ABSTRACT
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.
Subject(s)
Arthritis, Rheumatoid , Knee Joint , Synovitis, Pigmented Villonodular , Humans , Synovitis, Pigmented Villonodular/diagnosis , Female , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/diagnosis , Knee Joint/pathology , Knee Joint/diagnostic imaging , Adult , Arthroscopy , Arthralgia/etiology , Synovectomy , Antirheumatic Agents/therapeutic use , Magnetic Resonance Imaging , Diagnosis, DifferentialABSTRACT
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.
