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Unusual case of lipoma arborescens in the subacromial-subdeltoid bursa

Lim MC, See PL, Wang SY, Wee AT, Tee UL

Med J Malaysia, 2018 12;73(6):400-402.
PMID: 30647212

A 38-year-old female presented with a 10-month history of right shoulder pain with impingement symptoms. She was diagnosed on magnetic resonance (MR) imaging to have supraspinatus tendon tear and degenerative changes contributing to subacromial impingement. She also had lipoma arborescens of the subacromial-subdeltoid bursa, an uncommon condition in a particularly rare location. Lipoma arborescens is a benign intra-articular condition characterized by lipomatous proliferation of synovium with replacement of subsynovial tissue by mature adipocytes. It is typically a monoarticular process affecting the knee. Due to the presence of pathognomonic fat, diagnosis is usually straightforward with MR as the preferred imaging modality.

Matched MeSH terms: Joint Diseases/diagnosis*; Joint Diseases/pathology; Joint Diseases/surgery
Hyaluronic acid, an efficient biomacromolecule for treatment of inflammatory skin and joint diseases: A review of recent developments and critical appraisal of preclinical and clinical investigations

Chen LH, Xue JF, Zheng ZY, Shuhaidi M, Thu HE, Hussain Z

Int J Biol Macromol, 2018 Sep;116:572-584.
PMID: 29772338 DOI: 10.1016/j.ijbiomac.2018.05.068

Hyaluronic acid (HA) plays multifaceted role in regulating various biological processes and maintaining homeostasis into the body. Numerous researches evidenced the biomedical implications of HA in skin repairmen, cancer prognosis, wound healing, tissue regeneration, anti-inflammatory, immunomodulation. The present review was aimed to summarize and critically appraise the recent developments and efficacy of HA for treatment of inflammatory skin and joint diseases. A thorough analysis of the literature revealed that HA based formulations (i.e., gels, creams, autologous graft, thin sheets, soaked gauze, gauze pad, tincture, injection) have shown remarkable efficacy in treating a wide range of inflammatory skin diseases. The safety, tolerability, and efficacy of HA (as intra-articular injection) have also been well-documented for treatment of various types of joint disease including knee osteoarthritic, joint osteoarthritis, canine osteoarthritis, and meniscal swelling. Intra-articular injection of HA produces remarkable reduction in joint pain, synovial inflammation, and articular swelling. A remarkable improvement in chondrocyte density, territorial matrix appearance, reconstitution of superficial amorphous layer of the cartilage, collagen remodelling, and regeneration of meniscus have also been evident in patients treated with HA. Conclusively, we validate that the application/administration of HA is a promising pharmacotherapeutic regimen for treatment of inflammatory skin and joint diseases.

Matched MeSH terms: Joint Diseases/drug therapy*; Joint Diseases/metabolism; Joint Diseases/pathology
The unusual traumatic locked young knee

Mohd Miswan MF, Latiff Alsagoff S, Muhamad Effendi F, Ibrahim MI

Malays Fam Physician, 2019;14(2):26-28.
PMID: 31827732

Locked knee is an orthopaedic condition requiring urgent treatment. Although the condition can be diagnosed via history, physical examination and imaging studies, the cause of the mechanical obstruction may only be apparent during arthroscopic examination of the knee joint. It is known that imaging plays a role in evaluating the integrity of intra-articular structures, however in some atypical cases, imaging cannot identify the definitive cause of locked knee. Here we report on two cases of locked knee, due to uncommon conditions which were unobservable via normal imaging studies.

Matched MeSH terms: Joint Diseases
The early development of medial coronoid disease in growing Labrador retrievers: radiographic, computed tomographic, necropsy and micro-computed tomographic findings

Lau SF, Wolschrijn CF, Hazewinkel HA, Siebelt M, Voorhout G

Vet J, 2013 Sep;197(3):724-30.
PMID: 23702281 DOI: 10.1016/j.tvjl.2013.04.002

Medial coronoid disease (MCD) encompasses lesions of the entire medial coronoid process (MCP), both of the articular cartilage and the subchondral bone. To detect the earliest signs of MCD, radiography and computed tomography were used to monitor the development of MCD in 14 Labrador retrievers, from 6 to 7 weeks of age until euthanasia. The definitive diagnosis of MCD was based on necropsy and micro-computed tomography findings. The frequency of MCD in the dogs studied was 50%. Radiographic findings did not provide evidence of MCD, ulnar subtrochlear sclerosis or blunting of the cranial edge of the MCP. Computed tomography was more sensitive (30.8%) than radiography (0%) in detecting early MCD, with the earliest signs detectable at 14 weeks of age. A combination of the necropsy and micro-computed tomography findings of the MCP showed that MCD was manifested as a lesion of only the subchondral bone in dogs <18 weeks of age. In all dogs (affected and unaffected), there was close contact between the base of the MCP and the proximal radial head in the congruent joints. Computed tomography and micro-computed tomography findings indicated that the lesions of MCD probably originated at the base of the MCP.

