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At least 19 recordsLinked to original sources
PubMed1978

Synovial membrane histopathology in the differential diagnosis of rheumatoid arthritis, gout, pseudogout, systemic lupus erythematosus, infectious arthritis and degenerative joint disease.

The synovial membrane histologic sections from patients with six common rheumatic diseases were reviewed without knowledge of the clinical diagnosis. After histopathologic evaluation, the synovial membrane characteristics were grouped according to the patient's clinical diagnosis, and included 29 patients with rheumatoid arthritis, 13 with systemic lupus erythematosus, 17 with degenerative joint disease, 10 with acute bacterial arthritis, 8 with gout, and 13 with pseudogout. The only specific characteristics identified were bacteria (infectious arthritis), crystals (gout, pseudogout), and lymphoid follicles (rheumatoid arthritis). Nevertheless, other characteristic features of differential diagnostic utility were recognized, including the intensity and nature of synovial lining cell hyperplasia and of leukocyte infiltration. Light microscopic histopathologic changes in the common rheumatic diseases are not specific, but are of diagnostic utility. Complete and exhaustive review of each pathologic synovial membrane characteristic provides more justification for the routine use of synovial membrane biopsy as an adjunct to arthrocentesis in the evaluation of common rheumatic diseases.

Arthritis↗
PubMedDate not supplied

Pasteurella multocida infectious arthritis.

Pasteurella multocida, a small gram-negative rod, is a domestic animal saprophyte that occasionally causes disease in humans. Infectious arthritis may develop from a superficial animal bite or scratch. Nine previous cases of infectious arthritis due to this organism have been documented in the literature, and a tenth case is reported here. Most patients had recent animal exposure, and half the patients had underlying chronic rheumatoid arthritis. Clinical signs of inflammation were consistently present; however, systemic infection was infrequent. The lack of positive synovial fluid gram-stain smears may make differentiation from other forms of infectious arthritis difficult. Penicillin in moderate doses is effective therapy, with osteomyelitis developing in only two patients. The tendency for this syndrome to affect patients with rheumatoid arthritis may reflect deficient local defense mechanisms, chronic steroid therapy, or increased ownership of pets. The mechanism of spread of infection to the joint space appears to be through contiguous spread from a skin site rather than by the hematogenous route in most cases.

Aged↗
PubMedDate not supplied

Infectious arthritis due to Hemophilus influenzae.

A healthy 51-year-old male developed multiarticular infectious arthritis due to Hemophilus influenzae, a rare cause of infectious arthritis in adults. Previous case reports are reviewed. Predisposing factors include chronic illness, underlying joint disease, joint trauma, and respiratory infection. H. influenzae is frequently misidentified on Gram stain, being mistaken for gonococci or pneumococci. Infections due to H. influenzae may occur in normal adults. Aspects of immunity are discussed.

Adult↗
PubMed1976

Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis).

The clinical course of 59 patients with acute nongonococcal septic arthritis has been reviewed with special emphasis on the changing bacterial spectrum in recent years. The results of treatment were dependent on various factors, including the specific microbial agent and host defenses. Treatment should include parenteral antibiotics and drainage with needle aspiration, except in hips which should be surgically drained. Successful therapy requires rapid initiation of treatment and ongoing assessment of adequacy of response.

Acute Disease↗
PubMed1979

Infectious arthritis.

One hundred thirteen patients with 120 episodes of septic arthritis were seen during a 14-year period. The most common bacteria cultured from joint fluid or blood during the acute episodes were gonococci, staphylococci, and streptococci. Seventeen other bacteria were the infecting organisms in one or more cases each. Other infections and medical conditions frequently were present. In some instances the septic arthritis was a complication of another infection. In other patients septic arthritis appeared to occur because of diminished resistance to infection. The majority of patients responded well to medical treatment, but eight died and 26 had persistence of articular pain at follow-up examination.

Adolescent↗
PubMed1978

Markedly raised synovial fluid leucocyte counts not associated with infectious arthritis in children.

