Ann Rehabil Med.  2012 Feb;36(1):144-147. 10.5535/arm.2012.36.1.144.

A Case of Rheumatoid Arthritis with Unilateral Knee Synovial Hypertrophy in Hemiplegia

• Kim CW
• Kim MJ
• Park SB
• Han SH

• KMID: 2266793
• DOI: http://doi.org/10.5535/arm.2012.36.1.144

Abstract

A 64-year-old woman suffering right hemiplegia came in with pain and swelling on her left knee, general weakness and poor oral intake for 2 months. On physical examination we were able to palpate a mass with irregular margin around the left suprapatellar area. From the results of the magnetic resonance imaging (MRI), synovial proliferative disease, infectious arthritis, or gouty arthritis was suspected. We performed a blood laboratory test to detect rheumatologic diseases, knee joint aspiration, and bone scan for differential diagnosis, and were able to diagnose rheumatoid arthritis (RA) from the results of blood laboratory, physical examination, and bone scan. Consequently, we started medications for controlling RA. Herein, we report a case of rheumatoid arthritis with unilateral knee synovial hypertrophy in hemiplegia. If a right hemiplegic patient has recurrent pain on the left knee and synovial hypertrophy, and fails to respond to treatment for osteoarthritis, early detection by evaluation for rheumatic disease is crucial to prevent severe sequelae influencing rehabilitation of hemiplegia.

Keyword

Hemiplegia; Synovial hypertrophy; Rheumatoid arthritis

MeSH Terms

Arthritis
Arthritis, Gouty
Arthritis, Rheumatoid
Communicable Diseases
Diagnosis, Differential
Female
Hemiplegia
Humans
Hypertrophy
Knee
Knee Joint
Magnetic Resonance Imaging
Middle Aged
Osteoarthritis
Physical Examination
Porphyrins
Rheumatic Diseases
Stress, Psychological
Porphyrins

Figure

• 

  Fig. 1 Simple radiograph of left knee shows narrowing of the patellofemoral and femorotibial joint space. (A) AP view. (B) Right lateral view. (C) Left lateral view.

• 

  Fig. 2 Left knee MRI shows severe synovial hypertrophy and heterogenous contrast enhancement in hypertrophied synovium. (A) Sagittal view. (B) Transverse view.

• 

  Fig. 3 Bone scan shows polyarthritis in both hands, left wrist, right elbow, both shoulders and left knee.

Reference

1. Gabriel SE, Crowson CS, O'Fallon WM. The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955-1985. Arthritis Rheum. 1999; 42:415–420. PMID: 10088762.

2. Yaghmai I, Roohomamini SM, Faunce HF. Unilateral rheumatoid arthritis: protective effect of neurologic deficits. AJR Am J Roentgenol. 1977; 128:299–301. PMID: 401618.

3. Kamermann JS. Protective effect of traumatic lesions on rheumatoid arthritis. Ann Rheum Dis. 1966; 25:361–363. PMID: 5947582.

4. Kim HY. Diagnosis and differential diagnosis of rheumatoid arthritis. J Korean Med Assoc. 1986; 29:15–20.

5. Adunsky A, Hershkowitz M, Rabbi R, Asher-Sivron L, Ohry A. Functional recovery in young stroke patients. Arch Phys Med Rehabil. 1992; 73:859–862. PMID: 1514896.

6. Hindfelt B, Nilsson O. Long-term prognosis of ischemic stroke in young adults. Acta Neurol Scand. 1992; 86:440–445. PMID: 1481624.

7. Thompson M, Baywaters EG. Unilateral rheumatoid arthritis following hemiplegia. Ann Rheum Dis. 1962; 21:370–377. PMID: 13981183.

8. Norton WL, Ziff M. Electron microscopic observations on the rheumatoid synovial membrane. Arthritis Rheum. 1966; 9:589–610.

9. Dixon AS, Grant C. Acute synovial rupture in rheumatoid arthritis. Clinical and experimental observations. Lancet. 1964; 1:742–774. PMID: 14107983.

10. Frassica FJ, Combs JJ Jr, Sim FH. Synovial proliferative disorders: differential diagnosis. Arthroscopy. 1985; 1:183–189. PMID: 3006715.