Matched MeSH terms: Joint Diseases/pathology; Joint Diseases/radiography; Joint Diseases/veterinary*
Fulltext Proximal third femoral shaft fractures in children: prevention of angular deformities using bilateral Thomas splints

Kamal MH, Razak M, Ibrahim S, Lim A

Med J Malaysia, 2000 Sep;55 Suppl C:68-73.
PMID: 11200047

This is a prospective study to look at the outcome of unilateral proximal third femoral shaft fractures in children treated with a bilateral Thomas splint in the Department of Orthopaedic Surgery Universiti Kebangsaan Malaysia between the period of January 1996 and June 1998. Eighteen children aged between 2 years and 12 years old with unilateral proximal third fractures of the femoral shaft were treated using a bilateral Thomas splint. Angular deformities were measured using a goniometer metric scale before and after Thomas splints. The percentage of varus tilt corrected ranged from 17% to 72% with an average correction of 29% from the initial deformity and the difference was statistically significant (p < 0.05). The percentage of posterior tilt corrected ranged from 19% to 60% with the average correction of 20% from the initial deformity. The difference was statistically significant (p < 0.05). From this study, we conclude that bilateral Thomas splints can give a better correction of angular deformity for proximal third femoral shaft fractures in children below twelve years of age.

Matched MeSH terms: Joint Diseases/prevention & control
Brufen in conditions allied to, but excluding rheumatoid arthritis and osteoarthrosis--open study

Subramaniam N

Med J Malaysia, 1976 Jun;30(4):323-7.
PMID: 979739
Matched MeSH terms: Joint Diseases/drug therapy*
Assessment of articular cartilage and subchondral bone using EPIC-microCT in Labrador retrievers with incipient medial coronoid disease

Lau SF, Wolschrijn CF, Siebelt M, Vernooij JC, Voorhout G, Hazewinkel HA

Vet J, 2013 Oct;198(1):116-21.
PMID: 23846028 DOI: 10.1016/j.tvjl.2013.05.038

The aetiopathogenesis of medial coronoid disease (MCD) remains obscure, despite its high prevalence. The role of changes to subchondral bone or articular cartilage is much debated. Although there is evidence of micro-damage to subchondral bone, it is not known whether this is a cause or a consequence of MCD, nor is it known whether articular cartilage is modified in the early stages of the disease. The aim of the present study was to use equilibrium partitioning of an ionic contrast agent with micro-computed tomography (microCT) to investigate changes to both the articular cartilage and the subchondral bone of the medial coronoid processes (MCP) of growing Labrador retrievers at an early stage of the disease and at different bodyweights. Of 14 purpose-bred Labrador retrievers (15-27 weeks), six were diagnosed with bilateral MCD and one was diagnosed with unilateral MCD on the basis of microCT studies. The mean X-ray attenuation of articular cartilage was significantly higher in dogs with MCD than in dogs without MCD (P<0.01). In all dogs, the mean X-ray attenuation of articular cartilage was significantly higher at the lateral (P<0.001) than at the proximal aspect of the MCP, indicating decreased glycosaminoglycan content. Changes in parameters of subchondral bone micro-architecture, namely the ratio of bone volume to tissue volume (BV/TV), bone surface density (BS/TV), bone surface to volume ratio (BS/BV), trabecular thickness (Tb.Th; mm), size of marrow cavities described by trabecular spacing (Tb.Sp; mm), and structural model index (SMI), differed significantly by litter (P<0.05) due to the difference in age and weight, but not by the presence/absence of MCD (P>0.05), indicating that subchondral bone density is not affected in early MCD. This study demonstrated that cartilage matrix and not subchondral bone density is affected in the early stages of MCD.

