idiopathic joint apoplexy

COMMSJNICATIONS - Idiopathic Joint Apoplexy Sir: In the June, 1969, issue of Arthritis Rheum., page 287, the abstract entitled “Idiopathic Joint Apoplexy” written by George L. Cohen, Allen R. Myers, and Edward D. Harris, Jr., all of Boston, Mass., raises the question in my mind as to whether these individuals may not actually have intraarticular hemangiomas. In reviewing the literature and my own personal experience with intraarticular hemangiomas, I find that it is not uncommon for patients to present with a history of pain, swelling, warmth, and erythema of a single joint with negative x-rays, and to have grossly bloody synovial fluid. When these joints are opened, an intraarticular hemangioma is often found. If these joints are merely aspirated, bloody synovial fluid is obtained. If the synovial tissue is biopsied, a nonspecific inflammatory reaction is often present with hemo- siderin within the synovial lining cells. I would like to call your attention to this intraarticular neoplasm and suggest that, rather than feel secure in the diagnosis of idiopathic joint apoplexy, an exploration of the involved joint be carried out, inasmuch as intraarticular hemangioma may present the exact same picture. Not only can the diagnosis be established at exploration, but also cure can be achieved by the simple removal of the intraarticular hemangioma. In reviewing the histories of patients with intraarticular hemangiomas, I found it interesting to note that many of these patients went undiagnosed for many years. Their symptoms were recurrent and subsided when they were placed on salicylates and bed rest, only to return after the hemangioma was traumatized during either walking or some other type of activity. Many of these patients were initially thought to be neurotic inasmuch as no objective evidence of joint disease was present until the actual episode of bleeding occurred, and at that time many were initially treated con- servatively until joint exploration revealed the true etiology of their pathology. ALFRED MILLER, M.D. San Antonio, Texas 646 ARTHRITIS AND RHEUMATISM, VOL. 12, No. 6 (DECEMBER, 1969)

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COMMSJNICATIONS --

Idiopathic Joint Apoplexy

Sir: In the June, 1969, issue of Arthritis Rheum.,

page 287, the abstract entitled “Idiopathic Joint Apoplexy” written by George L. Cohen, Allen R. Myers, and Edward D. Harris, Jr., all of Boston, Mass., raises the question in my mind as to whether these individuals may not actually have intraarticular hemangiomas.

In reviewing the literature and my own personal experience with intraarticular hemangiomas, I find that it is not uncommon for patients to present with a history of pain, swelling, warmth, and erythema of a single joint with negative x-rays, and to have grossly bloody synovial fluid. When these joints are opened, an intraarticular hemangioma is often found. If these joints are merely aspirated, bloody synovial fluid is obtained. If the synovial tissue is biopsied, a nonspecific inflammatory reaction is often present with hemo- siderin within the synovial lining cells.

I would like to call your attention to this intraarticular neoplasm and suggest that, rather than feel secure in the diagnosis of idiopathic joint

apoplexy, an exploration of the involved joint be carried out, inasmuch as intraarticular hemangioma may present the exact same picture. Not only can the diagnosis be established at exploration, but also cure can be achieved by the simple removal of the intraarticular hemangioma.

In reviewing the histories of patients with intraarticular hemangiomas, I found it interesting to note that many of these patients went undiagnosed for many years. Their symptoms were recurrent and subsided when they were placed on salicylates and bed rest, only to return after the hemangioma was traumatized during either walking or some other type of activity. Many of these patients were initially thought to be neurotic inasmuch as no objective evidence of joint disease was present until the actual episode of bleeding occurred, and at that time many were initially treated con- servatively until joint exploration revealed the true etiology of their pathology.

ALFRED MILLER, M.D. San Antonio, Texas

646 ARTHRITIS AND RHEUMATISM, VOL. 12, No. 6 (DECEMBER, 1969)

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