Distal extremity swelling with pitting oedema in rheumatoid arthritis.
Distal extremity swelling with pitting oedema due to altered lymphatic drainage has been reported in some patients with rheumatoid arthritis (RA). The resistant-to-therapy oedema usually affected the upper limbs in an asymmetrical pattern. Until now, extensor tenosynovial involvement has not been described in RA patients suffering from distal extremity swelling with pitting oedema. Three patients are described: two of them had predominant extensor tenosynovial involvement in their hands, with impaired lymphatic drainage demonstrated by (MRI) and lymphoscintigraphy, respectively. In both cases the oedema was chronic and not responsive to treatment. One patient had extensor tenosynovial involvement without impaired lymphatic drainage. In this case, the oedema remitted completely after a few days of corticosteroid therapy. None of them showed differences in serum levels of vascular endothelial growth factor (VEGF), whether they were RA patients with no pitting oedema or healthy volunteers.
Rheumatology Department, Hospital José M.Cullen and Centro de Diagnóstico por Imágenes, Entre Rios, Santa Fe, Argentina.
S
S
Paira
L
L
Caliani
N
N
Luraquiz
D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000503:physiopathology*; D004487:Edema / Q000175:diagnosis* / Q000209:etiology*; D016228:Endothelial Growth Factors / Q000097:blood; D005121:Extremities / Q000473:pathology*; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008222:Lymphokines / Q000097:blood; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D011859:Radiography; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
D016228:Endothelial Growth Factors; D008222:Lymphokines; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors