in the inactive group. SII was higher in the active uveitis group compared with the inactive group (<i>P</i> < .001) and the healthy controls (P .002). The cutoff value for SII was > 701.72 with 79.17% sensitivity and 100% specificity. SII levels were higher in bilateral uveitis (1232.47) compared with unilateral active uveitis (870); however, the difference was not statistically significant.</p><p><strong>Conclusion: </strong>SII was highest in BD patients with active uveitis, significantly differing from those with inactive disease and healthy controls, supporting its potential as a biomarker for uveitis activity. Further research is needed to explore its correlation with disease severity.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"19 ","pages":"11795441251412830"},"PeriodicalIF":1.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12847684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Polymyalgia Rheumatica and Giant Cell Arteritis With COVID-19 Vaccination: A Systematic Review.","authors":"Fatima Shahid, Hareem Farooq, Huzaifa Abeer, Ghulam Mustafa Mahmood, Habibah Sheikh, Muhammad Zain Ameer, Laveeza Fatima, Fatima Ameer, Zunaira Amjad, Talha Zartash Ahmad, Ghazia Rehman, Aqeeb Ur Rehman","doi":"10.1177/11795441251414673","DOIUrl":"10.1177/11795441251414673","url":null,"abstract":"<p><strong>Background: </strong>Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are interrelated inflammatory conditions, and evidence suggests that infection and vaccination might act as a trigger for these conditions. This descriptive systematic review summarizes the published case reports and case series on new-onset PMR and GCA following COVID-19 vaccination, highlighting their clinical features, diagnostic findings, and treatment outcomes.</p><p><strong>Objectives: </strong>To do a systematic analysis of available literature regarding the association between COVID-19 vaccination and the first onset or flare of PMR and/or GCA.</p><p><strong>Design: </strong>Systematic review of case reports and case series.</p><p><strong>Data sources and methods: </strong>A systematic literature search was conducted using PubMed/MEDLINE, Cochrane, ScienceDirect, and Google Scholar. Data on patient demographics, clinical features, outcomes, and latency periods were extracted and analyzed. Quality assessment of included studies was performed using the Joanna Briggs Institute Critical Appraisal Tool.</p><p><strong>Results: </strong>A total of 32 articles, documenting 50 new-onset cases (30 PMR and 20 GCA), were identified for inclusion. The mean age for patients with PMR was 71.06 years, and 72.85 years for GCA. A slight female predominance was observed (60%) for both PMR and GCA. Pfizer-BioNTech (48%) and AstraZeneca (38%) vaccines were most frequently associated with disease onset. The mean latency period from vaccination to symptom onset was 11.03 days for PMR and 5.3 days for GCA, indicating a temporal relationship. Most of these studies originated from North America and Europe mimicking the global scale of vaccination. Most patients responded well to symptomatic treatment with corticosteroids.</p><p><strong>Conclusions: </strong>There exists a temporal association between COVID-19 mRNA or viral vector-based vaccines and the onset of PMR and GCA. While causality is not proven, this review underscores the need for clinicians to be aware of this potential association to ensure timely diagnosis and treatment, particularly as booster vaccinations continue to be administered. Larger epidemiological studies with long-term follow-up are essential to further explore this association.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"19 ","pages":"11795441251414673"},"PeriodicalIF":1.9,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diverse Vascular Manifestations of Takayasu Arteritis: Coronary Artery Stenosis and Aneurysmal Dilation in pediatric patients.","authors":"Amira Hussein, Mona Hafez, Sohier Yahia, Alaa Abdelrahman, Mona M Sabaa, Doaa Mosad Mosa, Mayada Zeid","doi":"10.1177/11795441251406902","DOIUrl":"10.1177/11795441251406902","url":null,"abstract":"<p><p>Takayasu arteritis (TA) is a rare, chronic inflammatory disease that primarily affects large arteries, and in childhood (c-TA), it often presents with diverse and delayed manifestations that complicate diagnosis. We describe 2 pediatric cases that highlight the importance of early recognition and intervention. The first was a 3-month-old girl who presented with fever, respiratory distress, and peripheral cyanosis. Laboratory investigations revealed leukocytosis, anemia, elevated inflammatory markers, and hypercoagulability, while Doppler ultrasound and computed tomography angiography (CTA) demonstrated extensive vascular involvement with arterial occlusions and aneurysms. She was diagnosed with c-TA based on the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria and responded favorably to high-dose corticosteroids, infliximab, methotrexate, and antiplatelet therapy. The second case was a 17-year-old female with a history of hypertensive encephalopathy who presented with chest