Open AccessPancreatitis with arthropathy and subcutaneous fat necrosis
Author(s) -
Alexander Wilson H.,
Askari Ali D.,
Neiderhiser Dewey H.,
MyronJohnson A.,
Andrews Brian S.,
Hoskins Lansing C.
Publication year - 1983
Publication title -
arthritis & rheumatism
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/art.1780260201
Subject(s) - adipose tissue , medicine , pancreatitis , necrosis , synovial fluid , fat necrosis , pathology , endocrinology , fatty acid , steatosis , lipase , enzyme , chemistry , osteoarthritis , biochemistry , alternative medicine
The occurrence of peripheral fat necrosis in exceptional cases of pancreatic disease is not well understood. We report studies on such a patient with arthropathy and subcutaneous nodules. Examination of serial serum samples demonstrated striking elevations of the pancreatic enzymes phospholipase A, 3–3.4 units/ml (normal 0.17–0.41); lipase, 7–39 Sigma‐Tietz units/ml (normal < 1); immunoreactive trypsin, 912–3,207 ng/ml (normal 12–41). The distinguishing characteristic of the patient's synovial fluid was a marked elevation of hydrolized fatty acids (680 mg/dl versus 19 ± 19 in control inflammatory joint fluids). Synovial fluid fatty acid distribution was identical to values for tissue fat. In contrast, serum fatty acid levels and distribution were normal. No associated proteinase inhibitor or significant immunologic abnormality was detected. Certain properties of adipose cells and lipolytic enzymes may help explain the characteristically selective necrosis of fat cells observed in this syndrome.