The diagnostic dilemma of undifferentiated inflammatory synovitis of the knee joint/joints: a comprehensive approach

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Abstract:

Abstract Objective: 

The objective of this pilot study was to describe clinical features, laboratory investigations and enhanced MRI features in patients presenting with undifferentiated inflammatory synovitis of the knee. Patient and methods: 

Fifteen patients with undifferentiated inflammatory synovitis of the knee joint were recruited for this study. All patients underwent full history-taking, detailed rheumatological examination, synovial fluid analysis including polarized microscopy, rheumatoid factor (RF), anti-nuclear antibody (ANA), anti-cyclic citrullinated peptide (CCP), C-reactive protein, and erythrocyte sedimentation rate. MRI/gadolinium-enhanced MRI was done for all patients with unilateral presentation and for the most symptomatic knee in cases of bilateral knee involvement. Results: 

Enhanced MRI showed the following findings: synovial enhancement and effusion 15/15, pannus formation 13/15, bone marrow edema 3/15, bone erosions 2/15, cartilaginous erosions 1/15, synovial cysts 2/15, Baker's cyst 2/15, periarticular soft tissue edema 3/15, and lipoma arborescencs 2/15. Conclusions: 

Undifferentiated synovitis of the knee is not necessarily a benign condition. It represents a diagnostic dilemma in rheumatological practice that deserves early identification and early treatment in order to prevent inevitable and irreversible articular damage if left untreated. The ability of MRI to detect early changes like bone marrow edema and bony and cartilaginous erosions (usually not obvious on plain X-rays) makes this a highly sensitive tool for evaluation of patients presenting with undifferentiated synovitis affecting the knee joint. When combined with gadolinium, it allows accurate assessment of the degree of synovial thickening (pannus) and picks up local intra-articular lesions especially in patients with unilateral disease.

Keywords: anti CCP2; gadolinium enhanced MRI; undifferentiated inflammatory synovitis of the knee joint/joints

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1479-8077.2007.00287.x

Affiliations: 1: Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University and Rheumatology and Rehabilitation Department, Dr Erfan and Bagedo General Hospital Jeddah, KSA, 2: Radiology Department, Faculty of Medicine, Cairo University and Radiology Department, Dr Erfan and Bagedo General Hospital Jeddah, KSA, 3: Opthalomolgy Department Faculty of Medicine, Cairo University

Publication date: September 1, 2007

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