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Knee Arthrocentesis in Adults

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Published on: February 25, 2022

Subarticular Inflammatory Pseudoabscesses: A Pathologic Study With Clinical Correlation.

Lingxin Zhang^1,2, Serene Z Mirza¹, Edward F DiCarlo¹

¹Department of Pathology and Laboratory Medicine, Hospital for Special Surgery.

The American Journal of Surgical Pathology

|April 16, 2020

Summary

This summary is machine-generated.

Inflammatory pseudoabscesses, collections of immune cells in bone, mimic infection but are linked to inflammatory joint diseases like rheumatoid arthritis. Recognizing this pattern aids in diagnosing non-infectious inflammatory conditions.

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Area of Science:

Pathology
Orthopedics
Rheumatology

Background:

Subarticular bone neutrophil accumulation often suggests osteomyelitis or septic arthritis, serious infections.
A distinct pattern of subarticular inflammation mimicking infection was observed.
This pattern was termed "inflammatory pseudoabscess".

Purpose of the Study:

To describe the clinicopathologic features of inflammatory pseudoabscesses.
To determine the association of inflammatory pseudoabscesses with underlying joint diseases.
To differentiate inflammatory pseudoabscesses from infectious processes.

Main Methods:

Retrospective analysis of 157 primary arthroplasty/osteotomy specimens (1997-2015).
Histopathologic examination for neutrophils, macrophages, fibrin, and inflammatory joint disease features.
Review of clinical information for 137 patients.

Main Results:

157 cases of inflammatory pseudoabscesses identified in specimens without penetrating trauma or hardware.
Predominant features included lymphoplasmacytic synovitis (95.3%) and subchondral osseous chronic inflammation (80.3%).
107 patients (74.8%) had diagnosed inflammatory arthropathy, most commonly rheumatoid arthritis; 21.0% had no documented inflammatory disorders but suggestive features.

Conclusions:

Inflammatory pseudoabscesses represent an intraosseous manifestation of noninfectious inflammatory joint disorders.
Recognition by pathologists can prompt clinical evaluation for undiagnosed inflammatory joint diseases.
This finding helps distinguish non-infectious inflammatory conditions from bone infections.