OLGU SUNUMLARI
Her İki Diz Ekleminde Sinoviyal Kondromatozisi Olan Romatoid Artritli Bir Hasta
Bilateral Synovial Chondromatosis of Knee Joint in a Patient with Rheumatoid Arthritis
Received Date : 18 May 2020
Accepted Date : 28 Sep 2020
Available Online : 18 Jan 2021
Hakan ALKANa, Ayşe SARSANa, Necmettin YILDIZa, Harun Reşit GÜNGÖRb
aDepartment of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, TURKEY
bDepartment of Orthopaedics and Traumatology, Pamukkale University Faculty of Medicine, Denizli, TURKEY
Doi: 10.31609/jpmrs.2020-76435 - Makale Dili: EN
J PMR Sci. 2021;24(1):76-80
ÖZET
Sinoviyal kondromatozis (SK), etiyolojisi bilinmeyen nadir görülen
bir hastalıktır ve eklem sinoviyumu veya boşluğunda multipl kıkırdak
nodüllerinin varlığı ile karakterizedir. Bu olgu sunumunda,
romatoid artrite (RA) sekonder Milgram'ın sınıflamasının farklı fazlarında
olan, nadir bir bilateral diz kondromatozisi olgusunu sunmayı
amaçladık. Yirmi beş yıldır RA tanısı olan 47 yaşındaki kadın hasta,
hastanemize sevk edildiğinde 5 yıllık diz ağrısı öyküsü mevcuttu. Her
iki diz ekleminde hassasiyet ile birlikte efüzyon ve hareket kısıtlılığı
vardı. Mukayeseli diz grafilerinde ise değişen boyutlarda, yaygın, multipl,
kalsifiye eklem fareleri, eklem aralığında daralma ve osteoporoz
görüldü. Ayrıca her iki diz manyetik rezonans görüntülemesinde, T1
ağırlıklı serilerde multipl hipointens ve az sayıda hiperintens kalsifiye
lobüler konturlu nodülün eklem boşluğuna dağılmış olduğu gözlendi
ve aynı kesitlerin T2 ağırlıklı serilerinde eşlik eden eklem efüzyonu ile
birlikte periferi hipointens, santrali hiperintens multipl nodüler lezyonlar
saptandı. Tanı, artroskopik biyopsiyi takiben patoloji ile doğrulandı.
SK, inatçı artriti bulunan RA’lı hastaların ayırıcı tanısında dikkate
alınmalıdır.
Anahtar Kelimeler: Romatoid artrit; eklem fareleri; sinoviyal kondromatozis
ABSTRACT
Synovial chondromatosis (SC) is an uncommon disorder
of unknown etiology and is characterized by the presence of multiple
cartilaginous nodules in the joint synovium or cavity. In this case
presentation, we aimed to present a rare case of bilateral knee chondromatosis
with different phases of Milgram’s classification secondary
to rheumatoid arthritis (RA). A 47 years-old female patient,
diagnosed with RA for 25 years, was presented with a history of 5
years knee pain when she was referred to our hospital. She had tenderness
in her both knees with effusion and limited knee range-ofmotion.
Bilateral knee radiographs showed widespread multiple
calcified loose bodies with variable in size, joint space narrowing and
osteoporosis. Moreover on bilateral knee magnetic resonance imaging,
multiple hypointense and few hyperintense calcified nodules distributed
throughout the joint with lobular contours were observed on
T1-weighted images and peripheral hypointense central hyperintense
multiple nodular lesions with an associated effusion were detected in
the same sections of T2-weighted images. The diagnosis was confirmed
by pathology following arthroscopic biopsy. SC should be
considered in the differential diagnosis of patients presenting with a
persistent arthritis in patients with RA.
Keywords: Rheumatoid arthritis; loose bodies; synovial chondromatosis
REFERENCES
- Chalasani P, Koduru S, Mikkineni K. A rare case of multiple rice bodies in glenohumeral joint, subscapular recess and along long head of biceps. J Orthop Case Rep. 2016;6(3):53-5.[Crossref] [PubMed] [PMC]
- Milgram JW. Synovial osteochondromatosis: a histopathological study of thirty cases. J Bone Joint Surg Am. 1977;59(6):792-801.[Crossref] [PubMed]
- O'Connell JX. Pathology of the synovium. Am J Clin Pathol. 2000;114(5):773-84.[Crossref] [PubMed]
- Shearer H, Stern P, Brubacher A, Pringle T. A case report of bilateral synovial chondromatosis of the ankle. Chiropr Osteopat. 2007;15:18.[Crossref] [PubMed] [PMC]
- Ümit Yemişçi O, Ozen S, Kart Köseoğlu H. A rare benign tumor with diagnostic difficulties: synovial chondromatosis. Arch Rheumatol. 2019;35(2):274-7.[Crossref] [PubMed] [PMC]
- Tahmasebi MN, Bashti K, Sobhan M, Ghorbani G. Bilateral synovial knee chondromatosis in a patient with rheumatoid arthritis: case-report and literature review. Arch Bone Jt Surg. 2014;2(4):260-4.[PubMed] [PMC]
- Padhan P, Ahmed S. Synovial chondromatosis. N Engl J Med. 2019;381(14):1364.[Crossref] [PubMed]
- Bhadu D, Das SK, Dhakad U, Sharma M, Srivastava D, Tripathy SR. Synovial chondromatosis involving multiple joints in rheumatoid arthritis: a case report review of the literature. Int J Rheum Dis. 2017;20(12):2148-51.[Crossref] [PubMed]
- Witwity T, Uhlmann R, Nagy MH, Bhasin VB, Bahgat MM, Singh AK. Shoulder rheumatoid arthritis associated with chondromatosis, treated by arthroscopy. Arthroscopy. 1991;7(2):233-6.[Crossref] [PubMed]
- Reverté Vinaixa MM, Singh R, Monyart JM, Llado GD, Dominguez MP, Feliu EC, et al. Wrist synovial chondromatosis: case report and literature review. Hand Surg. 2012;17(2):233-8.[Crossref] [PubMed]
- Ji JH, Shafi M, Jeong DS. Secondary synovial chondromatosis of the shoulder. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2624-7.[Crossref] [PubMed]
- Chiang CH, Jou IM, Wang PH, Chern TC, Huang MT. Synovial osteochondromatosis of the second metatarsophalangeal joint: a case report. J Foot Ankle Surg. 2011;50(4):458-61.[Crossref] [PubMed]
- Rogachefsky RA, Zlatkin MB, Greene TL. Synovial chondromatosis of the distal radioulnar joint: a case report. J Hand Surg Am. 1997;22(6):1093-7.[Crossref] [PubMed]
- Startzman A, Collins D, Carreira D. A systematic literature review of synovial chondromatosis and pigmented villonodular synovitis of the hip. Phys Sportsmed. 2016;44(4):425-31.[Crossref] [PubMed]
- Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics. 2007;27(5):1465-88.[Crossref] [PubMed]
- Yu GV, Zema RL, Johnson RW. Synovial osteochondromatosis. A case report and review of the literature. J Am Podiatr Med Assoc. 2002;92(4):247-54.[Crossref] [PubMed]