The Journal of Rheumatology Volume 43, no. 5

with Systemic Lupus ErythematosusSynovial Chondromatosis of the Suprapatellar Pouch of the Knee in a Patient

YASUHIRO SUYAMA, SHUICHI NAKAYAMA and KIYOFUMI HAGIWARA

http://www.jrheum.org/content/43/5/948J Rheumatol 2016;43;948

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948 The Journal of Rheumatology 2016; 43:5; doi:10.3899/jrheum.151396

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Synovial Chondromatosis of the Suprapatellar Pouch ofthe Knee in a Patient with Systemic Lupus ErythematosusYASUHIRO SUYAMA, MD, Division of Rheumatology, JR Tokyo General Hospital, Tokyo, Japan; SHUICHI NAKAYAMA, MD, Department ofOrthopedic Surgery, JR Tokyo General Hospital, Tokyo, Japan; KIYOFUMI HAGIWARA, MD, PhD, Division of Rheumatology, JR Tokyo GeneralHospital, Tokyo, Japan. Address correspondence to Dr. Y. Suyama, Division of Rheumatology, JR Tokyo General Hospital, 2-1-3 Yoyogi Shibuya-ku, Tokyo151-8528, Japan. E-mail: y-suyama@jreast.co.jp. J Rheumatol 2016;43:948; doi:10.3899/jrheum.151396

Synovial chondromatosis is an uncommon benign neoplasticdisease that mainly affects men in the third to fifth decadesof life. Secondary synovial chondromatosis is considered tobe associated with slowly progressive degenerative jointdisease, including trauma and neurological disease1.Systemic lupus erythematosus (SLE) is not related to theetiological factor.A 75-year-old woman with a history of SLE and schizo-

phrenia presented with a complaint of right knee pain for 3years. There was no history of trauma. Physical examinationrevealed tenderness and edema over the right knee, limitedrange of motion in the knee, and a bony nodule palpated underthe suprapatellar region. Synovial fluid analysis was negativefor crystals, malignant cells, and bacteria. Radiographs of theright knee revealed multiple ossified nodules in both thesuprapatellar pouch and joint space of the knee (Figure 1A).The patient was diagnosed with synovial chondromatosis and

underwent open synovectomy. The patient was found to havea thickened synovium containing smaller calcific bodieswithin the suprapatellar pouch, which was extending into theadjacent knee joint space. An area of smaller nodules that wascoexisting with multiple smaller loose bodies and the synovialtissue were removed (Figure 1B).The characteristic loose bodies develop as a result of the

proliferation of the synovial membrane. The fragments maybreak off from the synovial surface into the joint space, whichmay lead to pain, swelling, and locking of the joint. It isusually monoarticular, and the primary joints affected are theknee, hip, elbow, and humeral joint2. Extraarticular sitesarising in the synovium around the tendons or bursa, and agiant solitary synovial osteochondromatosis have also beendescribed1. Complete synovectomy and removal of the loosebodies are recommended for pain relief and functionalmovement recovery2.

Figure 1.A. Anteroposterior andlateral radiographs of the right kneerevealed multiple ossified nodules inboth the suprapatellar pouch and jointspace of the knee. B. Opensynovectomy revealed a thickenedsynovium containing smaller calcificbodies within the suprapatellar pouch,which was extending into the adjacentknee joint space.

REFERENCES 1. Edeiken J, Edeiken BS, Ayala

AG, Raymond AK, Murray JA,Guo SQ. Giant solitary synovialchondromatosis. Skeletal Radiol1994;23:23-9.

2. McKenzie G, Raby N, RitchieD. A pictorial review of primarysynovial osteochondromatosis.Eur Radiol 2008;18:2662-9.

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