Fistulization of rheumatoid joints. Spectrum of identifiable syndromes.

Abstract

G. (1975A 52-year-old woman with a 14-year history of seropositive RA characterized by subcutaneous nodules and progressive unremitting synovitis in the shoulders, metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints, hips, knees, and metatarsophalangeal (MTP) joints was admitted for metatarsal head resections. Nine months earlier intermittent clear drainage appeared in the space between the right 2nd and 3rd toes, at the plantar surface of the right 3rd metatarsal head, and along the medial surface of the left 1st metatarsal head. Cultures for aerobic and anaerobic bacteria and fungi were sterile. X-rays showed extensive osteoporosis, erosions, and subluxations at the MTP joints (Fig. 1A). Surgery was deferred for 8 months because of suspected infection and the patient was treated with antibiotics; despite treatment, drainage continued. At the time of admission for surgery, examination of the right foot showed severe hallux valgus deformity with overriding of the 3rd toe and subluxation of all MTP joints; draining sinuses were present at the sites described above. Similar deformity was noted on the left with a single small draining sinus at the medial side of the 1st MTP. At surgery, cultures for aerobic and anaerobic bacteria, fungi, and mycobacteria, obtained from superficial and deep regions of each meta-

Rheumatoid arthritis: A review of the cutaneous manifestations

“…This condition is known as fistulous rheumatism and requires extensive synovectomy. 70,85 Acute synovial rupture in RA patients may present with a cutaneous hemorrhagic (ecchymotic) crescent sign, due to synovial fluid enzymatic damage that causes capillary permeability. 86 Nodules may also contain significant amounts of lipids and cholesterol that are released into adjacent bursae and lead to milky bursal effusions, known as rheumatoid chyliform bursitis.…”

Spontaneous rheumatoid fistula of the elbow joint

“…Some infections have occurred primarily but most have followed prosthetic arthroplasty. [1][2][3][4] Spontaneous fistulization of a non-infected rheumatoid joint is a rare occurrence and to our knowledge only six cases have been published'-3 involving mainly small joints of the feet and hands.…”

Rheumatoid bursitis extending into the clavicle and to the skin surface.

“…However, cases of sterile fistulae with cutaneous drainage have also been reported in patients with rheumatoid arthritis. '- 3 Bywaters' attributed such 'fistulous rheumatism' to the foreign body effect of necrotic bone and rheumatoid granulation tissue on the articular and para-articular soft tissues.…”