RESUMEN
Erosive hand osteoarthritis is common and debilitating. Diagnosis is based on the presence of bone erosions which can appear late. Ultrasonography allows earlier diagnosis. The presence of apatite deposits could be of poor prognosis. Non pharmacological treatment includes the explanation of the inflammatory phenomena involved and the use of splints and physical therapy. Drug therapy includes analgesics, NSAIDs and infiltration of a steroid. Chondroitin sulfates have an analgesic and functional effect proven. DMARDs such as hydroxychloroquine and methotrexate have been used successfully. Some patients also benefited from isotope synoviortheses. New therapeutic ways, based on the pathophysiology of the disease, are new under evaluation.
Asunto(s)
Antirreumáticos/uso terapéutico , Apatitas/metabolismo , Osteoartritis/terapia , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Sulfatos de Condroitina/uso terapéutico , Glucocorticoides/uso terapéutico , Mano , Humanos , Hidroxicloroquina/uso terapéutico , Metotrexato/uso terapéutico , Osteoartritis/diagnóstico , Osteoartritis/fisiopatología , PronósticoRESUMEN
Pulmonary involvement is the most frequent extra-articular manifestation of rheumatoid arthritis. The occurrence of a chronic hydro-pneumo-thorax associated with pulmonary nodules is rare. Cavitation of the most superficial nodules and their rupture into the pleural cavity are most likely involved in this complication. The presence of broncho-pleural fistulae may be responsible for the persistence of the phenomenon in our patient.
Asunto(s)
Artritis Reumatoide/complicaciones , Hidroneumotórax , Humanos , Hidroneumotórax/complicaciones , Hidroneumotórax/diagnóstico , Hidroneumotórax/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía Torácica , Nódulo Reumatoide/diagnóstico , Toracoscopía , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. CASE REPORT: We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. DISCUSSION: We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space.
Asunto(s)
Calcinosis/complicaciones , Calcinosis/diagnóstico , Discitis/complicaciones , Discitis/diagnóstico , Dolor de la Región Lumbar/etiología , Compresión de la Médula Espinal/diagnóstico , Compresión de la Médula Espinal/etiología , Enfermedad Aguda , Anciano , Antiinflamatorios no Esteroideos/uso terapéutico , Diagnóstico Diferencial , Discitis/tratamiento farmacológico , Femenino , Humanos , Dolor de la Región Lumbar/tratamiento farmacológico , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
Low back pain is a major burden for health care. According to the International Classification of Function, it is a disability of complex origin. Risk factors for chronification are of psychosocial and not physical nature. Primary targets of treatment should be physical fitness and the self-management of problem by the patient. Awareness of the psychosocial factors (yellow, blue and black flags) which can disturb occupational reintegration should be developed. Rehabilitation is based on measures to modify patient's beliefs and fitness. The prescribed treatment should aim to relieve pain, correct disability, prevent relapses, inform and educate the patient. Every low back pain sufferer which does not improve in 1 month should be sent to a team skilled in handling this kind of problem.
Asunto(s)
Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/terapia , Humanos , Dolor de la Región Lumbar/fisiopatología , Factores de RiesgoRESUMEN
The aim of this study was to assess the frequency and the outcome of patients suffering from rheumatoid arthritis in which calcium pyrophosphate dihydrate (CPPD) crystal deposits were found to coexist in synovial fluid analysis. Such association was more frequent than previously believed with CPPD crystals found in 25.8% of 93 patients with rheumatoid arthritis. As a group, a trend toward a worse outcome was suggested by more frequent prostheses of the lower limb.