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Background Platelet-rich plasma (PRP) therapy is utilized for chronic tenosynovitis to reduce inflammation and promote tendon sheath repair. This study compared the temporal kinetics of PRP-derived growth factors with clinical outcomes of PRP versus saline injection over 3 months. Methods In a randomized controlled trial, 200 patients with chronic tenosynovitis were assigned to non-activated PRP ( n  = 100) or saline ( n  = 100) tendon sheath injection. PRP group blood samples were collected at 1 h, 8 h, Days 1, 3, 7, 14, and 1 month post-injection; both groups had clinical and ultrasound assessments at 1 and 3 months. Serum VEGF, PDGF-AB, EGF, and TGF-β were quantified via ELISA, with platelet counts analyzed. Pain (VAS), function (WOMAC, DASH), and tendon sheath thickness were evaluated. Repeated-measures ANOVA and t-tests assessed changes. Results In the PRP group, non-activated PRP achieved a platelet concentration of 1030 ± 130 × 10³/µL (4.5× baseline), and biomarkers varied significantly ( p  < 0.001). VEGF peaked at Day 14 (285.44 ± 50.0 pg/mL), sustained at 260.0 ± 45.0 pg/mL (1 month). PDGF-AB peaked at 8 h (1253.28 ± 160.0 pg/mL), declining to 300.0 ± 90.0 pg/mL (1 month). EGF peaked at Day 7 (451.84 ± 75.0 pg/mL), returning to 380.0 ± 75.0 pg/mL (1 month). TGF-β exhibited plateau kinetics without a distinct peak, stabilizing at 8.50 ± 1.80 ng/mL (1 month). PRP outperformed saline in pain (− 50.0 mm vs. −31.0 mm), function (QuickDASH − 35.0 vs. −21.0), and sheath thickness reduction (− 0.9 mm vs. −0.4 mm) at 3 months (all p  < 0.001). PRP reduced VAS by 57% (30.0 ± 11.0 mm), WOMAC by 42% (35.0 ± 7.5), DASH by 38% (40.0 ± 9.5), and thickness by 45% (1.54 ± 0.30 mm) at 1 month; by 3 months, VAS was 20.0 ± 9.0 mm, WOMAC 25.0 ± 6.5, DASH 30.0 ± 7.5, thickness 1.40 ± 0.28 mm ( p  < 0.001). Saline reduced VAS by 30% (50.0 ± 14.0 mm), WOMAC by 26% (45.0 ± 9.5), DASH by 24% (50.0 ± 10.5), thickness by 30% (1.99 ± 0.38 mm) at 1 month; by 3 months, VAS was 40.0 ± 11.0 mm, WOMAC 40.0 ± 8.5, DASH 45.0 ± 9.5, thickness 1.85 ± 0.35 mm ( p  < 0.01). PRP outperformed saline ( p  < 0.001). Adverse events were mild (15% PRP, 7% saline). Conclusions Non-activated PRP induces time-specific growth factor release, outperforming saline in 3-month pain, function, and tendon thickness outcomes for tenosynovitis. The larger sample size enhances generalizability, aligning with recommendations for robust musculoskeletal trials and refuting claims of PRP equivalence to placebo. These findings guide PRP timing and support its efficacy over placebo. They also underscore the importance of individualized PRP dosing strategies based on platelet concentration thresholds. Trial registration In the Pan African Clinical Trials Registry (PACTR202506613254896) on 10 June 2025, and is accessible at: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=34788 .

Nocardiosis, typically affecting immunocompromised patients, can manifest in rare forms like hand tenosynovitis. We report a 91-year-old man with Nocardia vinacea , confirmed by genetic sequencing after negative cultures, likely caused by a gardening injury. The diagnosis was made early, in less than a week, thanks to molecular biology techniques performed directly on the specimen (synovial biopsy), drastically shortening the time needed to introduce antibiotic therapy adapted to Nocardiosis, as the Nocardia culture grew in around a month. This case emphasizes the need for early PCR testing and tailored diagnostic approaches. Clinical trial NA.

