person-years compared with an overall incidence rate of 10.2 and 4.1 per million person-years in localized and diffuse types, respectively3. To date, the incidence rate for chronic monoarthritis
in children and adolescents is unknown. Savolainen et al. calculated an incidence rate of 64 per 100,000 for all types of arthritis in children (< 16 years) in a defined population in Finland24.
Although TGCT in children probably accounts for only a small percentage of all types of arthritis, it should still be considered in the differential diagnosis.
Symptoms in children seemed similar to those in adults (Table 1). Nonspecific symptoms accompanied by pain and diffuse joint swelling with thickening of the synovial capsule and/or joint effusion resulted in limited movement in approximately half of the patients. Studies in adults add mechanical symptoms, instability, and stiffness5, 25.
A systematic review (without age limitations) in 20135 reported average recurrence rates for
localized TGCT in the knee after open resection (4%) and after arthroscopic resection (6%) in contrast to diffuse type after open resection (14%) and after arthroscopic resection (40%) at a mean followup of 108 months. Patel et al.25 presented 214 patients with knee TGCT of all ages with
a recurrence rate of 9% in 100 localized patients and 48% in 114 patients with diffuse TGCT after a mean followup of 25 months (range, 1-168 months). Palmerini et al.26 reported 294 patients with
TGCT of all ages in all joints with a local failure rate of 14% in localized and 36% in diffuse type after a median followup of 4.4 years (range, 1-20 years). The sole primary disease or patients with a first relapse were included. The current paediatric case-series showed comparable recurrence rates of 7% in localized and 39% in diffuse type after a mean followup of 55 months (range, 7-350 months). TGCT is a rare condition in adults and it is even less common in children. Nonspecific symptoms often contribute to a delay in establishing a diagnosis. TGCT should be considered in chronic monoarthritis both in adults and in children. Recurrent disease after surgical treatment of this orphan disease seems comparable between children and adults. With targeted therapies now being developed27, future research should define the most effective treatment strategies for this
heterogeneous disease. Supplementary data
Supplementary data are available in the online version of this article: https://dx.doi.org/10.1007/s11999.0000000000000102
134 Chapter six
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