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Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature

Lipoma arborescens (LA) is a chronic, slowly progressive intra-articular mass associated with the proliferation of synovial villi. It can affect one or several joints and has been commonly described in adults with degenerative joint disease. Most patients have been diagnosed with MRI and/or biopsy f...

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Autores principales: Frkovic, Marijan, Kujundzic, Magdalena, Cavka, Mislav, Jelusic, Marija
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9763560/
https://www.ncbi.nlm.nih.gov/pubmed/36561488
http://dx.doi.org/10.3389/fped.2022.1014536
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author Frkovic, Marijan
Kujundzic, Magdalena
Cavka, Mislav
Jelusic, Marija
author_facet Frkovic, Marijan
Kujundzic, Magdalena
Cavka, Mislav
Jelusic, Marija
author_sort Frkovic, Marijan
collection PubMed
description Lipoma arborescens (LA) is a chronic, slowly progressive intra-articular mass associated with the proliferation of synovial villi. It can affect one or several joints and has been commonly described in adults with degenerative joint disease. Most patients have been diagnosed with MRI and/or biopsy findings and are usually treated with partial or total synovectomy. Case reports of LA in children, particularly with juvenile idiopathic arthritis (JIA) are scarce. We present a 16-year-old girl with a prolonged course of psoriatic JIA (initial bilateral knee affection and subsequent involvement of wrists and elbows combined with psoriatic scalp lesions) and LA of both knees. Psoriatic JIA has been diagnosed at the age of 13, with immediate start of methotrexate (MTX) therapy. Several weeks later, magnetic resonance imaging (MRI) of the right knee, performed with the aim of the most swollen joint additional evaluation, revealed synovial changes consistent with LA; arthroscopic biopsy confirmed the diagnosis. After two years of MTX treatment, despite the successful maintenance of minimal JIA activity except for repetitive bilateral knee swelling, control MRI revealed bilateral knee lesions identical to those described two years earlier in the right knee. Following the step-up approach in JIA treatment, the TNF inhibitor adalimumab was added in therapy. Finally, six months later, clinical reduction of both knees swelling was noticed with almost complete LA regression in the right, and partial regression in the left knee, confirmed by final MRI control. A conservative approach, including TNF inhibitors, instead of usually performing synovectomy, seems like a reasonable option in cases of LA with underlying JIA.
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spelling pubmed-97635602022-12-21 Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature Frkovic, Marijan Kujundzic, Magdalena Cavka, Mislav Jelusic, Marija Front Pediatr Pediatrics Lipoma arborescens (LA) is a chronic, slowly progressive intra-articular mass associated with the proliferation of synovial villi. It can affect one or several joints and has been commonly described in adults with degenerative joint disease. Most patients have been diagnosed with MRI and/or biopsy findings and are usually treated with partial or total synovectomy. Case reports of LA in children, particularly with juvenile idiopathic arthritis (JIA) are scarce. We present a 16-year-old girl with a prolonged course of psoriatic JIA (initial bilateral knee affection and subsequent involvement of wrists and elbows combined with psoriatic scalp lesions) and LA of both knees. Psoriatic JIA has been diagnosed at the age of 13, with immediate start of methotrexate (MTX) therapy. Several weeks later, magnetic resonance imaging (MRI) of the right knee, performed with the aim of the most swollen joint additional evaluation, revealed synovial changes consistent with LA; arthroscopic biopsy confirmed the diagnosis. After two years of MTX treatment, despite the successful maintenance of minimal JIA activity except for repetitive bilateral knee swelling, control MRI revealed bilateral knee lesions identical to those described two years earlier in the right knee. Following the step-up approach in JIA treatment, the TNF inhibitor adalimumab was added in therapy. Finally, six months later, clinical reduction of both knees swelling was noticed with almost complete LA regression in the right, and partial regression in the left knee, confirmed by final MRI control. A conservative approach, including TNF inhibitors, instead of usually performing synovectomy, seems like a reasonable option in cases of LA with underlying JIA. Frontiers Media S.A. 2022-12-06 /pmc/articles/PMC9763560/ /pubmed/36561488 http://dx.doi.org/10.3389/fped.2022.1014536 Text en © 2022 Frkovic, Kujundzic, Cavka and Jelusic. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Frkovic, Marijan
Kujundzic, Magdalena
Cavka, Mislav
Jelusic, Marija
Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature
title Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature
title_full Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature
title_fullStr Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature
title_full_unstemmed Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature
title_short Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature
title_sort successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9763560/
https://www.ncbi.nlm.nih.gov/pubmed/36561488
http://dx.doi.org/10.3389/fped.2022.1014536
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