Multicentric Reticulohistiocytosis - A Rare Clinicopathological Entity

This is a rare case report of a thirty-eight-year-old male who presented with multiple asymptomatic hyper-pigmented papulonodular lesions on the face for the past two years without the association of pain or pruritus and with restriction of elbow movements. The diagnosis of multicentric reticulohistiocytosis was made on histopathological findings of Touton type of giant cells and sheets of foamy histiocytes along with immunohistochemistry (IHC) studies. Workup was done for other associated diseases. Multicentric reticulohistiocytosis (MRH) is also known as lipoid dermatitis,1 a rare disease which is characterised by the presence of extensive papulonodular cutaneous eruptions and severe, sometimes destructive arthropathy, followed by eruption of the skin and mucous membrane lesion.2,3 It’s a rare idiopathic nonLangerhans cell histiocytosis.4 This disorder is characterised by predominant cutaneous manifestation and joint involvements. The lesions may show regression and recurrence, many case studies show an association of this lesion with internal malignancies, autoimmune diseases, hyperlipidaemias, and tuberculosis.5,6 Few cases have shown musculoskeletal involvement with features such as myositis. The disease was described initially as reticulocytosis granuloma in 1952 by Caro and Senear, later the term was coined by Goltz and Laymon as multicentric reticulohistiocytosis in 1954.4 It is also known by different names such as giant cell histiocytosis, lipoid dermato-arthritis, lipoid-rheumatism and reticulohistiocytosis granuloma. The disease incidence is very low worldwide, less than 200 cases have been reported in literature5 and reports from India are limited.

Destructive Arthropathy of the Interphalangeal Joint Following Revascularization After Degloving Hand Injury: A Case Report

It is difficult to achieve satisfactory results in the treatment of advanced degloving injury, which is one of the most challenging injuries in hand surgery. In this report, we present a case of marked destructive arthropathy of the interphalangeal joint that developed following revascularization after degloving hand injury. A 37-year-old, right-handed female manual worker sustained a degloving injury of her fingers, including the dorsal hand. We performed revascularization and secondary surgery, which included tenolysis and a tendon graft, to obtain functional improvement. These 2 procedures provided significant improvement in the active range of motion of the respective fingers. However, the patient complained of postoperative pain in the proximal interphalangeal joint. X-ray revealed destructive changes in the interphalangeal joint, which advanced progressively. Destructive changes in the interphalangeal joint following advanced degloving injury should be recognized as a potential complication that could be a limitation of functional restoration. Follow-up X-ray examination is necessary, even in cases with no fracture of the phalanges at the time of injury. In the management of degloving injury, patients should be informed of the potential risk of destructive arthropathy, which could result in restricted motion with pain.

Is there a role for cherries in the management of gout?

Despite the availability of effective urate-lowering therapy (ULT) and anti-inflammatory drugs for the treatment of gout, there is considerable interest in novel treatment approaches. Patients with gout often have a multitude of comorbidities, leading to concern over drug–drug interactions and medication adverse events. The cherry is a small nutrient-rich fruit that has garnered a great deal of attention in recent years as a nonpharmacologic option for the treatment of a multitude of disease manifestations. Perhaps a quarter of patients with gout try cherries or cherry products to treat their gout, which have antioxidant and anti-inflammatory (IL-6, TNF-α, IL-1β, IL-8, COX-I and -II) properties, hypouricemic effects, and the ability to downregulate NFkB-mediated osteoclastogenesis. Based on these properties, cherries may reduce both the acute and chronic inflammation associated with recurrent gout flares and its chronic destructive arthropathy. In this review, we explore the potential benefits of cherries and cherry products as a nonpharmacologic option for the treatment of gout.

Hämochromatose-assoziierte Arthropathien

Arthropathy is the most common and often the earliest clinical manifestation of hereditary hemochromatosis (HH). It is difficult to treat and there is a high risk for early endoprosthetic joint replacement. Research done during the last decade shows that it is a joint disease in its own right. Clinically, there are degenerative articular changes with an atypical pattern of distribution, a crystal arthropathy (CPPD) with congenital joint swelling and synovitis like in RA. The X-ray image shows typical but not exclusive findings. In MRI, groundbreaking subchondral findings are found, especially in the large joints, and ultrasound shows inflammatory lesions in non-arthropathy patients as well. In animal experiments and pathomorphological studies of the synovial membrane, the arthropathy can be differentiated from osteoarthrits and RA. The pathophysiological significance of iron overload can be distinguished from immunohistochemical and cytogenetic investigations in chronic degenerative HH arthropathy and inflammatory-destructive arthropathy in hemophilia. By elucidating the pathophysiology, new therapeutic approaches can be formulated. In addition to colchicine, the IL-1 receptor antagonist anakinra is available for activation of the NLRP3 inflammasome by CPPD crystals and subsequent induction of IL-1β overproduction. Other manifestations include symptomatic pain therapy and intensive physiotherapy and occupational therapy. To promote further research into hemochromatosis arthropathy, the Hemochromatosis Arthropathy Research Initiative (HARI) was established in 2016.