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CME Rheumatology 24: DISH of the Hand and Undifferentiated Polyarthritis Abstract. We present a case with undifferentiated, unclassified polyarthritis and with peripheral diffuse idiopathic skeletal hyperostosis (DISH). We discuss the differential diagnoses of "seronegative" polyarthritis and explain the radiographic findings of the little-known peripheral aspects of DISH.

CME Rheumatology 20: Parvovirus B19-Induced Tenosynovitis? Abstract. In this case presentation we discuss diagnostic algorithms and differential diagnoses in undifferentiated tenosynovitis. We present a case of a patient with chronic tenosynovitis in the 4th extensor tendon compartment. With unremarkable anamnesis and due to normal laboratory results a «seronegative (RF), ACPA (CCP)-negative tenosynovitis without arthritis» had been reported. Diagnostic and therapeutic tenosynovectomy was performed. Histologic processing revealed a positive PCR for parvovirus B19. We discuss articular and extraarticular manifestations. A parvovirus B19-associated manifestation in the musculoskeletal system is usually self-limiting. The therapy should be carried out symptomatically. In our patient there was a marked local finding, so that the complete tenosynovectomy followed by a single steroid injection led to a persistent restitutio ad integrum.

Injections of joint and of periarticular structures (e. g. tendon sheath) are frequent procedures in daily practice. In this review we summarize recent guidelines of injection technique, as we presented at the practical workshops oft he «Medidays» congress at the University Hospital Zurich. Furthermore we discuss drugs, indications, complications, adverse reactions and contraindications. Lastly we discuss the role of ultrasound guided injections. Ultrasound-guided diagnostic and therapeutic interventions are characterized by their excellent accuracy and improvement of clinical effectiveness compared to unguided procedures.

Many rheumatic diseases show changes and are visible in the hands. The pattern of distribution in the relevant joints, soft-tissue changes, skin manifestations, neurological and vascular symptoms and clinical findings provide fundamental information. Imaging and lab results provide diagnostic support. In this review, common diseases are presented in terms of their clinical expressions in the hands: osteoarthritis, rheumatoid arthritis, gout, calcium pyrophosphate dihydrate deposition disease, psoriatic arthritis, reactive arthritis, systemic sclerosis, dermatomyositis/polymyositis and systemic lupus erythematosus. Furthermore, we discuss pathological findings of the hands as a result of diabetic cheiroarthropathia, endocarditis, secondary hypertrophic osteo-arthropathy and chronic regional pain syndrom.

Musculoskeletal ultrasonography (US) is an established and validated imaging technique in rheumatology. Ultrasonography is able to directly visualize soft tissue pathologies such as synovial tissue changes. Pathological findings in superficial cartilage, bone lesions and synovial tissue changes in the context of rheumatoid arthritis, spondyloarthritis or crystal arthropathies may only be seen by sonography or detected earlier by ultrasonography compared to conventional imaging techniques. The activity of an inflammatory arthropathy can be visualized using Doppler and power Doppler US. US is helpful in the detection of early inflammatory changes, particularly in patients with undifferentiated arthritis and/or unremarkable conventional radiography. In addition to diagnosis in early arthritis and monitoring of therapy in rheumatoid arthritis, sonography is able to detect pivotal pathologies in spondyloarthritis and crystal deposition diseases such as gout, pseudogout and apatite deposition disease. Ultrasound-guided diagnostic and therapeutic interventions are characterized by their excellent accuracy and improvement of clinical effectiveness compared to unguided procedures. In conclusion, ultrasonography plays a pivotal role in the assessment and monitoring of therapy in rheumatic diseases.

This article reviews the aspects which were discussed at the SGUM congress in Davos in the talk «why are bats better than physicians». The talk focussed on modern aspects of Ultrasound (US) diagnostics at the locomotor system. High frequency US probes allow accurate diagnosis, initial assessment and follow up in Rheumatoid Arthritis and Osteo-Arthritis. Basic pathologic features in these pathologic conditions in form of synovitis, erosion and cartilage damage are described. In case of entrapment neuropathies -- first of all in carpal tunnel syndrome -- pathognomonic sonomorphologic changes can be detected and allow to confirm a clinical suspicion. The correct indication for diagnostic or therapeutic interventions at the musculoskeletal system can be critically verified and if necessary revised. The guidance of the intervention by US guarantees high accuracy of needle placement and thereby increases the diagnostic yield and the therapeutic success of injections/infiltrations [ABSTRACT FROM AUTHOR]

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