The High Clinical Burden of Erosive Hand Osteoarthritis is Associated with Clinical Findings, Pain, and Radiographic Severity

Varying reports exist on the clinical impact of erosive hand osteoarthritis (EHOA) in terms of pain and articular function. Few studies have assessed the association of a patient's clinical features with the presence of more severe radiographic disease. The aim was to evaluate clinical and radiographic characteristics in EHOA comparing with non-erosive (NEHOA); to examine pain and functional impairment between EHOA and NEHOA; and correlate functional impairment with clinical findings, pain, and radiographic severity.

METHODS

62 patients with EHOA and 57 with NEHO were included. Pain was assessed through Visual Analogue Scale (VAS) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain. Functioning was evaluated with the Health Assessment Questionnaire (HAQ) concerning hand function and AUSCAN. Radiographs were scored with the Kallman scale and subchondral erosions with the Verbruggen-Veys method. Student t-tests were used for comparing quantitative data, chi-squared tests for categorical variables, and Pearson or Spearman tests for assessing correlation.

RESULTS

Patients with EHOA reported significantly higher levels of pain on the VAS and AUSCAN (p<0.01). In EHOA, VAS positively correlated with the HAQ and AUSCAN scales (rho=0.68 and 0.77). In NEHOA, Visual Analogue Scale (VAS) positively and strongly correlated with HAQ and AUSCAN (rho=0.84 and 0.89). Nodes, Kallman score and erosions showed a positive but weak correlation with HAQ and AUSCAN in both groups.

CONCLUSION

Both EHOA and NEHOA participants had functional impairment, but the erosive subtype had higher clinical burden and increased joint damage. This higher clinical burden is attributed mainly to pain.

The High Clinical Burden of Erosive Hand Osteoarthritis is Associated with Clinical Findings, Pain, and Radiographic Severity

Varying reports exist on the clinical impact of erosive hand osteoarthritis (EHOA) in terms of pain and articular function. Few studies have assessed the association of a patient's clinical features with the presence of more severe radiographic disease. The aim was to evaluate clinical and radiographic characteristics in EHOA comparing with non-erosive (NEHOA); to examine pain and functional impairment between EHOA and NEHOA; and correlate functional impairment with clinical findings, pain, and radiographic severity.

METHODS

62 patients with EHOA and 57 with NEHO were included. Pain was assessed through Visual Analogue Scale (VAS) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain. Functioning was evaluated with the Health Assessment Questionnaire (HAQ) concerning hand function and AUSCAN. Radiographs were scored with the Kallman scale and subchondral erosions with the Verbruggen-Veys method. Student t-tests were used for comparing quantitative data, chi-squared tests for categorical variables, and Pearson or Spearman tests for assessing correlation.

RESULTS

Patients with EHOA reported significantly higher levels of pain on the VAS and AUSCAN (p<0.01). In EHOA, VAS positively correlated with the HAQ and AUSCAN scales (rho=0.68 and 0.77). In NEHOA, Visual Analogue Scale (VAS) positively and strongly correlated with HAQ and AUSCAN (rho=0.84 and 0.89). Nodes, Kallman score and erosions showed a positive but weak correlation with HAQ and AUSCAN in both groups.

CONCLUSION

Both EHOA and NEHOA participants had functional impairment, but the erosive subtype had higher clinical burden and increased joint damage. This higher clinical burden is attributed mainly to pain.

[Arthritis: an unusual and anticipatory clinical presentation of pediatric acute lymphoblastic leukemia. A case report]

BACKGROUND

Acute lymphoblastic leukemia initially shows osteoarticular manifestations. However, it is rare that it shows juvenile idiopathic arthritis (JIA) symptoms.

CLINICAL CASE

A child with acute lymphoblastic leukemia initially misdiagnosed with malignant neoplasia and septic arthritis, and later on with juvenile idiopathic arthritis. The child had persistent articular pain and swelling despite treatment. Six months later, a full blood count revealed leukopenia and neutropenia with lymphocytosis. A bone marrow aspirate confirmed pre-B acute lymphoblastic leukemia with hypodyploidia.

CONCLUSION

This case initially showed typical signs of arthritis, and a diagnosis of acute lymphoblastic leukemia was ruled out, since the those clinical features and hematologic alterations characterizing this hematologic neoplasia.

Fibrous hamartoma of infancy. Case report

BACKGROUND

Fibrous hamartoma of infancy (FHI) is an infrequent benign proliferation of the soft tissues. Ninety one percent of cases occur during the first year of life. FHI is characterized as a subcutaneous lesion with characteristic morphology with a triphasic organoid growth pattern.

CLINICAL CASE

We present the case of a 6-month-old male infant with a tumor in the medial plantar region of the left foot, which was completely withered. Histopathological study reported a fibrous hamartoma of infancy.

CONCLUSIONS

Fibrous hamartoma of infancy most frequently affects males. It may be localized at any anatomic site, although 5-10% of cases affect the lower limbs. Few cases are reported in the foot. This is a lesion with a characteristic morphological pattern; however, in small biopsies, its differential diagnosis is important with other fibroadipose lesions for appropriate treatment. Ample surgical resection with lesion-free borders confers a good prognosis for these patients.

[Tendon sheath lipoma associated with quadriceps tendon rupture. Case report]

BACKGROUND

Tendon sheath lipoma is an uncommon tumor characterized morphologically by mature fatty tissue lobes adherent to the tendon or intersecting its fibers. The association with quadriceps tendon rupture is unusual. Etiologic factors that may condition those ruptures have not yet been fully described. However, several authors suggest the existence of a subjacent pathology such as metabolic or inflammatory diseases. Minimal trauma may lead to such ruptures as well as associated ligamentous or bony injuries. The prognosis regarding quadriceps tendon rupture mainly depends on the lap between injury and time of repair.

CLINICAL CASE

We present the case of a quadricipital tendinous rupture produced by the presence of a benign neoplasm, which is a very infrequent association. The patient was surgically treated for quadriceps tendon reconstruction via tendinous reinsertion at the patella. Currently, during rehabilitation, the patient is symptom free with an almost-complete flexion/ extension of his left knee.

CONCLUSIONS

We consider that importance must be given to neoplastic disease as a cause of tendinous rupture, regardless of their infrequency and unusual clinical presentation.