Matched MeSH terms: Joint Diseases/etiology; Joint Diseases/pathology; Joint Diseases/veterinary*
Fulltext Results of meniscal surgery of the knee

Ang LC

Med J Malaysia, 1992 Sep;47(3):220-4.
PMID: 1491648

From 1988 to 1990, eighty operations on eighty knees of seventy-nine patients with a clinical diagnosis of meniscal tear was entered into a prospective study. The clinical diagnosis was correct in 76% of patients. Excellent or good results were achieved in 90% of knees which had only meniscal lesions but dropped to 70.5% when other intraarticular pathologies coexisted with the meniscal lesions. Excellent or good results were achieved in 71% of the knees in the presence of Anterior Cruciate Ligament (ACL) deficiency.

Matched MeSH terms: Joint Diseases/pathology; Joint Diseases/surgery
Spondyloarthropathies in eastern Asia

Feltkamp TE, Mardjuadi A, Huang F, Chou CT

Curr Opin Rheumatol, 2001 Jul;13(4):285-90.
PMID: 11555729

The association between HLA-B27 and the spondyloarthropathies (SpAs) is so strong that it is supposed that the HLA-B27 molecule plays a pathogenetic role. In whites and Indonesians, the frequency of HLA-B27 is about 10%; in Chinese it is about 8%; and in Japanese it is only about 1%. The prevalence of SpA in the Chinese is at least 0.2%, but in native Indonesians, Philippinos, and Malaysians, SpA is rarely seen. Twenty-three subtypes (B*2701-B*2723) have been distinguished. These subtypes are not equally distributed over the world. In most countries the distribution of the subtypes among HLA-B27 SpA patients is the same as that among the normal HLA-B27-positive population. In China, the subtype B*2704 is frequent and the prevalence of SpA is high. Native Indonesians, however, mostly have subtype B*2706, and SpA is rarely seen in this population. It was shown that B*2706, probably like B*2709 in Sardinia, is not associated with SpA. The difference between the SpA-associated and non-SpA-associated subtypes is limited to only two amino acid residues (114 and 116) at the bottom of the peptide-binding groove of HLA-B27. This small difference between health and disease rewards studies for different peptide-binding capacities and may help us characterize the peptides that are involved in the pathogenesis of SpA. The differences in disease associations in these countries also have clinical implications. In Southeast Asia, HLA-B27 typing without subtyping has less clinical usefulness than in parts of the world where B*2706 is rarely seen. When native Indonesians, Malaysians, or Philippinos are suspected of having ankylosing spondylitis or a related SpA, it is worth asking if they had white or Chinese ancestors. If native HLA-B27-positive Indonesians (with subtypes other than B*2706) develop SpA, the clinical features are not different from those in other parts of the world. In the Chinese population on the mainland and in Taiwan, juvenile SpA is frequently seen. The onset is often a peripheral arthritis or enthesitis.

Matched MeSH terms: Joint Diseases/ethnology*; Joint Diseases/genetics
Delayed endochondral ossification in early medial coronoid disease (MCD): a morphological and immunohistochemical evaluation in growing Labrador retrievers

Lau SF, Hazewinkel HA, Grinwis GC, Wolschrijn CF, Siebelt M, Vernooij JC, et al.

Vet J, 2013 Sep;197(3):731-8.
PMID: 23746870 DOI: 10.1016/j.tvjl.2013.04.021

Medial coronoid disease (MCD) is a common joint disease of dogs. It has a multifactorial aetiology, but the relationship between known causal factors and the disease has yet to be elucidated. As most of the published literature is clinical and it reports changes associated with advanced disease, it is not known whether the changes reflect the cause or consequences of the condition. The aim of this study was to investigate early micromorphological changes occurring in articular cartilage and to describe the postnatal development of the medial coronoid process (MCP) before MCD develops. Three litters of MCD-prone young Labrador retrievers were purpose-bred from a dam and two sires with MCD. Comparisons of the micromorphological appearance of the MCP in MCD-negative and MCD-positive joints demonstrated that MCD was initially associated with a disturbance of endochondral ossification, namely a delay in the calcification of the calcifying zone, without concurrent abnormalities in the superficial layers of the joint cartilage. Cartilage canals containing patent blood vessels were only detected in dogs <12 weeks old, but the role of these channels in impaired ossification requires further investigation. Retained hyaline cartilage might ossify as the disease progresses, but weak areas can develop into cracks between the retained cartilage and the subchondral bone, leading to cleft formation and fragmentation of the MCP.

