Proximal Rheumatoid Arthritis

Lymphadenopathy may occur in patients with rheumatoid arthritis, particularly in nodes proximal to more actively involved joints. Renal involvement is rare but can be associated with treatment, including nonsteroidal anti-inflammatory drugs (NSAIDs), gold salts, and penicillamine. Amyloidosis is a rare complication of long-standing rheumatoid arthritis. It appears to be more common in Europe than in the United States. 

The protein p56 lymphoid T-cell tyrosine kinase (Lck) is predominantly expressed in T lymphocytes where it plays a critical role in T-cell-mediated immune response. Lck participates in phosphotyrosine-dependent protein-protein interactions through its modular binding unit, the Src homology-2 (SH2) domain. SH2 domains are noncatalytic modules of about 100 amino acid residues that play important roles in intracellular signal transduction and represent potential targets for pharmacological intervention. Failure of the p5 6 Lck S H 2 domain to bind to immunoreceptor tyrosine-based activation motifs (ITAMs) of CD3 hampers the T-cell receptor (TCR) proximal activation process and suppresses the downstream T-cell activation signaling cascades [143]. Small compounds that would be able to block Lck SH2 domain-dependent protein-protein interactions could find therapeutic utility as immunosuppressants and in the treatment of T-cell leukemias, lymphomas, and autoimmune diseases such as rheumatoid arthritis. 

Elbow is one of the most complex articular anatomy of human joint. Distal humerus, Proximal radius, and Proximal ulna are three elbow joint bones which are connected by tendons, ligaments and muscles [1]. Most famous disease that can affect normal elbow s function is rheumatoid arthritis that weaken the function status of patient. Total elbow arthroplasty can be the best decision for those patients that has advance elbow dysfunction, regarding to relive the pain and restore the normal physiological function [2]. Like all other joint replacement some complication such as instability, loosening, dislocation, polyethylene wear and infection, has restricted the long term survivorship of Total elbow arthroplasty [3]. 

Fig. 8.54a,b. Subolecranon bursitis nodule in a patient with severe rheumatoid arthritis, a Transverse 12-5 MHz US image reveals a painless heterogeneous soft-tissue mass (arrows) with mixed echotexture located in the subcutaneous tissue over the proximal posterior ulna, compatible with subolecranon bursitis, b Photograph of the same case shown in a... 

Fig. 11.57a-c. Rheumatoid arthritis, a Longitudinal and transverse (see insert) 12-5 MHz US images over the dorsal aspect of the metacarpophalangeal joint of the index finger reveal bony erosions (arrows) over the surface of the metacarpal head (Met) associated with distension of the dorsal recess of the joint by synovial pannus (asterisks), b Contralateral normal finger. Comparing a and b observe the different appearance of erosions compared with the normal focal notch (arrowhead) located on the dorsal aspect of the metacarpal. PP, proximal phalanx, c Radiographic correlation confirms erosions (arrow) at the level of the metacarpal head... 

Fig. 14.94a,b. Baker cyst anomalous caudal extension. Patient with longstanding rheumatoid arthritis, a Longitudinal 12-5 MHz US image over the proximal medial leg with b schematic drawing correlation reveals a large base of the cyst (asterisk) extending distally between the medial head of the gastrocnemius (MHG) and the deep soleus muscle (S)... 

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