Juxta-articular adiposis dolorosa: what is it? Report of 2 cases.

Abstract

suMMARY Juxta-articular adiposis dolorosa may be defined as the localised accumulation of painful fat near joints, most commonly the knee. It exists as a separate entity that must be distinguished from other causes of knee pain. We present 2 patients with this condition and review the literature. Various approaches to therapy are discussed. A classification of painful fat near joints is proposed.Juxta-articular adiposis dolorosa (JAD)-does it exist? What is it? Literally it means painful fat near a joint. We believe the condition does exist as a separate entity and that it may coexist with other disorders affecting joints. We describe 2 patients with this disorder and review the available literature. It is important to recognise the condition as a not so rare cause of knee pain. Nevertheless we have been unable to find a single publication about this disorder in the rheumatology journals and reviews. A classification of painful fat in and around joints is proposed, and various pharmacological and physiotherapeutic measures are discussed. effusion. Just medial to each knee was a fist-sized mass of rather tense and extremely tender fatty tissue. There was also tenderness of both pes anserine bursae.Investigations revealed a normal complete blood count, differential white cell count, and erythrocyte sedimentation rate. Biochemical tests were normal except for a serum calcium of 11 2 mg/dl, serum phosphorus of 2 * 3 mg/dl, and a serum parathyroid hormone level of 109 ,tlEq/ml (normal 90-100) (at the time of writing no disposition of her hyperparathyroidism has been made). Thyroid function tests, glucose tolerance test, RA latex, ANA, serum uric acid, and an electromyogram of both lower limits were normal or negative. Roentgenograms (including weight-bearing views) of both knees were also normal. A fat biopsy from the mass on the left knee was also normal.A diagnosis of JAD was made. She was treated with aspirin, naproxen, indomethacin, and ibuprofen in full anti-inflammatory doses. None of the nonsteroidal agents relieved her pain. A course of carbamazepine (given elsewhere) was also without benefit. Local injection (of the painful fat) with lignocaine exacerbated her symptoms. Injection of the left anserine bursa with triamcinolone acetonide suspension and lignocaine was ineffective, and attempts at weight reduction were also unsuccessful. A trial of corrective shoes with medially wedged soles and heels in an effort to minimise valgus angulation and medial knee contact gave no relief. Finally, intermittent pneumatic compression (Jobst) was used in an attempt to compress the fat and possibly mobilise suspected local oedematous accumulations in fatty tissue. The patient was able to tolerate 65 mmHg of pressure for 1 hour twice daily, but when the pressure was increased to 70 mmHg 479 on 11 May 2018 by guest. Protected by copyright.

Rare adipose disorders (RADs) masquerading as obesity

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