Objectives To investigate whether a treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid injections suppresses MRI inflammation and halts structural damage progression in patients with early rheumatoid arthritis (ERA), and whether adalimumab provides an additional effect. Methods In a double-blind, placebo-controlled trial, 85 disease-modifying antirheumatic drug-naïve patients with ERA were randomised to receive methotrexate, intra-articular glucocorticosteroid injections and placebo/adalimumab (43/42). Contrast-enhanced MRI of the right hand was performed at months 0, 6 and 12. Synovitis, osteitis, tenosynovitis, MRI bone erosion and joint space narrowing (JSN) were scored with validated methods. Dynamic contrast-enhanced MRI (DCE-MRI) was carried out in 14 patients. Results Synovitis, osteitis and tenosynovitis scores decreased highly significantly (p<0.0001) during the 12-months’ follow-up, with mean change scores of −3.7 (median −3.0), −2.2 (−1) and −5.3 (−4.0), respectively. No overall change in MRI bone erosion and JSN scores was seen, with change scores of 0.1 (0) and 0.2 (0). The tenosynovitis score at month 6 was significantly lower in the adalimumab group, 1.3 (0), than in the placebo group, 3.9 (2), Mann–Whitney: p<0.035. Furthermore, the osteitis score decreased significantly during the 12-months’ follow-up in the adalimumab group, but not in the placebo group, Wilcoxon: p=0.001–0.002 and p=0.062–0.146. DCE-MRI parameters correlated closely with conventional MRI inflammatory parameters. Clinical measures decreased highly significantly during follow-up. Conclusions A treat-to-target strategy with methotrexate and intra-articular glucocorticosteroid in patients with ERA effectively decreased synovitis, osteitis and tenosynovitis and halted structural damage progression as judged by MRI. The findings suggest that addition of adalimumab is associated with further suppression of osteitis and tenosynovitis.

ObjectiveThe aim of this study was to compare the efficacy of intramuscular versus ultrasound (US)-guided intratenosynovial glucocorticoid injection in providing disease control after 2, 4 and 12 weeks in patients with rheumatoid arthritis(RA) with tenosynovitis.MethodsFifty patients with RA and tenosynovitis were randomised into two double-blind groups: (A) ‘intramuscular group’, receiving intramuscular injection of betamethasone and US-guided intratenosynovial isotonic saline injection and (B) ‘intratenosynovial group’ receiving saline intramuscularly and US-guided intratenosynovial betamethasone injection. All patients were in stable disease-modifying anti-rheumatic drug treatment prior to and during the study. Patients were excluded, and considered non-responders, if any treatments were altered during the follow-up period. ‘US tenosynovitis remission’, defined as US tenosynovitis grey-scale score ≤1 and colour Doppler score=0, was assessed at week 4 (primary outcome), and weeks 2 and 12, using non-responder imputation for missing data.ResultsUS tenosynovitis remission at week 4 was achieved in 25% (6/24) in the ‘intramuscular group’ versus 64% (16/25) in the ‘intratenosynovial group’, that is, a difference of −39 percentage point (pp) (CI −65pp to −13pp), Fisher exact test p=0.001. Corresponding values for the ‘intramuscular group’ versus the ‘intratenosynovial group’ at 2 and 12 weeks were 21% (5/24) versus 48% (13/25), that is, a difference of −27pp (CI −53pp to −2pp), p=0.072 and 8% (2/24) versus 44% (11/25), that is, difference of −36pp (−58pp to −13pp), p=0.003. Most US, clinical and patient-reported scores improved more in the ‘intratenosynovial group’ at all follow-up visits.ConclusionsIn this randomised double-blind clinical trial, patients with RA and tenosynovitis responded significantly better to US-guided intratenosynovial glucocorticoid injection than to intramuscular glucocorticoid injection, both at 4 and 12 weeks follow-up.Trial registration numberEudraCT nr: 2013-003486-34.

Mycoplasma arginini is a bacterium primarily found in animals and is seldom reported in human infections. We identified M. arginini infection in a severely immunocompromised kidney transplant recipient in Slovenia. Clinicians should be aware of M. arginini's potential as a pathogen in immunocompromised persons with animal contact.

