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Allopurinol and risk of incident peripheral arterial disease 47 Singh JA, Hodges JS, Asch SM. Opportunities for im- 49 Zhu Y, Pandya BJ, Choi HK. Comorbidities of gout and proving medication use and monitoring in gout. Ann hyperuricemia in the US general population: NHANES Rheum Dis 2009;68:126570. 2007-2008. Am J Med 2012;125:67987.e1. 48 Harrold LR, Andrade SE, Briesacher BA et al. Adherence 50 Johnson ES, Bartman BA, Briesacher BA et al. The inci- with urate-lowering therapies for the treatment of gout. dent user design in comparative effectiveness research. Arthritis Res Ther 2009;11:R46. Pharmacoepidemiol Drug Saf 2013;22:16. Rheumatology 2018;57:461 doi:10.1093/rheumatology/kex312 Clinical vignette Advance Access publication 11 August 2017 Multicentric reticulohistiocytosis misdiagnosed as FIG.1 Findings of multicentric reticulohistiocytosis in a tenosynovial giant cell tumour 39-year-old man A 39-year-old man was referred to our institution in September 2012 with multiple nodular lesions of the hands (Fig. 1A), elbows, knees and ankles. The hand tu- mours had been operated on twice by an orthopaedic surgeon at the pre-referral hospital in 2009 and 2010. The pathological diagnoses were both tenosynovial giant cell tumour (TS-GCT). However, the new occurrence of multiple lesions in addition to the pulmonary lesions, which caused him dyspnoea, prompted the physicians to refer him to our hospital. We conducted a roentgenolo- gic examination (Fig. 1B), MRI and 2-deoxy-2-[fluorine- 18]fluoro-D-glucose ( F-FDG) PET/CT scan (Fig 1C and D). A specialized pathologist in our institution diagnosed the specimen as multicentric reticulohistiocytosis (MRH) (Fig. 1E). Major joints including the wrists already ex- hibited erosive arthritic change (Fig. 1B). MRH is a very rare systemic non-Langerhans histiocy- tosis characterized by erosive arthritis, skin lesions and occasionally lesions of internal organs. The presence of periarticular or articular lesions can lead to this disease (A) Macroscopic appearance revealed multiple nodular being misdiagnosed as RA. However, extra-articular or lesions of the fingers that differed from RA. (B) A plain soft tissue lesions will be diagnosed incorrectly, such as radiograph showed a periarticular soft tissue mass and TS-GCT, particularly by non-specialized surgeons in gen- degenerative arthritis. (C and D) High uptake of F-FDG in eral hospitals, because of a lack of precise knowledge of multiple lesions on a PET/CT scan. (E) Infiltration of mul- not only MRH, but also TS-GCT. Considering that a tinucleated giant cells and histiocytes resembled TS-GCT number of patients with MRH suffer progression of the histologically. erosive arthritis to an arthritis mutilanslike state, early and precise diagnosis and early initiation of adequate treatment are crucial for such patients. 1 1 1 Yoshihiro Nishida , Shuji Asai and Eisuke Arai Funding: No specific funding was received from any Department of Orthopaedic Surgery, Nagoya University bodies in the public, commercial or not-for-profit sectors Graduate School of Medicine, Nagoya, Japan to carry out the work described in this article. Correspondence to: Yoshihiro Nishida, Department of Orthopaedic Surgery, Nagoya University Graduate School of Disclosure statement: The authors have declared no Medicine, 65-Tsurumai, Showa, Nagoya, 466-8550, Japan. conflicts of interest. E-mail: ynishida@med.nagoya-u.ac.jp The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com https://academic.oup.com/rheumatology 461 Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/3/461/4082026 by Ed 'DeepDyve' Gillespie user on 22 March 2018
Rheumatology – Oxford University Press
Published: Mar 1, 2018
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