Matched MeSH terms: Joint Diseases/pathology; Joint Diseases/veterinary*
Radiographic and computed tomographic assessment of the development of the antebrachia and elbow joints in Labrador Retrievers with and without medial coronoid disease

Lau SF, Hazewinkel HA, Voorhout G

Vet Comp Orthop Traumatol, 2015;28(3):186-92.
PMID: 25804656 DOI: 10.3415/VCOT-14-09-0144

To compare the development, monitored by radiography and computed tomography, of the antebrachia and elbow joints in seven Labrador Retrievers with healthy elbow joints and in seven Labrador Retrievers that developed medial coronoid disease (MCD), in order to determine whether disturbances in the development of the antebrachia and elbow joints, between the age of six and 17 weeks may lead to medial coronoid disease.

Matched MeSH terms: Joint Diseases/pathology; Joint Diseases/radiography; Joint Diseases/veterinary*
Fulltext Minimally Invasive Total Hip Arthroplasty in a Patient with Hereditary Multiple Exostoses: A Case Report

Santoso A, Utomo P, Im CJ, Park KS, Yoon TR

Malays Orthop J, 2018 Nov;12(3):53-56.
PMID: 30555649 DOI: 10.5704/MOJ.1811.010

Hip geometry abnormalities found in patients with hereditary multiple exostoses (HME) could promote premature hip joint degeneration which needs treatment. We report the case of a 45-year old male with right hip arthrosis who underwent two-incision minimally invasive (MIS-2) total hip arthroplasty (THA), with satisfactory outcome. This technique could be an alternative approach for performing THA in patients with hereditary multiple exostoses.

Matched MeSH terms: Joint Diseases
Fulltext Arthroscopic All-Inside Repair of Tear of the Anterior Horn of Discoid Lateral Meniscus

Muniandy M, Rajagopal S, Tahir SH

Surg J (N Y), 2019 Jan;5(1):e35-e37.
PMID: 31093532 DOI: 10.1055/s-0039-1688951

The anterior horn of lateral meniscus tear is usually repaired using outside-in technique. Although easy to perform, it was associated with several complications which may alter the outcome of the surgery. Here, we present a case of an adolescent girl presented with incomplete discoid lateral meniscus accompanied by tear of anterior horn. The tear was repaired using all-inside technique without any implants. We described the surgical technique and discussed the rationale.

Matched MeSH terms: Joint Diseases
First series of Exeter small stem primary total hip arthroplasty minimum 5 years of follow-up

Tai CC, Nam HY, Abbas AA, Merican AM, Choon SK

J Arthroplasty, 2009 Dec;24(8):1200-4.
PMID: 19682839 DOI: 10.1016/j.arth.2009.07.001

We carried out a prospective study of 47 Exeter (Stryker Inc, Warsaw, Ind) small stem total hip arthroplasty in 42 patients with an average age of 58 years and a mean follow-up of 8.5 years. The Oxford hip score improved from a preoperative mean of 47 to 17 at last follow-up. More than 87% patients had excellent or good Harris hip scores, and 90% were able to walk with little or no pain. Stem subsidence within the cement mantle was observed in 26% of cases, and none showed evidence of aseptic loosening or implant failure. Two stems were removed due to infection. The survival rate of this implant was 95.7% at 10 years. This first series of Exeter small stem showed excellent medium-term results, comparable to its larger counterparts.

Matched MeSH terms: Joint Diseases/surgery*
Fulltext Ultrastructural characteristics of synovial effusion cells in some arthropathies

Kapitonova MY, Othman M

Malays J Pathol, 2004 Dec;26(2):73-87.
PMID: 16329559

OBJECTIVE: To evaluate the range of activation changes of polymorphonuclear leukocytes (PMN) and the ratio of apoptosis and necrosis in synovial effusions of patients with various arthropathies, and to reveal possible correlations with clinical variants of joint inflammation.
METHODS: Synovial effusions were aspirated from the knee joints of patients with rheumatoid arthritis (RA, 28 cases), and seronegative spondyloarthritides (SSA): Reiter's disease (RD, 9 cases), peripheral form of the ankylosing spondyloarthritis (6 cases) and psoriatic arthritis (6 cases); and primary osteoarthritis (OA, 9 cases). Cytospin preparations were processed for transmission electron microscopy and assessed for the incidence of apoptosis, necrosis, and cytophagocytic cells (CPC) in the synovial fluid (SF). The range of activation changes of the neutrophil granulocytes, the dominating cell population in the arthritic SF, was evaluated.
RESULTS: In all arthropathies under investigation most of the synovial effusion cells had intact ultrastructure with a certain amount of apoptotic cells dominating over the cells with signs of necrosis, and a few CPC. The highest rate of apoptosis was discovered in the synovial effusions of patients with RA, the lowest in those with OA, while the rate of CPC among the inflammatory joint diseases was the lowest in RA. In RA the current disease activity correlated with the incidence of apoptotic cells and CPC, while the clinical stage was related only to the CPC rate. These data suggest that in RA, despite exposure to the anti-apoptotic signals, apoptosis of the synovial effusion PMN is maintained at a significantly higher level than in non-rheumatoid arthropathies, both inflammatory (SSA) and degenerative (OA), providing elimination of the neutrophils accumulating in the joint cavity and thus stimulating resolution of the joint inflammation.

