Reachout Orthopedics - Issue 2

Table 1: Summary of clinical characteristics of the presented four cases with rheumatoid arthritis combined with knee osteoarthritis. Case 1 Case 2 Case 3 Case 4 Age at onset of symptom 62 75 54 66 Disease duration (years) 16 11 18 7 Sex Female Female Female Female Laboratory test  Serology   RF (IU/ml) 23 101 61 <20   ACPA (U/ml) 43 1740 3377 271   ESR (mm/h) 110 31 85 42   CRP (mg/dl) 5.99 0.1 2.55 0.1 Disease activity at surgery  Joint count   TJC 3 0 1 0   SJC 3 1 1 2   DAS28-ESR 4.84 3.1 4.71 3.43 Current medication  DMARDs Sulfasalazine 2 g/day Leflunomide 20 mg/day Methotrexate 15 mg/week Methotrexate 15 mg/week, hydroxychloroquine 200 mg/day  Glucocorticoid Prednisolone 5 mg/day Not used Prednisolone 5 mg/day Not used  Biologics Subcutaneous golimumab Not used Subcutaneous golimumab Not used  Location Both Left Left Both Left Right Left Right X-ray  K–L grade 2 2 2 3 3 3 MRI  Size of cyst (cm) 4.1 5.4×3.0×1.6 2.4×1.3×6.7 3.0 2.0×3.7×2.1 4.1×3.0×5.3  Cyst septation Yes Yes Yes N/A Yes Yes  Cyst leakage Yes Yes No Yes No No  Meniscus tear Yes Yes Yes Yes Yes Yes  Ligament damage No No Yes Yes No No Joint fluid analysis  WBC count (1/ mm 3 ) 17,200 NA 400 16,000 90 NA  PMN cell (%) 74 NA 45 73 28 NA No. of glucocorticoid IAI within 6 months of surgery 2 1 1 1 1 1 Surgery Arthroscopic cystectomy Arthroscopic partial cystectomy Arthroscopic cystectomy and debridement of medial meniscus Arthroscopic cystectomy and synovectomy Arthroscopic cystectomy with partial meniscectomy Follow-up duration after surgery 12 12 12 12 12 12 Recurrence No No No No No No RF rheumatoid factor, ACPA anti-citrullinated peptide antibody, ESR erythrocyte sediment rate, CRP C-reactive protein, TJC tender joint count, SJC swollen joint count, DAS28-ESR disease activity score 28-ESR, DMARDs disease-modifying anti-rheumatic drugs, K–L grade Kellgren–Lawrence grade, PMN polymorphonuclear cell, IAI intra-articular injection, NA not applicable 25 reachOut Orthopedics