DR.MOHAMMED IRFAN SHEIKH4 months ago

Synovial Chondromatosis

A 46-year-old woman presented to the rheumatology clinic with a 3-month history of walking difficulty due to worsening knee pain. She had received a diagnosis of rheumatoid arthritis 12 years earlier but had received treatment inconsistently, with frequent changes between prescribed medical therapies and complementary medicine practices. On physical examination, she had nodular swelling and outward bowing of both knees. She had limited range of motion in her left shoulder and in both wrists and both knees. The number of swollen and tender joints, the disease activity score, and elevated C-reactive protein level were consistent with active rheumatoid arthritis. Radiographs of the knees showed multiple calcified loose bodies and narrowing of the joint space (Panel A, anteroposterior view; Panel B, lateral view). These findings were consistent with synovial chondromatosis, a disorder of the synovium that is characterized by the development of loose cartilaginous bodies. For treatment of the rheumatoid arthritis flare, she was given methotrexate and folic acid with short-term glucocorticoids. The treatment of synovial chondromatosis can include surgery; however, the patient declined surgical evaluation. At follow-up 3 months later, her disease activity score for rheumatoid arthritis had decreased, and she had moderate reduction in her knee pain and enhanced mobility with the use of a walker.