allopurinol and Synovitis

Monoarticular arthritis is inflammation characterized by joint pain, swelling, and sometimes periarticular erythema. Although chronic causes are seen, the onset is often acute. An infected joint can quickly lead to permanent damage, making it a medical emergency. However, acute gout presenting as monoarticular arthritis is often so uncomfortable it requires urgent attention. Monoarticular crystalline arthritis is common and a septic joint is a medical emergency so it is no surprise that these diagnoses come to mind with complaint of inflammation in 1 joint. However, there are many causes of monoarticular arthritis that clinicians must consider.

Topics: Adrenal Cortex Hormones; Arthritis; Arthritis, Infectious; Arthrocentesis; Chondrocalcinosis; Diagnosis, Differential; Gout; Injections, Intra-Articular; Synovitis; Uricosuric Agents; Xanthine Oxidase

Topics: Alkylating Agents; Allopurinol; Analgesics; Anti-Inflammatory Agents; Antimalarials; Antimetabolites; Arthritis, Rheumatoid; Arthroplasty; Aspirin; Gold; Gout; Humans; Immunosuppressive Agents; Indomethacin; Phenacetin; Polymyalgia Rheumatica; Prednisolone; Prednisone; Rheumatic Fever; Synovitis

We report a case of acute gouty synovitis after total knee arthroplasty (TKA) in a patient with no history of gout. The diagnosis was confirmed by the presence of urate crystals in the synovial fluid. Acute gouty synovitis, though rare, should be considered in the differential diagnosis of an inflammed knee after TKA to avoid unnecessary surgical revision.

Topics: Acute Disease; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthroplasty, Replacement, Knee; Diagnosis, Differential; Female; Gout; Gout Suppressants; Humans; Middle Aged; Synovitis

We describe a patient with a 2-month history of right shoulder monoarthritis and fever as the presenting symptoms of a subsequent diagnosis of chronic myeloid leukemia in blast crisis. Imaging studies showed changes consistent with leukemic infiltration of the soft tissues around the right shoulder joint and the proximal humerus. Immunophenotypic and morphologic analysis of the large number of cells obtained from the synovial fluid confirmed the shoulder synovitis to be an extramedullary manifestation of myelomonocytic blast crisis of chronic myeloid leukemia. The patient was not a candidate for aggressive chemotherapy treatment because of her poor overall condition, and she had no compatible donor for allogenic bone marrow transplantation. Her painful arthropathy was refractory to standard pain management but she achieved excellent pain relief with palliative radiation therapy. We conclude that the involvement of extramedullary sites by chronic myeloid leukemia blast cells can predate hematological blast crisis in some of chronic myeloid leukemia cases. Also, painful leukemic synovitis can be managed by low dose radiotherapy in a candidate who is refractory to chemotherapy and other medical therapy.

Topics: Adult; Allopurinol; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Blast Crisis; Combined Modality Therapy; Diagnosis, Differential; Female; Humans; Hydroxyurea; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Synovitis

Granulomatous inflammation in a tissue specimen raises concern about infection with Mycobacterium tuberculosis, atypical mycobacteria, certain fungi, Brucella species, and other infectious agents. Inflammatory disorders, such as sarcoidosis, crystal-associated arthritis, or foreign body reactions also are considered when granulomatous changes are seen on histological examination of a tissue specimen. We describe two cases of granulomatous tenosynovitis due to tophaceous deposits in patients with gout. In one case, tuberculous synovitis was considered the primary diagnosis until the diagnosis of gout was confirmed by examination of a tissue specimen with polarized light. In the second case, gout and tuberculosis were found in the patient's wrist joint. After antituberculous therapy was discontinued, he continued to have wrist synovitis and chronic drainage due to granulomatous tophaceous gout. The findings in this report suggest that gouty tenosynovitis can mimic tuberculous tenosynovitis and that gout should be considered in the differential diagnosis of granulomatous tenosynovitis, especially when acid-fast stains and cultures are negative for mycobacteria.

Topics: Adult; Allopurinol; Antitubercular Agents; Diagnosis, Differential; Finger Joint; Gout; Gout Suppressants; Granuloma; Humans; Male; Middle Aged; Synovitis; Tendons; Tenosynovitis; Tuberculosis, Osteoarticular; Wrist Joint

The presence of the xanthine oxidase enzyme system has been demonstrated in the rheumatoid synovium. This supplies a reactive oxygen species generating system to synovium that is subjected to hypoxic-reperfusion cycles (cf inflamed rheumatoid synovium). An antibody to bovine milk xanthine oxidase has been used to localise the enzyme by immunohistochemistry to synovial endothelium. This implicates the endothelial cell as playing a major part in exacerbations of synovitis, induced by radicals.

Topics: Antigens; Endothelium; Enzyme-Linked Immunosorbent Assay; Humans; Immunohistochemistry; Synovial Membrane; Synovitis; Xanthine Oxidase

In an attempt to define why the joint synovial cavity is prone to develop persistent synovial inflammation we show that hypoxia is induced by pressure changes caused by exercise in the presence of an inflammatory effusion. On resting 'reperfusion injury' may take place. The biochemistry of reperfusion injury has only recently been defined and perhaps surprisingly for an insult that has hypoxia as its central ingredient involves the subsequent production of oxygen derived free radical species. We apply the reaction sequences that are believed to occur during hypoxic/reperfusion injury to the joint synovial cavity and, on the basis of reported 'in vivo' observations, suggest novel therapeutic approaches that we believe are applicable to the treatment of persistent synovial inflammation.

Topics: Animals; Cats; Chronic Disease; Free Radicals; Humans; Hypoxia; Ischemia; Knee Joint; Oxygen; Partial Pressure; Perfusion; Physical Exertion; Rats; Synovitis; Xanthine Oxidase; Xanthines

Interleukin-1 (Il-1)-like activity in biological fluids was measured by their ability to rectify the Il-1-dependent lymphokine production of highly purified T lymphocytes to a recall antigen. Il-1-like activity was found in 9 of 11 synovial fluid (SF) specimens from patients with rheumatoid arthritis (RA) but only in 2 of 11 paired RA sera. In traumatic synovitis, low Il-1-like activity was recorded in 5 of 9 SF specimens, and a similar low activity was found in sera of 4 of these patients. The Il-1-like activity was partly absorbed by an anti-Il-1 antibody. The presence of Il-1 in the SF of patients with RA suggests in vivo activation of monocytes/macrophages.

Topics: Adsorption; Adult; Aged; Allopurinol; Arthritis, Rheumatoid; Female; Humans; Interleukin-1; Lipoproteins, HDL; Macrophages; Male; Middle Aged; Monocytes; Synovial Fluid; Synovitis; Wounds and Injuries