Katsumi Ito

New-onset demyelination induced by infliximab therapy in two rheumatoid arthritis patients.

Therapies aimed at inhibiting tumor necrosis factor, a proinflammatory cytokine implicated in autoimmune disease, are effective for rheumatoid arthritis (RA) and Crohn’s disease. We report two patients who newly developed multiple demyelinating lesions in the central nervous system in the course of infliximab therapy for active RA. Neurological symptoms and the number of gadolinium-diethylenetriamine pentaacetic acid-enhanced lesions in magnetic resonance imaging gradually diminished with steroid treatment.

Blockade of Interleukin 6 Signaling Induces Marked Neutropenia in Patients with Rheumatoid Arthritis

Therapies aimed at inhibiting interleukin 6 (IL-6), a pleiotropic cytokine implicated in the immune response, inflammation, hematopoiesis, and bone metabolism, are effective for rheumatoid arthritis (RA)1,2. We have found that a humanized anti-IL-6 receptor antibody (tocilizumab; Chugai, Japan) induced prompt and potent suppression of neutrophil recruitment into peripheral blood in patients with RA. One day after tocilizumab (8 mg/kg) was first administered to patients with active RA, the number of neutrophils in peripheral blood decreased significantly (Figure 1 … Address reprint requests to Dr. Nakamura; E-mail: ichiclast{at}yugawara-hosp.com

Radiologic Patterning of Joint Damage to the Foot in Rheumatoid Arthritis

Foot and ankle deformities greatly affect the quality of life of rheumatoid arthritis (RA) patients. The aim of this study was to elucidate the pattern of destruction of the RA foot and its impact on patients.

Spontaneous Bilateral Femoral Neck Fractures Associated With a Low Serum Level of Vitamin D in a Young Adult

Bilateral femoral neck fracture is an extremely rare injury in young adults. We report a young adult with bilateral femoral neck fracture after minimal stress. The current case did not demonstrate any abnormality on laboratory data, except for a low serum level of vitamin D(3). Although, in our case, the patient underwent bilateral femoral head arthroplasty, early diagnosis could have been helpful to avoid further displacement of the fracture and surgical treatment.

Distal Interphalangeal Joint Arthrodesis With the Reverse Fix Nail

PURPOSE Arthrodesis of distal interphalangeal (DIP) and thumb interphalangeal (IP) joints is a well-established procedure for the treatment of pain, deformity, and instability associated with arthritis and traumatic conditions. Fixation with various headless compression screws has become increasingly common and with favorable outcomes. However, there are still characteristic complications, such as hardware prominence with the distal end of the screw incompletely buried in the distal phalanx. The purpose of this study was to review the outcomes and complications associated with the arthrodesis of DIP and thumb IP joints using the Reverse Fix Nail (Tact Medical, Inc., Tokyo, Japan), a headless compression screw designed for DIP and thumb IP joint arthrodesis. METHODS We retrospectively reviewed 89 cases involving 60 patients, in which arthrodesis with the Reverse Fix Nail was performed for DIP and thumb IP joints. We referenced medical charts, radiographs, and operative records to investigate the complications and postoperative periods to bone union. RESULTS Of the 89 consecutive cases, 86 (97%) achieved bone union. Complications included 1 case of prominent hardware and 3 cases of nonunion (1 was asymptomatic and the other 2 were symptomatic, requiring secondary surgery). CONCLUSIONS The Reverse Fix Nail is a favorable implant for DIP joint or thumb IP joint arthrodesis with a comparable bone union rate and lower risk of hardware prominence than other implants.

Correlation between knee and hindfoot alignment in patients with rheumatoid arthritis: The effects of subtalar joint destruction

Abstract Objectives. Compensatory hindfoot alignment for deformities at the knee level has been demonstrated in patients with knee osteoarthritis. However, this phenomenon has not been elucidated in patients with rheumatoid arthritis (RA). The aim of this study is to investigate the relationship between knee deformity and hindfoot alignment and the effect of subtalar joint destruction in patients with RA. Methods. We retrospectively investigated RA patients (110 patients, 205 limbs) using radiographs in the standing anteroposterior knee, standing lateral foot, and hindfoot alignment views. The grade of destruction at the knee and subtalar joints was assigned using Larsens grading system. The correlation between the femorotibial and tibiocalcaneal angles and the effect of joint destruction on this correlation were analyzed using Pearsons correlation coefficients. Results. There was moderate correlation between the femorotibial and tibiocalcaneal angles in a group of knees with a Larsen grade of ≥ 4 (r = 0.544, p = 0.0239). This correlation was stronger in a group with less damaged subtalar joints with a Larsen grade of ≤ 3 (r = 0.705, p = 0.0049). Conclusion. These findings emphasized the importance of examining foot and ankles in patients with RA who undergo total knee arthroplasty.

