Cardiovascular complications of inactivity.

Inactivity has a number of consequences for the cardiovascular system. In particular, inactivity can lead to obesity, which can aggravate arthritis. An examination of the effect of exercise on the cardiovascular system requires the review of epidemiologic or population-based studies, because there are no large randomized trials with an exercise control group. Small randomized trials looking at exercise and the individual risk factors are reviewed.

Exercise and arthritis. Adaptive bicycling.

Bicycling, both indoor and outdoor, seems to be an excellent exercise for most patients with arthritis because it meets the criteria for the ideal recreational physical activity. This article outlines the physical and biomechanical advantages of bicycling as exercise and familiarizes the reader with the types of equipment available for both outdoor and indoor use. The proper mechanics of efficient bicycling and appropriate fit of machine to rider are addressed. Finally, guidelines are offered to initiate both indoor and outdoor cycling programs.

Pyriformis syndrome in a 10-year-old boy as a complication of operation with the patient in the sitting position.

We present a case of sciatic neuropathy due to the pyriformis syndrome after operation in the sitting position. Neither sciatic nerve injury nor the pyriformis syndrome has been reported after operation in the sitting position, although a low incidence of common peroneal nerve injury has been reported as a complication of operation on patients who are in the sitting position. The clinical findings of sciatic neuropathy, external rotation of the ipsilateral foot in the position of comfort, and a therapeutic response to local anesthetic injection into the pyriformis muscle are diagnostic of the syndrome. Nerve conduction studies should be performed to aid in the differentiation between a common peroneal and sciatic neuropathy. The syndrome may occur because of extreme flexion of the hips and prolonged pressure while in the sitting position, leading to pyriformis muscle trauma, resultant spasm, and sciatic compression. The prognosis is for complete recovery after symptomatic treatment with nonsteroidal antiinflammatory medication and physical therapy.

Essential cryoglobulinemia associated with intense and persistent synovitis of the knee.

Two patients with essential cryoglobulinemia, an immune complex disease, developed an intense, chronic, monoarticular knee synovitis. In each patient, synovial fluid findings (high white count and left shift) suggested a pyrogenic or crystalline etiology. A synovectomy was eventually performed in both patients to control their synovitis, which was refractory to medical management. The histologic and immunofluorescent synovial changes in the arthropathy of essential cryoglobulinemia, which was not previously been characterized, are marked by diffuse eosinophilic infiltration and edema. In both patients, synovial specimens suggested an immune complex process; immunofluorescent studies revealed immunoglobulin IgG in one patient, and IgG, IgA, and immune complexes (C1q) deposits in the other patients. Both patients, subsequently treated with D-penicillamine and chloroquine, or chloroquine alone, were followed for two years and had a slow but definite fall in their cryoglobulin levels, despite the persistence of monoarticular synovitis in one patient.

Coexistent Mycobacterium intracellulare gonarthritis and patellar osteomyelitis in a patient with pulmonary sarcoidosis. A case report and literature review.

We present a 48-year-old man with known pulmonary sarcoidosis who developed septic arthritis of the left knee with concomitant patellar osteomyelitis due to Mycobacterium intracellulare. The patient underwent synovectomy and was started on appropriate combination chemotherapy, but clinical improvement did not occur until patellectomy was performed. Both bone and radiogallium scans were important in the medical and surgical management of this patient.

Scintigraphic study of Osgood-Schlatter disease following delayed clinical presentation.

A case report of a 21-year-old man with Osgood-Schlatter disease is presented. Although the diagnosis was provided by the radiograph of the affected tibial tuberosity, the scan appears to have some diagnostic utility and may better correlate with clinical activity.

Right-sided endocarditis and ventricular septal defect.

Right-sided endocarditis occurred in a 40-year-old woman with ventricular septal defect. This association is uncommon in adults. Because of the changing and variable clinical patterns of this disease, it is difficult to make a prompt diagnosis. In this case diagnosis was delayed for almost a year. The occurrence of pneumonia due to Streptococcus viridans was the most important extracardiac manifestation.

Periarticular uptake of 99mtechnetium diphosphonate in psoriatics: correlation with cutaneous activity.

The periarticular uptake of 99mtechnetium-labeled diphosphonate (99mTcDp) was compared in 12 patients hospitalized for psoriasis and in 12 hospitalized for other dermatoses not associated with arthropathy. The 12 patients with psoriasis had recent onset disease of less than 5 years duration; neither group had historical or clinical evidence of arthritis. All psoriatics had markedly abnormal scans with symmetrically increased periarticular uptake about the imaged joints. None of the controls had similar findings. In 4 patients scanned with 99mtechnetium-pertechnetate within 24 hours of their 99mTcDP scan, no evidence of inflammatory synovitis was found. Three of these patients were serially imaged with 99mTcDP at intervals of 2 weeks to 3 months after their initial study, when obvious clinical improvement in their psoriasis was apparent. Improvement in the radionuclide joint images was demonstrated in some of the patients, but none reverted to normal during the study period. In light of recent evidence for the preferential binding of 99mTcDP to immature collagen, it is suggested that psoriasis may represent a generalized, but uncharacterized, collagen disorder present in bone as well as skin, linking the cutaneous disease with the potential for arthropathy.