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There is a latent period between the onset of symptoms and the initial positive radiographic finding The earliest changes of tuberculous arthritis are those of soft tissue swelling and distention of the capsule by effusion Subsequently, bone atrophy causes thinning of the trabecular pattern, narrowing of the cortex, and enlargement of the medullary canal As joint disease progresses, destruction of cartilage, both in the spine and in peripheral joints, is manifested by narrowing of the joint cleft and focal erosion of the articular surface, especially at the margins Where the lesion is limited to bone, especially in the cancellous portion of the metaphysis, radiography may demonstrate single or multilocular cysts surrounded by sclerotic bone With spinal tuberculosis, CT scanning or MRI is helpful in demonstrating paraspinal soft tissue extensions of the infection (eg, psoas abscess, epidural extension)
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ARTHRITIS IN SARCOIDOSIS
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The frequency of arthritis among patients with sarcoidosis is variously reported between 10% and 35% It is usually acute in onset, but articular symptoms may appear insidiously and often antedate other manifestations of the disease Knees and ankles are most commonly involved, but any joint may be affected Distribution of joint involvement is usually polyarticular and symmetric The arthritis is commonly self-limited, resolving after several weeks or months and rarely resulting in chronic arthritis, joint destruction, or significant deformity Sarcoid arthropathy is often associated with erythema nodosum, but the diagnosis is contingent on the demonstration of other extraarticular manifestations of sarcoidosis and, notably, biopsy evidence of noncaseating granulomas In chronic arthritis, radiographs show typical changes in the bones of the extremities with intact cortex and cystic changes Treatment of arthritis in sarcoidosis is usually symptomatic and supportive Colchicine may be of value A short course of corticosteroids may be effective in patients with severe and progressive joint disease
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Tuberculosis of the musculoskeletal system must be differentiated from all subacute and chronic infections, rheumatoid arthritis, gout, and, occasionally, osseous dysplasia In the spine, metastatic tumor may be suggested
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elevation of the extremity, is often associated with myeloproliferative diseases
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Chakravarty E et al Rheumatic syndromes associated with malignancy Curr Opin Rheumatol 2003 Jan;15(1):35 43 [PMID: 12496508]
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Abril A et al Rheumatologic manifestations of sarcoidosis Curr Opin Rheumatol 2004 Jan;16(1):51 5 [PMID: 14673389] Torralba KD et al Sarcoid arthritis: a review of clinical features, pathology, and therapy Sarcoidosis Vasc Diffuse Lung Dis 2003 Jun;20(2):95 103 [PMID: 12870718]
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NEUROGENIC ARTHROPATHY (CHARCOT S JOINT)
Neurogenic arthropathy is joint destruction resulting from loss or diminution of proprioception, pain, and temperature perception Although traditionally associated with tabes dorsalis, it is more frequently seen in diabetic neuropathy, syringomyelia, spinal cord injury, pernicious anemia, leprosy, and peripheral nerve injury Prolonged administration of hydrocortisone by the intra-articular route may also cause Charcot s joint As normal muscle tone and protective reflexes are lost, secondary degenerative joint disease ensues, resulting in an enlarged, boggy, painless joint with extensive cartilage erosion, osteophyte formation, and multiple loose joint bodies Radiographic changes may be degenerative or hypertrophic in the same patient Treatment is directed against the primary disease; mechanical devices are used to assist in weight bearing and prevention of further trauma In some instances, amputation becomes unavoidable
Anderson JJ et al Bisphosphonates for the treatment of Charcot neuroarthropathy J Foot Ankle Surg 2004 Sep Oct;43(5): 285 9 [PMID: 15480402]
PALINDROMIC RHEUMATISM
Palindromic rheumatism is a disease of unknown cause characterized by frequent recurring attacks (at irregular intervals) of acutely inflamed joints Periarticular pain with swelling and transient subcutaneous nodules may also occur The attacks cease within several hours to several days The knee and finger joints are most commonly affected, but any peripheral joint may be involved Systemic manifestations other than fever do not occur Although hundreds of attacks may take place over a period of years, there is no permanent articular damage Laboratory findings are usually normal Palindromic rheumatism must be distinguished from acute gouty arthritis and an atypical acute onset of rheumatoid arthritis In some patients, palindromic rheumatism is a prodrome of rheumatoid arthritis Symptomatic treatment with NSAIDs is usually all that is required during the attacks Hydroxychloroquine may be of value in preventing recurrences
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