Radiologic Patterning of Hallux Deformity in Rheumatoid Arthritis and Its Relationship to Flatfoot

Hallux deformities other than hallux valgus, especially those in the sagittal plane, have not yet been elucidated in the feet of patients with rheumatoid arthritis. The objectives of the present study were to classify rheumatoid arthritis hallux deformity in both the horizontal and the sagittal planes and investigate its relationship with flatfoot. Using a cross-sectional study design, we assessed patients with rheumatoid arthritis (527 feet in 274 patients) using radiographs and classified the deformity patterns of the great toes using cluster analysis. Of the 274 patients, the range of motion in the metatarsophalangeal joint was clinically investigated in 44 (16.1%) patients. The great toes could be divided into 5 clusters according to the characteristic configuration as follows: cluster I (normal type), cluster II (hallux valgus type), cluster III (boutonniere type), cluster IV (boutonniere with hallux valgus type), and cluster V (swan-neck type). Radiographic measurements revealed the characteristic deformities of each cluster, including splayed foot for cluster II; flat foot, metatarsal primus elevatus, and plantar displacement of the proximal phalanx for cluster III; and a mixture of these characteristics for cluster IV. Plantar displacement of the proximal phalanx, which was a specific characteristic of the boutonniere deformity, correlated significantly with the decreased dorsiflexion in the metatarsophalangeal joint. Our classification method revealed the relationship of hallux deformity in the sagittal plane to flatfoot and also demonstrated the usefulness of measuring basal phalanx displacement in predicting the range of motion of the metatarsophalangeal joint.

Lateral collapse of the tarsal navicular in patients with rheumatoid arthritis: Implications for pes planovarus deformity

Abstract Objectives: In patients with rheumatoid arthritis (RA), the talonavicular joint is commonly involved and midfoot collapse can lead to progressive flattening of the arch. Despite a general awareness of the important structural role of the talonavicular joint in rheumatoid foot disease, details of its destructive pattern have not been elucidated. Methods: We cross-sectionally investigated 176 RA patients (342 feet) and classified their feet into the following five groups according to radiographic findings: arthritis (RA changes with normal navicular shape), Müller–Weiss Disease (MWD) (collapse of the lateral aspect of the tarsal navicular), flat (flattened navicular), ankylosis (ankylosis of the talonavicular joint), and normal. We compared medical histories and radiographic measurements among all five groups. Results: The arthritis group comprised 91 feet, 36 in the MWD group, nine in the flat group, 12 in the ankylosis group, and 194 classified as normal. The MWD group demonstrated a trend towards pes planovarus deformity in contrast to pes planovalgus deformity in the arthritis group. Corticosteroid use and the mean daily dosage were the highest in the MWD group. Conclusions: This report revealed a high prevalence of MWD-like changes to the navicular in RA patients and its association with pes planovarus deformity and corticosteroid usage.

Wrist Arthrodesis in Rheumatoid Arthritis Using an LCP Metaphyseal Locking Plate versus an AO Wrist Fusion Plate

Objectives Although wrist arthrodesis using a plate is an established treatment with a well-documented successful union rate for severely destroyed wrists, plate-related complications are a matter of great concern. Methods We retrospectively compared wrist arthrodesis using an AO wrist fusion plate in nine and a locking compression plate (LCP) metaphyseal plate in seven cases of rheumatoid arthritis. Results The mean follow-up was 40.6 months in the AO wrist fusion plate group and 57.2 months in the LCP metaphyseal plate group. Bone union at the arthrodesis site was achieved in all cases in both groups. Comparison of the original position of the fusion on the immediate postoperative radiographs and the position on the most recent follow-up radiographs demonstrated good stability in both groups. Plate-related complications occurred in four cases in the AO wrist fusion plate group and no cases in the LCP metaphyseal plate group. Complications included pain over the plate, wound dehiscence and infection, extensor tendon adhesion, and fracture in one case each. Conclusion Wrist arthrodesis using an LCP metaphyseal plate was favorable for rheumatoid arthritis patients with comparable stability to that of and a lower risk of plate-related complications than an AO wrist fusion plate.

Pseudotumour occurring after a metal-on-metal total hip arthroplasty that was diagnosed based on venous congestion in unilateral leg: a case report

Abstract Pseudotumours, caused by an adverse reaction to metal debris (ARMD), are cystic or solid lesions that develop after metal-on-metal total hip arthroplasty (THA). They often lead to rapid osteolysis and muscle necrosis. To prevent consequent loosening of implants, early diagnosis is important. We report a rare case in which venous congestion in unilateral leg enabled the early diagnosis of ARMD. Three years and ten months after undergoing metal-on-metal THA for osteoarthritis, an 83-year-old woman experienced oedema in her lower extremity. Contrast-enhanced computed tomography and magnetic resonance imaging revealed a mass with fluid component that originated from the artificial hip joint and was compressing the external iliac vein. We performed resection of the mass and revision of the THA. The pathological findings from the resected mass revealed necrotic tissue and infiltrating inflammation cells, which is compatible with the diagnosis of ARMD. There was little solid component found inside the mass, and there was no loosening of prosthesis. The patient’s venous congestion improved immediately following the resection. When unilateral leg oedema or venous congestion are observed in cases with a history of metal-on-metal THA, the possibility of ARMD-induced pseudotumour should be taken into consideration.