RESUMEN
We describe a previously unreported association of ankylosing spondylitis with synovial chondromatosis, and briefly review previously reported cases and treatment of synovial chondromatosis in patients with other immune-mediated inflammatory arthritides. A 20-year-old man with ankylosing spondylitis whose axial disease was in remission with nonsteroidal anti-inflammatory drugs and oral disease-modifying anti-rheumatic drugs developed recurrent right knee pain and swelling. Magnetic resonance imaging of his right knee revealed calcified loose bodies, suggestive of synovial chondromatosis. While waiting for the surgical intervention and other invasive therapy previously reported in patients with synovial chondromatosis, a trial of etanercept eliminated the pain and swelling of the knee; however, the loose bodies have persisted during the 2-year follow-up. Thus, synovial chondromatosis should be considered in the differential diagnoses of a refractory monoarticular pain and swelling in patients with otherwise controlled inflammatory arthritis. Our report advocates a trial of anti-tumor necrosis factor drugs, which might delay the need for invasive therapy in patients with synovial chondromatosis.
Asunto(s)
Condromatosis Sinovial/tratamiento farmacológico , Etanercept/uso terapéutico , Espondilitis Anquilosante/tratamiento farmacológico , Inhibidores del Factor de Necrosis Tumoral/uso terapéutico , Condromatosis Sinovial/diagnóstico , Condromatosis Sinovial/inmunología , Humanos , Masculino , Espondilitis Anquilosante/diagnóstico , Espondilitis Anquilosante/inmunología , Resultado del Tratamiento , Adulto JovenRESUMEN
The antigenic phenotype of cartilage and synovial cells from six cases of primary synovial chondromatosis (PSC) was determined. This was compared with profiles similarly obtained for adult and fetal cartilage cells. The Ki-67 (proliferation-associated) antigen was present on 40-50 per cent of chondrocytes in the proliferative zone of fetal epiphyseal cartilage but absent in chondrocytes of adult articular cartilage and PSC cartilage nodules. The absence of Ki-67 antigen suggests that there were no proliferating cells in the synovium or cartilage in these cases of PSC. In PSC alone, some chondrocytes in the cartilage nodules and mononuclear subintimal cells around the nodules also reacted for CD68, suggesting that growth of the cartilage nodules may occur by a metaplastic process. All synoviocytes in PSC were positive for leucocyte common antigen, HLA-DR, and CD68, a pattern typical of reactive rather than normal synovium.
