title: Quickly progressive amyotrophy of the thigh: An unusual cause of rapid chondrolysis of the knee.
abstract: While rapidly destructive OA is more recognized in hip, we report the case of a 50-year-old woman who presented a rapid chondrolysis in the patellofemoral joint in a context of rapid loss of muscular strength. She had arthralgia, myalgia and proximal muscular deficit of the limbs. Creatine phospho kinase level was elevated and electromyogram exam showed a myogenic syndrome. Neither immune nor visceral disease was highlighted. As we suspected a polymyositis, we started corticosteroids and physiotherapy, then methotrexate and intravenous immunoglobulin. Concomitantly to the worsening of the muscular deficit and atrophy of hamstrings, she developed a persistent and disabling knee pain. Initial radiographs and magnetic resonance imaging (MRI) showed only a patellofemoral dysplasia and tiny cartilage damages. Because of aggravation of myalgia, we treated by mycophenolate mofetyl then rituximab. One year later, the knee remained painful and swollen. MRI showed signs of advanced osteoarthritis including an important loss of cartilage with an atrophy of hamstrings. Several articular corticosteroids injections were done. In the same time, the evolution of the muscular disease was unusual. Another histological analysis of muscle has highlighted a genetic myopathy due to mutation of calpain. Immunosuppressive treatments were stopped and a total joint replacement was performed. We show for the first time a case of rapid chondrolysis of patellofemoral joint related to a severe genetic myopathy.
authors: Rheumatology department, Saint Antoine Hospital, AP-HP, Inflammation-Immunopathology-Biotherapy i2B (DHU i2B) Department, Sorbonne University Paris 06, UPMC University Paris 06, Inserm, UMR_S 938, Paris, France.
authors: Maeva
authors: M
authors: Ferrari
authors: Rheumatology department, Saint Antoine Hospital, AP-HP, Inflammation-Immunopathology-Biotherapy i2B (DHU i2B) Department, Sorbonne University Paris 06, UPMC University Paris 06, Inserm, UMR_S 938, Paris, France.
authors: Karine
authors: K
authors: Louati
authors: Radiology department, Saint Antoine Hospital, AP-HP, Paris, France.
authors: Anne
authors: A
authors: Miquel
authors: Institute of Myology, Pitié-Salpêtrière Hospital, AP-HP, UPMC University Paris 06, Paris, France.
authors: Anthony
authors: A
authors: Behin
authors: Internal Medicine Department, Pitié-Salpêtrière Hospital, AP-HP, DHU i2B, Sorbonne University Paris 06, UPMC University Paris 06, Paris, France.
authors: Olivier
authors: O
authors: Benveniste
authors: Rheumatology department, Saint Antoine Hospital, AP-HP, Inflammation-Immunopathology-Biotherapy i2B (DHU i2B) Department, Sorbonne University Paris 06, UPMC University Paris 06, Inserm, UMR_S 938, Paris, France. Electronic address: jeremie.sellam@sat.aphp.fr.
authors: Jérémie
authors: J
authors: Sellam
mesh_terms: D018771:Arthralgia / Q000209:etiology; D002357:Cartilage Diseases / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D002358:Cartilage, Articular / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000473:pathology; D009135:Muscular Diseases / Q000188:drug therapy / Q000235:genetics / Q000473:pathology*; D020370:Osteoarthritis, Knee / Q000150:complications / Q000473:pathology* / Q000628:therapy; D057071:Patellofemoral Joint / Q000473:pathology*; D013848:Thigh
keywords: Amyotrophy; Femoro-patellar osteoarthritis; Myopathy; Rapidly destructive osteoarthritis; Risk factor