Hypertrophied Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an inflammatory disease of the synovium which results in erosion, deformity and finally the destruction of joints. Inflammation of the joints is associated with a villous hypertrophy of the synovial membrane, which on microscopy shows proliferation of the lining layer with an inflammatory infiltrate. There is extensive expression of HLA-... 

In rheumatoid arthritis, chronic synovitis leads to hypertrophy and hyperplasia of the synovium (pannus), progressive thinning of the articular cartilage and exposure of the subchondral bone. In early disease, when the cartilage still retains a certain thickness, the pannus typically causes marginal bone erosions, located at the periphery of the joint. 

Fig. 12.58a,b. Intra-articular synovial hypertrophy in a patient with rheumatoid arthritis. a,b Transverse oblique 12-5 MHz US images over the anterior femoral neck reveal distension of the anterior recess by hypoechoic fluid (asterisks) and echogenic pannus (curved arrow) leading to bulging of the capsular plane (straight arrows). Observe the anterior (straight arrows) and posterior (arrowheads) capsule. FH, femoral head... 

Brock JG, Meredith HC (1979) Case report 102. Osteomyelitis of hallux sesamoid. Skeletal Radiol 4 236-239 Brook A, Corbet M (1977) Radiographic changes in early rheumatoid arthritis. Ann Rheum Dis 36 71-73 Bruce WD, Christofersen MR, Phillips DL (1999) Stenosing tenosynovitis and impingement of the peroneal tendons associated with hypertrophy of the peroneal tubercle. Foot Ankle Int 20 464-467... 

Similar to the situation in adult rheumatoid arthritis, US has proved to be more sensitive than radiography or clinical examination in the detection of joint effusion and synovial hypertrophy in these patients (Sureda et al. 1994 Lamer and Sebag 2000 El-Miedany et al. 2001). In the knee of children with monoarticular or paudarticular juvenile idiopathic arthritis, quantitative assessment of... 

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