pain, arm numbness, and exertional dyspnea. Examination showed absent pulses and significant blood pressure discrepancies in the upper limbs, while laboratory tests revealed elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and positive antinuclear antibody (ANA). The CTA confirmed severe stenosis and occlusions in multiple arteries, fulfilling the diagnostic criteria for TA. Despite treatment with sarilumab, corticosteroids, methotrexate, and antiplatelet therapy, she continued to experience symptoms and required further intervention. These cases underscore the need to consider TA in pediatric patients with hypertension, absent or diminished pulses, blood pressure discrepancies, limb claudication, chest pain, or unexplained systemic inflammatory symptoms. Early recognition and aggressive immunosuppressive therapy are essential to prevent irreversible vascular damage and improve long-term outcomes.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"18 ","pages":"11795441251406902"},"PeriodicalIF":1.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12739090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Unusual and Rare Presentation of Rheumatoid Arthritis as Multiple Large Synovial Cysts in Uncommon Locations.","authors":"Natalie Nagib, Nicole Nagib, Abanoub Gabra, Alan Schiller, Ronald Emkey","doi":"10.1177/11795441251379096","DOIUrl":"10.1177/11795441251379096","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a chronic autoimmune disorder primarily characterized by persistent synovitis, leading to joint destruction, deformities, and systemic involvement. Synovial cysts are rare extra-articular manifestations of RA, usually arising from inflamed synovial tissues. While most synovial cysts occur in typical locations like the knees and wrists, we present a unique case of RA manifesting as multiple large synovial cysts in uncommon locations. A 67-year-old female patient with a history of well-controlled RA presented with complaints of progressive swelling and discomfort in her upper arms and thighs, unresponsive to conventional RA management. Physical examination revealed large, fluctuant masses, which were non-tender but limited the range of motion in the affected limbs. Diagnostic imaging, including ultrasound and magnetic resonance imaging (MRI), confirmed the presence of multiple synovial cysts, each measuring over 5 cm in diameter, situated in atypical areas around the elbow, hip, and shoulder joints. Given the patient's history, these findings were initially unexpected, prompting further investigation to exclude differential diagnoses, such as lipomas, abscesses, and malignancies. Aspiration of the cysts revealed a synovial fluid consistent with RA pathology, confirming the diagnosis. This case highlights an unusual and rare presentation of RA. While synovial cysts are a known manifestation, their appearance in less typical locations emphasizes the importance of a comprehensive diagnostic approach. This case underscores the need for clinicians to consider atypical presentations when evaluating RA patients, particularly those with unusual swelling or masses that do not respond to standard treatments. Proper imaging and aspiration can facilitate accurate diagnosis, ensuring timely and appropriate management. Further research is needed to understand the mechanisms driving such atypical cyst formations and to optimize treatment strategies for similar cases.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"18 ","pages":"11795441251379096"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relapsing Polychondritis With Palmoplantar Pustulosis: A Case Report.","authors":"Lainis Vasileios, Katsouli Olga, Vlachoyiannopoulos G Panayiotis","doi":"10.1177/11795441251378521","DOIUrl":"10.1177/11795441251378521","url":null,"abstract":"<p><p>Relapsing polychondritis (RP) is a rare autoimmune disease that affects cartilaginous tissues and proteoglycan-rich organs. Around 30% of cases have coexisting autoimmune inflammatory diseases. Palmoplantar pustulosis (PPP) is extremely uncommon in RP. We report a case of resistant RP, complicated with PPP. A 36-year-old female presented with fever, nose and earlobe chondritis, and symmetric arthritis. Infectious and connective tissue diseases were ruled out. The RP diagnosis was made, and she was treated with corticosteroids and methotrexate. Three years later, she experienced acute dyspnea due to tracheobronchial chondritis, and she was placed on induction treatment with 6 cyclophosphamide pulses, accompanied by maintenance therapy with mycophenolate mofetil (MMF). After 4 years, she presented with scleritis and panuveitis. The MMF was discontinued, and she was treated with tocilizumab (TCZ) 162 mg/week. Four months after the initiation of TCZ, the patient experienced erythematous papules and pustules on both palms and soles, suggestive of PPP. She received oral corticosteroids in addition to TCZ, with complete regression of symptoms.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"18 ","pages":"11795441251378521"},"PeriodicalIF":1.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}