Synovial fluid leucocyte counts greater than 50 000 cells/mm3 (50 X 10(9)/1) are usually associated with infectious arthritis. Six children, 3 of whom meet the criteria for juvenile rheumatoid arthritis (JRA), are described with synovial fluid white blood cell counts greater than 88 000 cells/mm3 (88 X 10(9)/1). Two had synovial fluid leucocyte counts greater than 100 000 cells/mm3 (100 X 10(9)/1). The diagnosis of infectious arthritis was unlikely in these 6 children since the synovial fluid smears and cultures for infectious agents were negative and their histories atypical for infection. While in most instances such markedly raised synovial fluid leucocyte counts indicate infection, this finding is not diagnostic of septic arthritis.

Adolescent↗
PubMed1979

Septic arthritis after ureteroneocystostomy.

Acute infectious arthritis is an uncommon disease that is most commonly caused by Neisseria gonorrhoeae or gram-positive cocci. Gram-negative bacteria are an infrequent and highly virulent cause of septic arthritis and most commonly enter the circulation through the urinary tract, as in this case after ureteroneocystostomy. The resulting arthritis carries a mortality of 25% and a morbidity of 80%. Early recognition and treatment with appropriate antibiotics and mechanical drainage is imperative. Needle drainage of the affected joint has been shown superior to open surgical drainage.

Acute Disease↗
PubMed1979

Arthritis of the temporomandibular joints.

The most common disease of the temporomandibular joint (TMJ) is osteoarthritis. Rheumatoid arthritis and psoriatic arthritis may also involve this joint. Other diseases that may occasionally affect the TMJ include familial Mediterranean fever, systemic lupus erythematosus, gout, Sjögren's syndrome and infectious arthritis. Many cases of TMJ syndrome are labeled as idiopathic facial pain syndrome, a category that probably represents a number of different entities. The role of dental malocclusion has been greatly overemphasized in the past.

Arthritis↗
PubMed1977

Acute venereal arthritis. Comparative study of acute Reiter syndrome and acute gonococcal arthritis.

Acute venereal arthritis, a syndrome of fever and inflammatory arthritis following recent sexual intercourse, is a frequently misdiagnosed arthritic presentation. Nearly half of 39 patients admitted with a diagnosis of acute gonococcal arthritis were subsequently recognized as having acute Reiter syndrome. A retrospective study of both diseases revealed differentiating features that, when prospectively applied to 21 consecutive patients, permitted a correct and prompt bedside diagnosis. Acute Reiter syndrome could be differentiated by characteristic mucucutaneous lesions, arthritis/tenosynovitis confined to lower extremities, massive recurrent knee effusions, low back pain, conjunctivitis, and genitourinary inflammation. Gonococcal arthritis could be differentiated by migratory arthralgias, high fevers, arthritis/tenosynovitis initially confined to upper extremities, typical cutaneous lesions, and dramatic defervescence to penicillin therapy. Laboratory data provided support for each diagnosis.

Adolescent↗
PubMedDate not supplied

Lactoferrin and lysozyme levels in synovial fluid: differential indices of articular inflammation and degradation.

Lysozyme and lactoferrin levels were measured in 71 synovial fluids (SF) of patients with traumatic effusions, osteoarthritis, rheumatoid arthritis, pseudogout, septic arthritis, and gout, as well as in 91 synovial fluids graded according to their neutrophil count. Elevated lysozyme levels were found in all the inflammatory arthritides and also in osteoarthritis. Lactoferrin levels were not increased in osteoarthritis but displayed a close correlation to the extent of the inflammatory response as judged by SF neutrophilia. The ratio of lysozyme to lactoferrin decreased progressively with increasing SF neutrophilia. In vitro experiments showed that lactoferrin is released from neutrophils isochronously with lysozyme and beta-glucuronidase. Lactoferrin was not found in hyaline cartilage, a tissue known to contain lysozyme. These results are consistent with belief that SF lysozyme has a major derivation from both cartilage and neutrophils, and that lactoferrin arises only from neutrophils. These findings indicate that the simultaneous measurement of lysozyme and lactoferrin provides a potentially useful index of both joint inflammation and cartilage degradation.

Adult↗