Matched MeSH terms: Joint Diseases/pathology*
Fulltext Ultrastructural changes of the articular cartilage in some arthropathies with special reference to chondrocyte cell death

Kapitonova MY, Mansor O

Malays J Pathol, 2003 Jun;25(1):15-27.
PMID: 16196374

OBJECTIVE: To determine in situ using TEM the balance of apoptosis and necrosis in the articular cartilage of patients with inflammatory (rheumatoid arthritis and seronegative spondyloarthritis) and degenerative (osteoarthritis) joint diseases and to establish possible correlation between the cell death rate and the matrix vesicles formation.
METHODS: Cartilage samples of the knee joint were obtained from patients with rheumatoid arthritis (RA, 18 cases), osteoarthritis (OA, 22 cases), Reiter's disease (RD, 9 cases), peripheral form of the ankylosing spondyloarthritis (AS, 6 cases) and psoriatic arthritis (PA, 6 cases) during arthroscopy or knee surgery. Normal samples taken from autopsy cases without a history of joint diseases were used as control. Samples were processed for TEM with subsequent semi-quantitative estimation of the cell death rate in the superficial, middle and deep zone of non-calcified articular cartilage, and computer-aided ultramorphometric evaluation of the matrix vesicles of different types.
RESULTS: Both apoptotic and necrotic cell death could be identified in the cartilage of patients with inflammatory joint diseases, including seronegative spondyloarthritides and degenerative arthropathies. Apoptosis dominated over necrosis in all examined arthritides, including RA patients in which necrosis of the chondrocyte was the most frequent among arthropathies, while the highest apoptotic cell death rate was discovered in OA in which it correlated with the volume and numeric density of the matrix vesicles. These data provide evidence that apoptosis may contribute to the cartilage breakdown not only in RA and OA but also in the seronegative spondyloarthritides, which had a significantly higher apoptotic rate than the normal cartilage.

Matched MeSH terms: Joint Diseases/pathology*
Fulltext Extraintestinal Manifestations of Pediatric Inflammatory Bowel Disease: Prevalence, Presentation, and Anti-TNF Treatment

Greuter T, Bertoldo F, Rechner R, Straumann A, Biedermann L, Zeitz J, et al.

J Pediatr Gastroenterol Nutr, 2017 08;65(2):200-206.
PMID: 27801751 DOI: 10.1097/MPG.0000000000001455

BACKGROUND: There is a paucity of data on extraintestinal manifestations (EIM) and their treatment in pediatric patients with inflammatory bowel disease (IBD).
METHODS: Since 2008, the Pediatric Swiss IBD Cohort Study has collected data on the pediatric IBD population in Switzerland. Data on 329 patients were analyzed retrospectively.
RESULTS: A total of 55 patients (16.7%) experienced 1-4 EIM (39 Crohn disease, 12 ulcerative colitis, and 4 IBD-unclassified patients). At IBD onset, presence of EIM was more frequent than in the adult population (8.5% vs 5.0%, P = 0.014). EIM were more frequent in Crohn disease when compared to ulcerative colitis/IBD-unclassified (22.5% vs 10.3%, P = 0.003). The most prevalent EIM were peripheral arthritis (26/329, 7.9%) and aphthous stomatitis (24/329, 7.3%). Approximately 27.6% of all EIM appeared before IBD diagnosis. Median time between IBD diagnosis and occurrence of first EIM was 1 month (-37.5-149.0). Thirty-one of the 55 patients (56.4%) were treated with 1 or more anti-tumor necrosis factor (TNF) agents. IBD patients with EIM were more likely to be treated with anti-TNF compared to those without (56.4% vs 35.0%, P = 0.003). Response rates to anti-TNF depended on underlying EIM and were best for peripheral arthritis (61.5%) and uveitis (66.7%).
CONCLUSIONS: In a cohort of pediatric patients with IBD, EIM were frequently encountered. In up to 30%, EIM appeared before IBD diagnosis. Knowledge of these findings may translate into an increased awareness of underlying IBD, thereby decreasing diagnostic delay. Anti-TNF for the treatment of certain EIM is effective, although a substantial proportion of new EIM may present despite ongoing anti-TNF therapy.

