Role of Newman's classification in predicting outcomes in patients with crystal arthritis.

PURPOSE: The aim of the study was to evaluate the utility of Newman's classification in predicting outcomes in patients presenting with crystal arthritis. METHODS: Between January and December 2009, all patients who presented to our institution with acute crystal arthritis and were investigated with microbiological assessment of their synovial fluid were included in the study. Patients were divided into two groups depending on the fulfilment of Newman's criteria for culture-negative septic arthritis. Group 1 included patients that fulfilled Newman's B criteria. Group 2 included patients that fulfilled Newman's C criteria. A database looking at the demographics, mode of presentation, investigations, treatment and outcomes was then established and the results compared between the two groups. RESULTS: A total of 58 patients were identified (group 1: n = 13; group 2: n = 45). The average age was 71 years (range 33-96). The joint most commonly involved was the knee followed by the wrist. Clinical findings at presentation were comparable in both groups; however, WBC and C-reactive protein (CRP) were more likely to be raised in group 1. Although most patients in group 1 were treated with antibiotics (62%) there was still a higher rate of morbidity, greater use of supportive therapy and a longer hospital stay (22.3 days, SD 17.4) in comparison with group 2, where most patients were treated by observation only (76%, mean hospital stay 3.5 days, SD ± 4.4). The difference in length of hospital stay was statistically significant (p < 0.0001). CONCLUSIONS: Newman's criteria are a good indicator for prognosis in patients with crystal arthritis. However, the presence of crystals in an acutely inflamed joint does not exclude the need for supportive therapy and long hospital stay even in the absence of positive synovial fluid culture.

[Subacromial impingement. Evaluating the concept--diagnosis--therapeutic concepts]. / Das subakromiale Impingement. Begriffsbestimmung--Diagnose--Therapiekonzepte.

Subacromial impingement is a condition that belongs to the group of diseases known collectively as periarthritis humeroscapularis and has a typical clinical presentation. The underlying cause is a late of sufficient space of various origin in the subacromial region that finally leads to rotator cuff damage. Depending on cause, three forms can be distinguished, primarily extrinsic, primarily intrinsic and secondary impingement. The diagnosis is primarily clinical (pain on raising the arms above the head, painful arc syndrome). The value of imaging techniques, and the diagnostic approach are described. Initially treatment is always conservative, but when pain becomes severe or function is lost, arthroscopic or open surgical treatment may be needed.

Frozen shoulder.

The frozen shoulder is a common cause of shoulder pain and disability. Most patients slowly improve over 12 to 24 months. Some have prolonged loss of movement, pain, and associated disability. Treatments include physiotherapy, corticosteroid injections, and manipulation. Clinical trials of these treatments have produced conflicting results.

[Surgical treatment of painful shoulders caused by lesions of the rotator cuff and biceps, treatment as a function of lesions. Reflections on the Neer's concept]. / Traitement chirurgical des épaules douloureuses par lésions de la coiffe et du long biceps en fonction des lésions. Réflexions sur le concept de Neer.

On the basis of their clinical and surgical experience of 480 shoulders operated upon for rotator cuff pathology, together with a review of the literature, the authors undertake a critical analysis of the Neer impingement syndrome. Since this syndrome cannot explain all lesions and above all cover all rotator cuff pathology, they suggest an anatomical classification based upon a description of lesions. They describe their indications for surgery on the basis of their results and of those from the literature.

[So-called humero-scapular periarthropathy--classification and analysis based on 1,266 cases]. / Die sogenannte Periarthropathia humeroscapularis--Klassifizierung und Analyse anhand von 1266 Fällen.

1266 cases of Periarthropathia humeroscapularis (PHS) were analyzed according to their clinical and sonographic findings. We found in 32.8% a PHS simplex (simple tendinitis), in 12.6% a PHS adhäsiva (stiff and painful shoulder with intact cuff), in 17% a PHS calcarea (calcareous tendinitis) and in 33.3% a PHS destructiva (rotator cuff lesions). Isolated tendinitis of long head of biceps was rare (0.7%). Frozen shoulder (adhaesive capsulitis) was differentiated from PHS adhäsiva and accounted of 1.9%. 33.3% of frozen shoulder patients suffered from type I Diabetes mellitus. Women were more affected by PHS calcarea and Frozen Shoulder. The average age of patients with PHS adhäsiva and PHS destructiva was definitely higher than that of PHS simplex cases. PHS adhäsiva and Frozen Shoulder had an even distribution of affected sides, whereas the right side was favoured from 1.7:1 (PHS calcarea and PHS destructiva) to 3.5:1 (isolated bicipital tendinitis). Cases of rotator cuff tears were stiff in 33.7%, and had active limited motion (pseudoparalysis) in 28.5%.

Palindromic rheumatism. A clinical survey of sixty patients.

Sixty patients with palindromic rheumatism (PR) with a total follow-up time of 598 years and 295 years prospectively are presented. The study shows that PR is not a rare condition, but the syndrome is often ignored or misdiagnosed by the physician. Most cases of PR appear to evolve into chronic arthritis. PR may precede other kinds of systemic diseases, such as SLE, Wegener's granulomatosis, and multiple myeloma. The presence of PR in patients with fibromyalgia is reported in this paper. Gold appears to be the best drug for the treatment of PR. Cases of fibromyalgia and PR are treated successfully with antimalarial drugs. Our proposed diagnostic criteria for PR are as follows: 1) recurrent attacks of sudden-onset mono or polyarthritis or of periarticular tissue inflammation, lasting from a few hours to one week; 2) verification of at least one attack by a physician; 3) subsequent attacks in at least three different joints; 4) exclusion of other forms of arthritides.