RESUMEN
OBJECTIVES: We aimed to compare the painless synovitis evolution with painful synovitis, based on bone erosion by ultrasonography over a year in women with longstanding rheumatoid arthritis. Ultrasound inflammatory measurements and radiographic, functional and clinical findings were also compared between groups at the end of the same follow-up. METHODS: A prospective cohort study was rolled out, involving 60 women with RA, divided into two groups: painless and painful, with 30 patients in each group. The wrist and MCPs joints were assessed by ultrasound and plain x-ray, initially and after 12 months (T0 and T12). There was also a clinical assessment (activity scores, functional tests, disease and treatment progression variables) at 6 and 12 months. RESULTS: Patients' average age was 58.0±12.8 and average length of disease 16.4±9.8 years. Initially, the demographic characteristics were similar between groups, however, the painful group had worse clinical and functional scores. There were no statistically significant differences in the majority of US bone erosions and US inflammatory measurements, nor in radiographic progression variables between the groups. Over one year, pinch strength test and DAS 28 remained worse in the painful group (p<0.05). Clinical worsening variables and change of treatment evolved similarly between the groups, on T6 and T12. CONCLUSIONS: According to the study, the painless group progressed similarly to the painful one over a year, as regards bone erosion, ultrasound inflammatory measurements, radiographic findings, clinical worsening and change of treatment in female longstanding RA patients.
Asunto(s)
Artritis Reumatoide , Sinovitis , Anciano , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/tratamiento farmacológico , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Sinovitis/diagnóstico por imagen , UltrasonografíaRESUMEN
Compare the medium-term effectiveness and tolerance between joint lavage (JL) in combination with triamcinolone hexacetonide (TH) intra-articular injection (IAI) and IAI with TH alone for treatment of primary osteoarthritis (OA) of the knee. A randomized, double-blind, controlled study was carried out on 60 patients with primary OA of the knee, randomized into two intervention groups: JL/TH group, joint lavage in combination with TH intra-articular injection and TH group, TH intra-articular injection. Patients were followed for 12 weeks by a blind observer using the following outcome measurements: visual analogue scale for pain at rest and in movement, goniometry, WOMAC, Lequesne's index, timed 50-ft walk, perception of improvement, Likert scale for improvement assessment, use of nonsteroidal anti-inflammatory drugs and analgesics, and local side effects. There were no statistical differences in the inter-group analysis for any of the variables studied over the 12-week period. Although both groups demonstrated statistical improvement in the intra-group evaluation (except for Likert scale according to patient and the use of anti-inflammatory drugs). In the Kellgren-Lawrence scale (KL) 2 and 3 sub-analysis, there was a statistical difference regarding joint flexion among patients classified as KL 2, favoring the TH group (p=0.03). For the KL 3 patients, there were statistical differences favoring the JL/TH group regarding Lequesne (p=0.021), WOMAC pain score (p=0.01), and Likert scale according to the patient (p=0.028) and the physician (p=0.034). The combination of joint lavage and IAI with TH was not more effective than IAI with TH alone in the treatment of primary OA of the knee. However, KL 3 patients may receive a major benefit from this combination.
Asunto(s)
Inyecciones Intraarticulares/métodos , Osteoartritis de la Rodilla/terapia , Triamcinolona Acetonida/análogos & derivados , Corticoesteroides/farmacología , Anciano , Antiinflamatorios/administración & dosificación , Antiinflamatorios/farmacología , Método Doble Ciego , Femenino , Humanos , Articulación de la Rodilla/efectos de los fármacos , Masculino , Persona de Mediana Edad , Reumatología/métodos , Programas Informáticos , Resultado del Tratamiento , Triamcinolona Acetonida/administración & dosificaciónRESUMEN
A hipoplasia de medula óssea é um efeito colateral incomum do uso de maetotrexato (MTX), em baixas doses, na artrite reumatóide (AR). Fatores de risco para essa complicação são: Hipoalbuminemia, queda do clearance de creatinina, alcoolismo, idade avançada e uso de certas drogas, como a ranitidina ou sulfametoxazol-trimetoprim. Os autores não encontraram relatos desse efeito adverso no lúpus eritematoso sistêmico e apresentam um caso de hipoplasia de medula óssea em paciente com LES em atividade, que estava sendo tratado com baixas doses de MTX. Discutem, também, os fatores de risco para essa complicação