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Joint Sonography in Patient with Hematoidin Crystals in a Clinically Suspected Septic Arthritis
Abstracts elbows, shoulders, acromioclavicular joints, sternoclavicular joints, knees, ankles, MTPs. Joint inflammation was assessed by ultrasound and graded 0-3 upon grey scale and power doppler. Human leukocyte antigen B results were reviewed retrospectively. Results: After excluding joints with symmetric normal presentation upon sonography, we analyzed the asymmetry of joint inflammation with categorical data. Right third DIP and left second MTP were affected more than their fellow ones (McNemar test, p50.049 and p50.039 respectively). HLA-B60, HLA-B46, HLA-B58, HLA-B27, HLA-B38, HLA-B39 were most frequently observed. Presence of the above-mentioned HLA-B alleles were distributed between PsA and PsO without significant difference and did not affect the distribution of the involved joints. After converting to continuous variables and considering normal symmetric joints, right third DIP and left second MTP joints remained (Wilcoxon signed-rank test, p50.041, p,0.001 respectively). Right second DIP was affected more than the left in patients positive for HLAB60 or B61. Left fourth MCP affected more than the fellow one in positive HLA-B27. Left second PIP in positive HLA-B38 or HLA-B39. Conclusions: Joint sonography can be useful in different HLA-B alleles in PsA and PsO patients. PPT15-010 Joint Sonography in Patient with Hematoidin Crystals in a Clinically Suspected Septic Arthritis Chih-Wei Tseng,1 Chong-Hong Lim,2 Jau-Chung Hwang,3 Yun Chen,4 Ching-Tsai Lin1 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan, 2Rheumatology Unit, Department of Internal Medicine, Hospital Sultanah Bahiyah, Aler Setar, Malaysia, 3 Department of Pathology, Lin Hsin Hospital, 4Department of Internal Medicine, Lin Hsin Hospital, Taiwan Objectives: Hematoidin is an erythrocyte derived product without containing iron. It is rare to find intracellular and extracellular hematoidin crystals in joint effusion. Sonographic description was never described before. We present a case of monoarthritis in a patient with alcoholic cirrhosis and compare his sonographic findings with CT scan and MRI and pathologic findings. Methods: Case report and literature review. Results: This 40 year-old man, Taiwanese aboriginal Atayal, with alcoholic liver cirrhosis and diabetes mellitus presented with left knee swelling of acute onset for 1 week. CT scan at emergency room showed free air within the joint effusion Ultrasound was performed and showed heteroechoic thickening of the synovium with focal hyperemia and hyperechoic lines suggesting free air in the synovium. There was also superficial enhancement of the articular cartilage layer. MRI of the knee showed no nodular proliferation of the synovium with lobulated margins or blooming artefact on gradient echo suggesting pigmented villonodular synovitis. Joint aspiration and synovial fluid analysis revealed the presence of intracellular and extracellular hematoidin which is a yellow, rhomboid plate. Joint bacterial culture was negative. He received joint synovectomy and no micro-organism was identified. Pathology showed focal necrosis with acute and chronic inflammatory cells in the synovium. Conclusions: Hematoidin is a soluble crystal which is seldom present in the synovial fluid. Previous report also showed that hematoidin is present in patients with staphylococcus aureus septic arthritis preceded by previous repeated previous repeated traumatic injuries. Here we presented the sonographic findings of a joint inflamed by the presence of hematoidin crystals.
