Swelling tendon with hyperemia in patient with RA

[Xue Heng]

Hi,Steve.
We know for RA, the target is the synovium, resulting in synovitis.
But in some patients with RA, except for synovitis, we sometimes observe swelling tendon with hyperemia and even ruptured tendon. Since there is no synovium inside the tendon, how can we explain this phenomenon and make the diagnosis?
Thank you for your detailed and patient answering, Steve.

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[Stephen Bird]

Good question Xue.

You are correct when you say that the tendon is made of collagen and not synovium so it should be immune to attack by RA.
However the tendon has a synovial sheath (well at least most do) and pin this case it is tibialis posterior and that certainly has a synovial sheath. The synovium in the sheath is attacked by the RA and a tenosynovitis results. The inflamed sheath is a hostile environment for the tendon and we see tendinosis and eventual rupture ensue.

This is a common problem in RA patients.

Your images are beautiful and a classic example of RA disease leading to tenosynovitis and eventual tendon failure.

You will also see other synovium containing structures coming under attack such as bursae.

Nice one Xue,

Steve

[Xue Heng]

Thank you very much, Steve.
“The inflamed sheath is a hostile environment for the tendon and we see tendinosis”, I will remenber the sentence and tell others who have the same question like me.

[Stephen Bird]

Nice one Xue,

With a bit of luck I will be able to travel to Beijing next year and we can do some great work together again.

Australian borders are opening up slowly as our vaccination rate increases.

Most things will be open by Christmas.

I hope to see you in 2022

Steve

[Xue Heng]

Hope the pandemic of COVID-19 be over soon.
Can’t wait to see you and to listen to your wonderful lectures.

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