ObjectivesSkin and joint involvement in psoriasis (PsO) and psoriatic arthritis (PsA) are thought to relate to the so-called Koebner response. Given that dactylitis is non-randomly distributed in the digits, this study tested the hypothesis that the accessory pulleys linked to the flexor tendons were thickened in PsA and thus exhibited koebnerisation.MethodsNinety-six subjects (27 PsA, 27 rheumatoid arthritis (RA), 23 PsO and 19 healthy controls (HCs)) were enrolled. The A1, A2 and A4 pulley thickness was measured using a high-resolution probe (22 MHz). All patients were in remission or low disease activity with current dactylitis being excluded.ResultsWithin 864 pulleys investigated, patients with PsA had thicker pulleys in every digit compared with both RA (P<0.001 and P=0.003) and HCs (P<0.001). RA and PsO groups had some pulleys in some digits thicker than HCs whereas some others were comparable. The second digit A1 pulley thickness was higher in patients with PsA with previous dactylitis (P=0.020). More pulleys were thickened in the PsA group (165/243, 68%) than RA (41/243, 17%; P<0.001) and HCs (13/171, 7.6%; P<0.001).ConclusionsIn established PsA, the accessory pulleys are thickened compared with RA, PsO or HCs and especially in subjects with a history of dactylitis. These findings implicate the involvement of pulleys in PsA-related tenosynovitis and dactylitis supporting the idea of deep koebnerisation in dactylitis and sites of high physical stress.

Pyogenic flexor tenosynovitis (FTS) is a rapidly progressing infection of the flexor tendon sheath synovial fluid. Bacterial seeding most often occurs from trauma overlying the sheath followed by swift proximal propagation. FTS is an uncommon but high morbidity disease that emergency physicians must identify early to prevent devastating complications such as tendon rupture, digit necrosis, and sepsis. Here, we report a case of FTS that occurred in an immunocompetent 82-year-old female approximately 48 h after a fingerstick glucose test.

ObjectiveTo define the role of ultrasound (US) for the assessment of patients with rheumatoid arthritis (RA) in clinical remission, including joint and tendon evaluation.MethodsA multicentre longitudinal study has been promoted by the US Study Group of the Italian Society for Rheumatology. 25 Italian centres participated, enrolling consecutive patients with RA in clinical remission. All patients underwent complete clinical assessment (demographic data, disease characteristics, laboratory exams, clinical assessment of 28 joints and patient/physician-reported outcomes) and Power Doppler (PD) US evaluation of wrist, metacarpalphalangeal joints, proximal interphalangeal joints and synovial tendons of the hands and wrists at enrolment, 6 and 12 months. The association between clinical and US variables with flare, disability and radiographic progression was evaluated by univariable and adjusted logistic regression models.Results361 patients were enrolled, the mean age was 56.20 (±13.31) years and 261 were women, with a mean disease duration of 9.75 (±8.07) years. In the 12 months follow-up, 98/326 (30.1%) patients presented a disease flare. The concurrent presence of PD positive tenosynovitis and joint synovitis predicted disease flare, with an OR (95% CI) of 2.75 (1.45 to 5.20) in crude analyses and 2.09 (1.06 to 4.13) in adjusted analyses. US variables did not predict the worsening of function or radiographic progression. US was able to predict flare at 12 months but not at 6 months.ConclusionsPD positivity in tendons and joints is an independent risk factor of flare in patients with RA in clinical remission. Musculoskeletal ultrasound evaluation is a valuable tool to monitor and help decision making in patients with RA in clinical remission.

Background Non-tuberculous mycobacteria (NTM) are environmental organisms that are increasingly contributing to human infections. Mycobacterium immunogenum , a variant of NTM discovered in 2001, is a rapidly growing mycobacterium that exhibits multidrug resistance. Reports of infections caused by this organism, particularly tenosynovitis in the musculoskeletal system, are limited. Case presentation A 71-year-old female with vesicular pemphigus, undergoing immunosuppressive therapy, presented with a progressively enlarging tumour on the dorsum of her right hand, along with erythematous papules that extended across her right forearm. The specimens of skin tissues and blood cultures revealed the presence of M. immunogenum . Magnetic resonance imaging evaluation led to the diagnosis of pyogenic extensor tenosynovitis. A multidrug regimen, comprising amikacin and clarithromycin, was initiated, followed by synovectomy. The patient underwent a course of 180 days of antimicrobial therapy and demonstrated no signs of disease recurrence one year after treatment completion. Conclusion Early diagnosis and surgical intervention are crucial to prevent the adverse prognostic implications of pyogenic extensor tenosynovitis caused by M. immunogenum . Effective management requires precise microbial identification and susceptibility testing, necessitating collaborative engagement with microbiological laboratories.