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PPT15-011 Joint Ultrasound In Patients with Psoriasis and Psoriatic Arthritis Chih-Wei Tseng,1 Chao-Kuei Juan,2 Chung-Yang Yen,2 Chien-Shan Chiu,2 Chiann-Yi Hsu,3 Kuo-Lung Lai1 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan, 2Department of Dermatology, Taichung Veterans General Hospital, 3Biostatistics Task Force, Taichung Veterans General Hospital Objectives: Patients with psoriasis have varied joint involvement. Some patients have symptomatic asymmetric oligoarthritis while some are asymptomatic. To evaluate the joint involvement in patients with psoriasis (PSO) and psoriatic arthritis (PSA), we compared fifty-two joints in patients with PSO and PSA and evaluated the symmetry of joint involvement. Methods: We enrolled a total of fifty-five patients with 38 PSA and 17 PSO and evaluated their IPs, PIPs, DIPs, MCPs, wrists, elbows, shoulders, acromioclavicular joints, sternoclavicular joints, knees, ankles, MTPs. Joint inflammation was graded from grade 0 to grade 3 on grey scales (GS) and on doppler signals (PD). A score of asymmetry was introduced to compare the right and left side of joint involvement. Results: Baseline demographics between PSA and PSO were not significantly different except that PSA patients had more tender joints (median value 5 2, Mann-Whitney U test, p,0.001) and swollen joints (median value 5 1, Mann-Whitney U test, p,0.001). GS score (median value 5 29, p,0.001), PD score (median value 51, p50.049) and composite scores (median value 5 35, p,0.001) were higher in PSA. PSA has more upper limb joints involvement (p,0.001). Right-Left asymmetry score was not significantly different among PSA and PSO (p50.956). Conclusions: Asymmetric oligoarthritis is one of the pattern of psoriatic arthritis. Ultrasound evaluation of PSA and PSO reveals more joint involvement than clinical examination. Joint asymmetry was not different between PSA and PSO. PPT15-012 Management of Refractory Sciatic Neuropathic Pain Using Ultrasound-Guided Pulsed Radiofrequency Min Cheol Jang, Dong Gyu Lee Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, South Korea Objectives: Nowadays, pulsed radiofrequency (PRF) is being used to control several types of musculoskeletal pain. Herein, we report a successful application of ultrasound (US)-guided PRF for a patient with refractory sciatic neuropathic pain. Methods: Case report. Results: We applied US-guided PRF to a 50-year-old man, suffering from refractory neuropathic pain on the left foot following sciatic neuropathy for a period of approximately 6 months. We performed PRF on the level of piriformis muscle because the lesion of the sciatic nerve was presented digitally from the level of piriformis muscle on the magnetic resonance images. Under US guidance, the catheter needle was placed close to the left sciatic nerve, and dysesthesia and tingling sensation were reported to be less than 0.2V. The PRF treatment was administered at 5Hz and 5ms pulsed width for 360 seconds at 45V. After PRF on the left sciatic nerve, pain intensity-based on a numeric rating scale-decreased from 8 to 2. The reduction of pain was sustained for at least 6 months after the PRF procedure.
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PPT15-011 Joint Ultrasound In Patients with Psoriasis and Psoriatic Arthritis Chih-Wei Tseng,1 Chao-Kuei Juan,2 Chung-Yang Yen,2 Chien-Shan Chiu,2 Chiann-Yi Hsu,3 Kuo-Lung Lai1 1 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan, 2Department of Dermatology, Taichung Veterans General Hospital, 3Biostatistics Task Force, Taichung Veterans General Hospital Objectives: Patients with psoriasis have varied joint involvement. Some patients have symptomatic asymmetric oligoarthritis while some are asymptomatic. To evaluate the joint involvement in patients with psoriasis (PSO) and psoriatic arthritis (PSA), we compared fifty-two joints in patients with PSO and PSA and evaluated the symmetry of joint involvement. Methods: We enrolled a total of fifty-five patients with 38 PSA and 17 PSO and evaluated their IPs, PIPs, DIPs, MCPs, wrists, elbows, shoulders, acromioclavicular joints, sternoclavicular joints, knees, ankles, MTPs. Joint inflammation was graded from grade 0 to grade 3 on grey scales (GS) and on doppler signals (PD). A score of asymmetry was introduced to compare the right and left side of joint involvement. Results: Baseline demographics between PSA and PSO were not significantly different except that PSA patients had more tender joints (median value 5 2, Mann-Whitney U test, p,0.001) and swollen joints (median value 5 1, Mann-Whitney U test, p,0.001). GS score (median value 5 29, p,0.001), PD score (median value 51, p50.049) and composite scores (median value 5 35, p,0.001) were higher in PSA. PSA has more upper limb joints involvement (p,0.001). Right-Left asymmetry score was not significantly different among PSA and PSO (p50.956). Conclusions: Asymmetric oligoarthritis is one of the pattern of psoriatic arthritis. Ultrasound evaluation of PSA and PSO reveals more joint involvement than clinical examination. Joint asymmetry was not different between PSA and PSO. PPT15-012 Management of Refractory Sciatic Neuropathic Pain Using Ultrasound-Guided Pulsed Radiofrequency Min Cheol Jang, Dong Gyu Lee Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, South Korea Objectives: Nowadays, pulsed radiofrequency (PRF) is being used to control several types of musculoskeletal pain. Herein, we report a successful application of ultrasound (US)-guided PRF for a patient with refractory sciatic neuropathic pain. Methods: Case report. Results: We applied US-guided PRF to a 50-year-old man, suffering from refractory neuropathic pain on the left foot following sciatic neuropathy for a period of approximately 6 months. We performed PRF on the level of piriformis muscle because the lesion of the sciatic nerve was presented digitally from the level of piriformis muscle on the magnetic resonance images. Under US guidance, the catheter needle was placed close to the left sciatic nerve, and dysesthesia and tingling sensation were reported to be less than 0.2V. The PRF treatment was administered at 5Hz and 5ms pulsed width for 360 seconds at 45V. After PRF on the left sciatic nerve, pain intensity-based on a numeric rating scale-decreased from 8 to 2. The reduction of pain was sustained for at least 6 months after the PRF procedure.