Matched MeSH terms: Joint Diseases/diagnosis; Joint Diseases/drug therapy; Joint Diseases/etiology*; Joint Diseases/epidemiology
Recombinant long-acting glycoPEGylated factor IX (nonacog beta pegol) in haemophilia B: assessment of target joints in multinational phase 3 clinical trials

Negrier C, Young G, Abdul Karim F, Collins PW, Hanabusa H, Colberg T, et al.

Haemophilia, 2016 Jul;22(4):507-13.
PMID: 26936227 DOI: 10.1111/hae.12902

BACKGROUND: The paradigm(™) 2 and 4 phase 3 clinical trials investigated the safety and efficacy of nonacog beta pegol, a recombinant glycoPEGylated factor IX (FIX) with extended half-life, in previously treated haemophilia B patients.
AIM: These post hoc analyses investigated the bleeding patterns in target joints.
METHODS: Patients randomized to 40 or 10 IU kg(-1) once weekly prophylaxis who had at least one target joint were included. Baseline demographics and disease-specific data were collected. Bleeding patterns were assessed, and an International Society on Thrombosis and Haemostasis (ISTH) definition of target joints was used.
RESULTS: A total of 67% and 8% of patients in the 40 and 10 IU kg(-1) arm, respectively, did not experience target joint bleeds during the paradigm(™) 2 trial. Twenty-four target joints were recorded in each prophylaxis arm at baseline. During the paradigm(™) 2 trial, no bleeds were reported in 17 (71%) and 7 (29%) target joints in the 40 and 10 IU kg(-1) arms respectively. All target joint bleeds in the 40 IU kg(-1) once weekly prophylaxis arm were controlled with a single injection of 40 IU kg(-1) nonacog beta pegol. By the latest ISTH definition, 90% and 58% of target joints in the 40 and 10 IU kg(-1) arms, respectively, were no longer considered target joints at the end of the paradigm(™) 2 trial. At the end of the paradigm(™) 4 extension trial, all target joints in the 40 IU kg(-1) arm were no longer considered target joints.
CONCLUSION: Routine prophylaxis with 40 IU kg(-1) once weekly nonacog beta pegol has the potential for effective management of target joint bleeds in haemophilia B patients.

Matched MeSH terms: Joint Diseases/epidemiology; Joint Diseases/physiopathology*
Fulltext Knee tuberculosis: a challenge in diagnosis and treatment

Muhammad Wafiuddin, Ahmad Faizal Roslan, Ahmad Hafiz Zulkifly

Borneo Journal of Medical Sciences, 2021;15(1):37-43.
MyJurnal

Tuberculosis (TB) is an ancient disease dated back from ancient Greece time. Once rare in developed countries, now it has re-emerged due to immigration and secondary immunodeficiency. A 27-year-old lady had left knee pain for the past 4 years, went for knee diagnostic arthroscopy procedure, and diagnosed as pigmented villonodular synovitis (PVNS) of the left knee. Despite regular analgesics and physiotherapy, patient symptoms worsen. Two years after the initial treatment, the patient went for a further workout and diagnosed as knee tuberculosis, commenced on anti-TB treatment, the patient still left complicated with a stiff knee and fixed flexion deformity. Identification of knee tuberculosis during the initial phase is crucial as late diagnosis and treatment will leave the patient with debilitating complications.

Matched MeSH terms: Joint Diseases
Fulltext A case of pustular psoriasis in a young boy

Meera Kuppusamy, Tarita Taib

Journal of Clinical and Health Sciences, 2017;2:39-42.

We report a case of a 13-year-old boy who presented with acute onset of generalised erythematous skin and patchy areas of pustules for one week duration. He was well until one month ago when he started having small scaly plaques on his scalp and extensors of his legs. During the acute episode, he also had joint pain and bilateral conjunctivitis. Skin biopsy confirmed pustular psoriasis. He developed leucocytosis and transaminitis during the acute phase of the pustular eruption while on acitretin, which was then withheld. Subsequently, treatment with oral cyclosporine induced remission of his skin and joint disease. The case is hereby reported because of rarity of presentation and clinical features. Oral cyclosporine should be considered in patients with generalised pustular psoriasis complicated with transaminitis.

Matched MeSH terms: Joint Diseases

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