Diffuse large B-cell lymphoma involving the left sternoclavicular joint mimicking rheumatoid arthritis flare: a case-based review.

Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting primarily joints and an increased risk of developing malignant lymphomas in RA has been well reported. However, primary lymphoma in a joint in RA patient is rare. We report the case of a 65-year-old man with RA suffering from pain and swelling of left sternoclavicular (SC) joint, which was not relieved by adding low-dose glucocorticoid. Magnetic resonance imaging (MRI) showed a para-osseous soft tissue swelling around the SC joint and a fracture of proximal clavicle. Histology of the soft tissue demonstrated diffuse large B-cell lymphoma and the patient subsequently underwent R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. He was successfully treated with six cycles of R-CHOP chemotherapy, with discontinuation of MTX, resulting in a complete response. We performed a literature review and identified nine cases of lymphoma which involved joints in patients with rheumatoid arthritis. This is the first described case of a primary large B-cell lymphoma involving the unilateral SC joint in a patient with RA, which was initially confused with aggravation of RA. Therefore, malignant lymphoma should be considered in the differential diagnosis when a RA patient develops monoarthritis with spontaneous fracture, even without B symptoms.

Intra-articular glucocorticosteroid injection into sternocostoclavicular joints in patients with SAPHO syndrome.

OBJECTIVE: Painful swelling of the anterior chest wall caused by osteitis and hyperostosis in the sternocostoclavicular region are characteristically observed in patients suffering from SAPHO syndrome. Autoimmune triggering of inflammation and bacterial infection is hypothesized to be involved in the pathogenesis. Promising treatment modalities include antirheumatic and antibiotic medications. METHODS: Ten patients with SAPHO syndrome and symptomatic osteitis in the sternocostoclavicular region were treated by a single instillation of glucocorticosteroids (20 mg triamcinolone) into the sternocostoclavicular joints. The disease activity was evaluated on the basis of a questionnaire asking for osteitis activity (quantified for complains on a scale of 0-6), by Health Assessment Questionnaire (HAQ) score, erythrocyte sedimentation rate, C-reactive protein, and magnet resonance imaging (MRI) scanning of the sternocostoclavicular region (osteitis scores quantified for inflammation on a scale of 0-2 by the radiologist) prior to injection and after 12 weeks. No changes of the preexisting antirheumatic therapy were allowed during the observation interval. RESULTS: All patients continued the study during the follow-up. The osteitis score changed from 4.2 (mean; standard error (SE) ±0.3) to 3.2 (±0.4), [P = 0.062], the erythrocyte sedimentation rate from 19.0 (range from 12 to 30) to 19.9 (from 12 to 27), [P = 0.430], and the MRI score from 1.6 (±0.2) to 1.5 (±0.2) [P = 1.0]. One patient developed an increase of the clinical osteitis activity from 3 to 5 according the scoring system; only 2 patients showed a reduction of the MRI activity score from 2 to 1. CONCLUSIONS: Intra-articular glucocorticosteroid instillation does not appear to reduce osteitis in the sternocostoclavicular region in patients with SAPHO syndrome.

Sternoclavicular steroid injection for treatment of pain in a patient with Osteitis condensans of the clavicle.

Osteitis condensans of the sternoclavicular joint was first described by Brower et al in 1974. It is a rare benign disorder primarily affecting women of child-bearing age. Persistent pain and swelling in the medial part of the clavicle are the most common presenting symptoms and may represent an inflammatory process in the joint among other proposed etiologies. Radiological findings include sclerosis of the medial part of the clavicle and a normal sternoclavicular joint. Diagnosis is usually confirmed by biopsy. Pain management can be challenging in these patients. Multiple treatments have been described in the past including oral NSAIDS, physical therapy, radiation, surgical resection, and oral corticosteroids but have met with limited success. This case report describes the novel utility of sternoclavicular joint steroid injections in treating a patient with Osteitis condensans of the clavicle after failed medical therapy. Based on our clinical experience, and given the limited clinical success of other reported conservative treatment measures, a sternoclavicular joint injection under fluoroscopic guidance using a local anesthetic-corticosteroid injectate should be considered as a viable treatment option for pain associated with Osteitis condensans of the clavicle.

Bilateral, spontaneous, anterior subluxation of the sternoclavicular joint: a case report and literature review.

A case of atraumatic, spontaneous, bilateral, sternoclavicular joint subluxation in a 20-year-old man on combat duty in Iraq is reported. There was no history of an underlying pathologic condition and no history of injury to the area. The patient demonstrated recurrent, mildly painful, subluxation whenever either arm was abducted past 80 degrees to 90 degrees. Computed tomographic scans of the joints in both reduction and subluxation were obtained, and pseudodislocation was excluded. The patient was reassured that the subluxation would not affect his upper extremity strength, was treated with conservative measures, and returned to duty. The literature was reviewed for comparison of surgical and nonsurgical options. Surgical stabilization of sternoclavicular joint dislocations is associated with a high incidence of serious complications. Spontaneous sternoclavicular joint subluxations have a benign course and do not fare well after surgical repair. It is recommended that all grade I and II sternoclavicular joint sprains be treated conservatively.

Artitris séptica esternoclavicular / Sternoclavicular septic arthritis

Reportamos nueve pacientes con artritis séptica esternoclavicular (ASEC), dos de los cuales fueron adictos a drogas endovenosas, pero en ningún caso a heroína. La edad promedio fue de 34.5 años. El sexo más frecuente fue el masculino. En seis pacientes se aisló el microorganismo causal, siendo el más frecuente aislado el Stafilococo aureus. Ocho pacientes fueron tratados y tuvieron excelente respuesta