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Total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) has different features from those seen in patients with osteoarthritis. In 1970 85% of the patients undergoing TKA had rheumatoid arthritis. Nowadays less than 5% of the patients undergoing TKA have rheumatoid disease. An important reason for the marked decrease is the improvement of the medical treatment. Fewer patients now progress to permanent structural damage requiring arthroplasty. TKA in RA has management difficulties that are unique to the disease. These include ipsilateral hip involvement, bilaterality, anticoagulation needs, flexion contractures, rheumatoid cysts and possibly the need for synovectomy. Patients with rheumatoid arthritis are more vulnerable to both early and late infections. They require a prosthesis and technique that provide adequate flexion for activities of daily living. Their often-profound osteopenia can lead to intraoperative and postoperative fractures. Finally, their cervical spine and temporal-mandibular disease create challenging anesthetic considerations. Nevertheless, given these considerations and the degree of preoperative disability suffered by patients with rheumatoid arthritis, the results of surgery can be extremely dramatic and gratifying to both patient and surgeon. [ABSTRACT FROM AUTHOR]

Background: Dupuytren's contracture (MD) and Ledderhose's disease (ML) are connective tissue disorders of palmar and plantar aponeurosis, respectively. Approximately two thirds of patients have a bilateral involvement. Both diseases are rare and occur in only 1-2 % of the population and MD is more frequent than ML with a predominance in males. Clinical aspects: Clinical changes in early stages include subcutaneous nodules and/or cords, while in later stages flexion contractures and functional hand and finger deficits (MD) or pain with gait dysfunction (ML) can occur. Therapy and results: The most recent treatment options include minimally invasive or invasive hand surgery (aponeurotomy), lipografting, injection of collagenase or steroids, interferon (INF) gamma and local shockwave therapy. Surgery is always indicated in cases of functional impairment. Radiotherapy is effective for early disease stages with proliferating fibroblasts as sensitive target cells. Further progression can be prevented in 80-90 % of cases and recurrence of nodes and cords in 20-30 % which has been confirmed by clinical studies with almost 500 patients and over 5 years follow-up. The exposure to a 30 Gy radiotherapy dose does not increase the surgical complication rate in case surgery becomes necessary due to a later disease progression. [ABSTRACT FROM AUTHOR]

The diagnosis of adrenal insufficiency is discussed in case of low blood pressure and digestive symptoms. Rare inaugural abdomino-crural muscle contracture can be a misleading symptom. Here we report two new cases. A 50-year-old woman presenting a leaning forward walking attitude and negligence for the past 2 months was referred to the neurologic unit. Abdomino-crural contracture, clinical hypogonadism, and hyponatremia directed towards a panhypopituitarism, which was confirmed by subsequent investigations. Pituitary MRI found an empty sella turcica. The outcome was dramatic after hormone replacement therapy, with drawing up of the trunk and re-establishment of walking after a few days. The second case is a 58-year-old man, hospitalized with altered general condition, with a weight loss of 22 kg, and anorexia in the aftermath of a comminuted fracture of the right lower limb, complicated by pseudoarthrosis. There was amyotrophy on the extremities with intense cruralgia. The patient had an antalgic attitude in the flexion affecting his rehabilitation. During 1 year, the symptoms were mimicking psychiatric disorders, malabsorption, or cancer before the final diagnosis of central hypocorticism with normal MRI was established. The evolution was remarkable after a few days of therapy with hydrocortisone, where the myalgia disappeared, the patient quickly gained weight, and the disappearance of the retractions allowed rehabilitation. These two observations emphasize the delayed diagnosis of adrenal insufficiency in the case of abdomino-crural-related symptoms and the presence of misleading neurological symptoms. The mechanisms of this syndrome remain unknown. [ABSTRACT FROM AUTHOR]

Musculoskeletal signs and symptoms of hypoadrenalism are less well described in the literature compared to other endocrine disorders such as diabetes mellitus and thyroid disease. This may in part be due to the difficulties associated with making a definitive diagnosis of hypoadrenalism where the general symptoms and signs can be very subtle. Hence, suspecting hypoadrenalism in a patient with mainly musculoskeletal features can be difficult and delayed. To illustrate this point, we present three cases of hypoadrenalism with varying degrees of rheumatological symptoms and signs. This article reviews all the cases of hypoadrenalism in the English, French and Spanish language medical literature, going back to the time of Thomas Addison. All the important clinical and laboratory features have been summarised to help clinicians diagnose and treat this disease. [ABSTRACT FROM AUTHOR]

We report the case of a 55-year-old male with flexion contractures of the hips and the knees due to an isolated adrenocorticotropin (ACTH) deficiency, a rare cause of secondary adrenal insufficiency. The presenting symptoms and signs, the laboratory investigations and the treatment are described. The case description is followed by a brief overview of ACTH deficiency and its symptoms and causes. Our case is then compared with other case reports available in the literature. The aetiology of the flexion contractures in adrenal insufficiency is still unclear. The authors want to draw attention to adrenal insufficiency as the cause of unexplained flexion contractures. [ABSTRACT FROM AUTHOR]