OLGU SUNUMLARI
Romatoid Artritli Bir Hastanın El Bileğinde Olağan Dışı Yumuşak Doku Kitlesi Görünümü
An Unusual Presentation of Soft Tissue Mass in the Wrist of a Patient with Rheumatoid Arthritis
Received Date : 15 Jul 2024
Accepted Date : 18 Oct 2024
Available Online : 24 Oct 2024
Ayşegül YAMANa, Pınar BORMANb, Ayşe Merve ATAc, Fatma Bilge ERGENd, Sedat KİRAZe
aAnkara Etlik City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey
bAnkara Medipol University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Türkiye
cUniversity of Health Sciences Ankara City Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Türkiye
dHacettepe University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
eHacettepe University Faculty of Medicine, Department of Internal Diseases, Division of Rheumatology, Ankara, Türkiye
Doi: 10.31609/jpmrs.2024-104864 - Makale Dili: EN
Turkiye Klinikleri Journal of Physical Medicine and Rehabilitation Sciences. 2025;28(1):103-7
ÖZET
Romatoid artrit (RA), sinovyumun inflamasyonu ile karakterize,
eklem harabiyeti ve çeşitli eklem dışı bulgulara yol açan kronik bir
otoimmün hastalıktır. Simetrik eklem tutulumu romatoid artritin ayırt
edici özelliği iken yumuşak doku lezyonları sıklıkla eklem dışı belirtiler
olarak ortaya çıkabilir. Bu lezyonlar enfeksiyonlara, tendinopatilere,
ganglion kistlerine, sinovite veya nodüllere bağlı olabilir. RA
hastalarında el bileği eklemi çevresindeki yumuşak doku lezyonlarını
ayırt etmek zor olabilir ve ayırıcı tanının anlaşılması doğru tedavi için
çok önemlidir. Ayrıca bu lezyonlar bir alevlenmenin işareti de olabilir.
Bu olgu sunumunda, yaşlı RA’lı bir hastanın sağ el bileği bölgesinde
bulunan büyük yumuşak doku kitlesini tanımlayarak böyle bir tablonun
ayırıcı tanısını tartıştık.
Anahtar Kelimeler: Yumuşak doku kitlesi; tenosinovit; romatoid artrit; alevlenme
ABSTRACT
Rheumatoid arthritis (RA) is a chronic autoimmune disease
characterized by inflammation of the synovium, leading to joint
destruction and various extraarticular manifestations. Symmetrical joint
involvement is a hallmark of rheumatoid arthritis, whereas soft tissue
lesions may frequently appear as extraarticular manifestations. These
lesions can be due to infections, tendinopathies, ganglion cysts, synovitis,
or nodules. Soft tissue lesions around the wrist joint can be challenging
to differentiate in RA patients, and understanding the
differential diagnosis is pivotal for accurate management. Furthermore,
these lesions could be a sign of a flare-up. In this case report, we describe
a large soft tissue mass found on the right wrist area of an elderly
patient with RA and discuss the differential diagnosis for such a
presentation.
Keywords: Soft tissue mass; tenosynovitis; rheumatoid arthritis; flare-up
REFERENCES
- Grassi W, De Angelis R, Lamanna G, et al. The clinical features of rheumatoid arthritis. Eur J Radiol. 1998;27 Suppl 1:S18-24. [Crossref] [PubMed]
- Studer A, Athwal GS. Rheumatoid arthritis of the elbow. Hand Clin. 2011;27:139-50, v. [Crossref] [PubMed]
- Alamanos Y, Drosos AA. Epidemiology of adult rheumatoid arthritis. Autoimmun Rev. 2005;4:130-6. [Crossref] [PubMed]
- Guo Q, Wang Y, Xu D, et al. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res. 2018;6:15. [Crossref] [PubMed] [PMC]
- Mohammed RHA, Bansal P. Hand and wrist rheumatoid arthritis. [Updated 2022 Jan 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. [Link]
- Khaled W, Drapé JL. MRI of wrist and hand masses. Diagn Interv Imaging. 2015;96:1238-46. [Crossref] [PubMed]
- Ornetti P, Guillier D, Jeudy G. Perforating rheumatoid nodule mimicking malignant soft-tissue mass of the forearm. J Rheumatol. 2021;48:1103. [Crossref] [PubMed]
- Kim JO, Lee YS, Park S. Soft tissue pseudotumors of the hand and wrist mimicking malignancy: two case reports. Medicine (Baltimore). 2023;102:e34236. [Crossref] [PubMed] [PMC]
- Gregush RE, Habusta SF. Ganglion cyst. [Updated 2021 Jul 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. [Link]
- Chua-Aguilera CJ, Möller B, Yawalkar N. Skin manifestations of rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritides. Clin Rev Allergy Immunol. 2017;53:371-93. [Crossref] [PubMed]
