Pigmented villonodular synovitis and rheumatoid arthritis: diagnostic challenges and therapeutic considerations in a case of knee pain.

We present a case of a woman in her 30s who visited the rheumatology clinic due to her persistent knee pain for 5 years, which spread to multiple joints. She was diagnosed with seropositive rheumatoid arthritis (RA). While most joints responded well to methotrexate and subsequently etanercept, persistent unilateral knee pain prompted further investigation. Imaging revealed synovitis and joint effusion in her knee, prompting arthroscopy and synovial biopsy, revealing pigmented villonodular synovitis (PVNS). Despite initial success with a tricompartmental synovectomy, her disease recurred. The decision was made to pursue medical therapy, with pexidartinib initiated by the oncology team. Our case report highlights the importance of considering other underlying conditions in patients with RA who do not achieve full clinical improvement despite standard treatment. Physicians should remain vigilant for atypical presentations and imaging features in patients with RA, for early recognition of PVNS can significantly impact treatment decisions and patient outcomes.

Telemedicine in Rheumatoid Arthritis: A Review of the PubMed Literature.

Objective: The COVID-19 pandemic increased the use of telemedicine in the management of rheumatoid arthritis (RA) patients. The paper intends to provide a narrative review of the PubMed literature (2017-2023) on the application of telemedicine in the management of RA to identify the trends in the application of telemedicine in RA and future research needs. Methods: The PubMed database was used to research data. "Telemedicine" and "rheumatoid arthritis" keywords were entered in the search box. Out of 126 publications between 2017-2023, ones that did not directly address RA, not relate to telemedicine, case reports, preliminary reports and comments to editors were screened. 31 articles were selected for the study. Results: 27 of 31 studies support the value of telemedicine in the monitoring of RA patients. Patient-reported outcomes mostly report positive perceptions, high satisfaction, and convenience. There was no statistically significant difference between telemedicine and hospital visits. Four studies reported the quality of care of telemedicine consultations was inferior to in-person consultations. One of these four studies reported limited health and digital literacy, and older age reduce satisfaction with telemedicine. Comparative and randomised clinical studies and research on modes of telemedicine were limited in quantity. Limitations in study design, lack of evaluation in various settings may impact the generalisability of findings. Conclusion: This review suggests that telemedicine is beneficial in the management of RA, however more studies are needed to pinpoint the most effective uses of telemedicine and to explore alternative health care services for patients with barriers to access telemedicine.

Association of Chondrocalcinosis in Knee Joints With Pain and Synovitis: Data From the Osteoarthritis Initiative.

OBJECTIVE: To evaluate the relationship between chondrocalcinosis and pain or synovitis in knee joints by examining data from the Osteoarthritis Initiative (OAI). METHODS: Data were obtained from the OAI public-use data sets. The relationship between chondrocalcinosis on baseline knee radiograph and pain at baseline and at 4 years was examined. Analyses were adjusted for age, sex, body mass index, and Kellgren-Lawrence (K/L) grade and the correlation between 2 knees in a subject was controlled using generalized estimating equations. The relationship between chondrocalcinosis and synovitis on magnetic resonance imaging (MRI) was examined by comparing knees with chondrocalcinosis at baseline and age, sex, and K/L grade-matched knees with no chondrocalcinosis. We read MRIs of a subset of knees for synovitis using the MRI Osteoarthritis Knee Score (MOAKS) on baseline and 4-year MRI. RESULTS: Knees with chondrocalcinosis (n = 162) more often had pain compared to knees without chondrocalcinosis (n = 2,030) at baseline and had higher Western Ontario and McMaster Universities Osteoarthritis Index pain scores, both at baseline (mean 2.4 [95% confidence interval (95% CI) 1.9, 2.9]) versus mean 1.8 [95% CI 1.7, 1.9]) and at 4 years (mean 2.5 [95% CI 1.9, 3.1] versus mean 1.6 [95% CI 1.5, 1.8]), as well as higher Intermittent and Constant Osteoarthritis Pain intermittent pain scores at 4 years. There was no difference in MOAKS synovitis scores at baseline and at 4 years between the chondrocalcinosis group (n = 102) and the control group (n = 99). CONCLUSION: Knees with chondrocalcinosis had increased pain and did not have higher synovitis scores on MRI compared to knees without chondrocalcinosis. The mechanisms by which chondrocalcinosis is associated with increased pain remain to be determined.

Head and Neck Manifestations of Eosinophilic Granulomatosis with Polyangiitis: A Systematic Review.

OBJECTIVE: To conduct the first and only systematic review of the existing literature on head and neck manifestations of eosinophilic granulomatosis with polyangiitis to guide clinical decision making for the otolaryngologist. DATA SOURCES: PubMed, Cochrane Library, Scopus, and LILACS. REVIEW METHODS: A systematic review of the aforementioned sources was conducted per the PRISMA guidelines. RESULTS: From an initial 574 studies, 28 trials and reports were included, accounting for a total of 1175 patients with eosinophilic granulomatosis with polyangiitis. Among clinical and cohort studies, 48.0% to 96.0% of all included patients presented with head and neck manifestations. In a distinct group of patients detailed in case reports describing patients presenting with head and neck manifestations, patients on average fulfilled 4.6 diagnostic criteria per the American College of Rheumatology. Furthermore, 95.8% of reported cases were responsive to steroids, and 60% required additional therapy. CONCLUSION: Otolaryngologists are in a unique position for the early diagnosis and prevention of late complications of eosinophilic granulomatosis with polyangiitis. The American College of Rheumatology criteria should be relied on in the diagnostic workup. Close surveillance of these patients in a multidisciplinary fashion and with baseline complete blood counts, chest radiographs, and autoimmune laboratory tests is often necessary. Such patients with head and neck manifestations of the disease are nearly always responsive to steroids and often require additional immunosuppressive therapy or surgical intervention in cases of cranial neuropathies, temporal bone involvement, and refractory symptoms.

A Unique Case of Systemic Lupus Erythematosus Pelvic Vasculitis.

The clinical presentation of Systemic Lupus Erythematosus (SLE) is diverse and vasculitis can be a potential manifestation. Cutaneous lesions involving small vessels are the most frequent presentation. However, medium and large vessel vasculitis may present with life-threatening visceral manifestations. We present a unique case of pelvic vasculitis mimicking a pelvic mass as an initial presentation of SLE. There are case reports of systemic vasculitis involving the female genital tract with giant cell arteritis (GCA), polyarteritis nodosa (PAN), and granulomatous with polyangiitis and microscopic polyangiitis (GPA/MPA), among others, but only a few cases attributed to SLE. Awareness of this condition and a prompt diagnosis are warranted as this is a severe and potentially life-threatening condition.

Ayurvedic medicine for rheumatoid arthritis.

Ayurvedic medicine is the traditional medicine of India, which originated over 5,000 years ago. Parts of this alternative medical system have become increasingly popular worldwide as patients seek approaches to medical care that they perceive as more holistic and less toxic than those offered by conventional Western medicine. Despite the advent of highly effective pharmacologic therapy, most individuals with rheumatoid arthritis (RA) continue to use alternative therapy at some point in the treatment of their disease. This report discusses some of the in-vitro data that suggest potential mechanisms through which Ayurvedic herbal medicines might have beneficial actions in rheumatoid arthritis, and the available clinical data evaluating the use of Ayurvedic medicine for RA.