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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
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.
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.
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