- Collaris EJ, van Marion AM, Frank J, et al. Cutaneous granulomas in rheumatoid arthritis. Int J Dermatol. 2007;46 Suppl 3:33-5. [Crossref] [PubMed]
- Terziroli Beretta-Piccoli B, Mainetti C, Peeters MA, et al. Cutaneous granulomatosis: a comprehensive review. Clin Rev Allergy Immunol. 2018;54:131-46. [Crossref] [PubMed]
- Jebakumar AJ, Udayakumar PD, Crowson CS, et al. Occurrence of gout in rheumatoid arthritis: it does happen! A population-based study. Int J Clin Rheumtol. 2013;8:433-7. [Crossref] [PubMed] [PMC]
- Kiefer D, Erkenberg J, Braun J. Similarities and differences between gouty arthritis and rheumatoid arthritis-an interesting case with a short look into the literature. Explor Musculoskeletal Dis. 2023;1:11-9. [Crossref]
- Merdler-Rabinowicz R, Tiosano S, Comaneshter D, et al. Comorbidity of gout and rheumatoid arthritis in a large population database. Clin Rheumatol. 2017;36:657-60. [Crossref] [PubMed]
- Chiou A, England BR, Sayles H, et al. Coexistent hyperuricemia and gout in rheumatoid arthritis: associations with comorbidities, disease activity, and mortality. Arthritis Care Res (Hoboken). 2020;72:950-8. [Crossref] [PubMed] [PMC]
- Petsch C, Araujo EG, Englbrecht M, et al. Prevalence of monosodium urate deposits in a population of rheumatoid arthritis patients with hyperuricemia. Semin Arthritis Rheum. 2016;45:663-8. [Crossref] [PubMed]
- Olaru L, Soong L, Dhillon S, et al. Coexistent rheumatoid arthritis and gout: a case series and review of the literature. Clin Rheumatol. 2017;36:2835-8. [Crossref] [PubMed]
- Hao H, Kong W, Li H. Carpal tunnel syndrome caused by tophi in the superficial flexor tendon: a case report. Front Surg. 2023;10:1282202. [Crossref] [PubMed] [PMC]
- Lu H, Chen Q, Shen H. A repeated carpal tunnel syndrome due to tophaceous gout in flexor tendon: a case report. Medicine (Baltimore). 2017;96:e6245. [Crossref] [PubMed] [PMC]
- Luo PB, Zhang CQ. Chronic carpal tunnel syndrome caused by covert tophaceous gout: a case report. World J Clin Cases. 2018;6:279-83. [Crossref] [PubMed] [PMC]
- Wakefield RJ, O'Connor PJ, Conaghan PG, et al. Finger tendon disease in untreated early rheumatoid arthritis: a comparison of ultrasound and magnetic resonance imaging. Arthritis Rheum. 2007;57:1158-64. [Crossref] [PubMed]
- Rowbotham EL, Freeston JE, Emery P, et al. The prevalence of tenosynovitis of the interosseous tendons of the hand in patients with rheumatoid arthritis. Eur Radiol. 2016;26:444-50. [Crossref] [PubMed]
- Rubin DA. MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I. Imaging findings. Skeletal Radiol. 2019;48:677-95. [Crossref] [PubMed]
- Niemantsverdriet E, van der Helm-van Mil AHM. Imaging detected tenosynovitis of metacarpophalangeal and wrist joints: an increasingly recognised characteristic of rheumatoid arthritis. Clin Exp Rheumatol. 2018;36 Suppl 114:131-8. [PubMed]
- Mangnus L, van Steenbergen HW, Reijnierse M, et al. Magnetic resonance imaging-detected features of inflammation and erosions in symptom-free persons from the general population. Arthritis Rheumatol. 2016;68:2593-602. [Crossref] [PubMed]
- van Steenbergen HW, Mangnus L, Reijnierse M, et al. Clinical factors, anticitrullinated peptide antibodies and MRI-detected subclinical inflammation in relation to progression from clinically suspect arthralgia to arthritis. Ann Rheum Dis. 2016;75:1824-30. [Crossref] [PubMed]
- Lisbona MP, Maymó J, Perich J, et al. Rapid reduction in tenosynovitis of the wrist and fingers evaluated by MRI in patients with rheumatoid arthritis after treatment with etanercept. Ann Rheum Dis. 2010;69:1117-22. [Crossref] [PubMed]
- Danielsen MA. Ultrasonography for diagnosis, monitoring and treatment of tenosynovitis in patients with rheumatoid arthritis. Dan Med J. 2018;65:B5474. [PubMed]
- Filippou G, Sakellariou G, Scirè CA, et al. The predictive role of ultrasound-detected tenosynovitis and joint synovitis for flare in patients with rheumatoid arthritis in stable remission. Results of an Italian multicentre study of the Italian Society for Rheumatology Group for Ultrasound: the STARTER study. Ann Rheum Dis. 2018;77:1283-9. [PubMed]