Massoud Saghafi, MD; Azita Azarian, MD
Abstract
Background: Rheumatoid arthritis is the most prevalent chronic inflammatory joint disease. Popliteal cyst may appear during the disease course and with increasing intra-articular pressure is extended down to the posterior aspect of the involved leg to produce a giant Baker's cyst. Local compression, ...
Read More
Background: Rheumatoid arthritis is the most prevalent chronic inflammatory joint disease. Popliteal cyst may appear during the disease course and with increasing intra-articular pressure is extended down to the posterior aspect of the involved leg to produce a giant Baker's cyst. Local compression, dissection, or rupture of the cyst may also, lead to a clinical presentation simulating thrombophlebitis. The aim of this paper is to report the clinical features, predisposing factors, diagnostic techniques, course and management of giant Baker’s cyst in patients with rheumatoid arthritis.Methods: In a retrospective cohort study, the complications of giant Baker's cyst in 993 patients with arthritis admitted in the rheumatology unit during the last 20 years were studied. Based on the clinical picture and confirmation of imaging techniques, 23 patients (12 female, 11 male) had giant Baker's cyst which extended lower than the inferior level of the popliteal fossa. This was the material for this study.Results: The mean age of the patients was 48 years old (24-71) and mean duration of the rheumatoid disease by the time of development of giant Baker’s cyst was 6.8 years (1-20). Right knee was involved in 13 and left knee in 10 patients. The clinical features- other than the underlying disease- were: pain and tenderness of the involved leg in 8 (34.8%), and the symptoms similar to thrombophlebitis in 15 patients (65.2%). There was a deep vein thrombosis accompanied with giant Baker’s cyst in one patient. Rupture of the cyst was detected in 5 patients (21.7%). The management was generally medical and conservative and resulted into satisfactory outcome. Two patients, however, had recurrence of Baker's cyst and signs of rupture of the cyst. They underwent surgical cystectomy along with synovectomy of the involved knee joint.Conclusion: Popliteal cyst in patients with rheumatoid arthritis should be considered and preventive and conservative management should be performed before it extends to become a giant Baker's cyst leading to complications of local compression, rupture, and pseudothrombophlebitis.
