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Artritis , Quistes , Enfermedades Pulmonares Intersticiales , Humanos , Niño , Pulmón , Artritis/diagnóstico por imagenRESUMEN
OBJECTIVES: To measure with US the intima-media thickness (IMT) of temporal (superficial, parietal and frontal branches) and axillary arteries in subjects without a diagnosis of GCA and/or PMR with different cardiovascular (CV) risk; and to assess the performance of previously proposed cut-off values for normal IMT. METHODS: Subjects ≥ 50 years without a diagnosis of GCA or PMR were included. Bilateral US of the temporal arteries, including the frontal and parietal branches, and axillary arteries was performed by two sonographers using a 10-22 MHz and 6-18 MHz probe. The following previously proposed cut-offs were considered: superficial temporal artery: 0.42 mm; frontal branch: 0.34 mm; parietal branch: 0.29 mm; axillary artery: 1.0 mm. RESULTS: A total of 808 arteries in 101 subjects were evaluated; of these, 31 (30.7%) were classified as very high CV risk, seven (6.9%) as high, 34 (33.7%) as moderate and 29 (28.7%) as low risk. Subjects with very high or high risk showed higher IMT than those with moderate or low risk in the superficial temporal arteries [0.23 (s.d. 0.07) vs 0.20 (s.d. 0.04), P < 0.01] and in the axillary arteries [0.54 (s.d. 0.17) vs 0.48 (s.d. 0.10), P = 0.002] . The IMT was higher than the reference cut-off in 13/808 (1.6%) arteries, in ≥1 artery in 10/101 subjects (10.1%). Of these 10 subjects, 8 (80%) were classified as having very high or high risk. CONCLUSION: Our results suggest that CV risk might influence the US-determined IMT of the temporal and axillary arteries in subjects without GCA. Therefore, in patients with suspected GCA, particular attention should be paid when measuring the IMT in those patients with very high/high CV risk.
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Artritis/complicaciones , Arteria Axilar/diagnóstico por imagen , Arteritis de Células Gigantes/diagnóstico por imagen , Factores de Riesgo de Enfermedad Cardiaca , Arterias Temporales/diagnóstico por imagen , Anciano , Artritis/diagnóstico por imagen , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
BACKGROUND: The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). OBJECTIVES: To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. METHODS: Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. RESULTS: Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p < 0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. CONCLUSION: MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.
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Enfermedades Musculoesqueléticas/complicaciones , Psoriasis/complicaciones , Calidad de Vida , Adolescente , Artralgia/complicaciones , Artralgia/diagnóstico , Artralgia/epidemiología , Artritis/diagnóstico por imagen , Artritis Psoriásica/etiología , Niño , Preescolar , Estudios Transversales , Entesopatía/diagnóstico por imagen , Fatiga/complicaciones , Femenino , Fibromialgia/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/epidemiología , Dolor Musculoesquelético/diagnóstico , Enfermedades de la Uña/complicaciones , Enfermedades de la Uña/diagnóstico , Palpación , Sacroileítis/diagnóstico por imagen , Índice de Severidad de la Enfermedad , UltrasonografíaRESUMEN
Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants that Brazil has received in the past years, skipping the early total ankle replacement generation who present more complications and low survival rate in the literature. The negative aspects are related to gap of experience with Brazilian surgeons unable to participate in the development of the technique and implant designs during these years. This article discusses the aspects of the Brazilian experience with total ankle replacement since the earliest procedures performed.
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Articulación del Tobillo/cirugía , Artritis/cirugía , Artroplastia de Reemplazo de Tobillo , Prótesis Articulares , Adulto , Anciano , Articulación del Tobillo/diagnóstico por imagen , Artritis/diagnóstico por imagen , Artroplastia de Reemplazo de Tobillo/efectos adversos , Brasil , Femenino , Humanos , Prótesis Articulares/efectos adversos , Masculino , Persona de Mediana Edad , Diseño de PrótesisAsunto(s)
Artritis/diagnóstico por imagen , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Síndrome Inflamatorio de Reconstitución Inmune/etiología , Artritis/etiología , Infecciones por Enterobacteriaceae/microbiología , Femenino , Humanos , Imagen por Resonancia Magnética , Morganella morganii , Recurrencia , Adulto JovenRESUMEN
PURPOSE: To evaluate the outcome of revision surgery for failed thumb carpometacarpal (CMC) arthroplasty. METHODS: We retrospectively analyzed 32 patients with failed thumb CMC arthroplasty. The primary reason for revision was pain caused by metacarpal subsidence. Revision surgery included soft tissue interposition and distraction pinning to address the metacarpal subsidence. Additional ligament reconstruction was performed in patients with thumb instability. Eight patients required additional metacarpophalangeal joint fusion for concomitant joint hyperextension. Eleven required additional partial excision of the trapezoid for concomitant scaphotrapezoidal joint arthritis. All patients were evaluated clinically and radiographically. RESULTS: Mean follow-up was 57 months (range, 24-121 months). Pain levels evaluated by visual analog scale were significantly reduced in all patients after revision surgery. Mean grip strength and key pinch strength significantly increased. Twenty-seven patients achieved good functional results; those for 5 patients were fair. CONCLUSIONS: This study showed that revision surgery with distraction pinning and soft tissue interposition with or without ligament reconstruction was an effective treatment for failed CMC arthroplasty of the thumb. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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Artritis/cirugía , Artroplastia , Articulaciones Carpometacarpianas , Reoperación , Pulgar , Adulto , Artritis/diagnóstico por imagen , Artritis/etiología , Femenino , Fuerza de la Mano , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The objectives of the present study were to compare the survival function of antisynthetase syndrome (ASS) Jo1-positive patients with ASS non-Jo1 patients, all with interstitial lung disease (ILD), and to evaluate other factors such as the extension of pulmonary disease and the time between the onset of symptoms and diagnosis and its association to survival in a cohort of ASS patients. Patients with ASS, all with ILD, were included. At the baseline, pulmonary function tests were realized and a high-resolution chest tomography was obtained; lung inflammation and fibrosis were measured with the Goh score and the Kazerooni index. The following autoantibodies were measured: Jo1, Ej, Oj, PL7, and PL12. Patients had to be positive for one of them in order to be included in the study. The survival function was estimated and compared with the log rank test, and the hazard ratio (HR) was estimated using Cox regression procedure. Forty-three patients were included, of which six patients died (14 %). Patients who died were different in comparison with survivors as regards the frequency of anti-Jo1 positivity: Survivors had anti-Jo1 autoantibodies more frequently (86 %) than patients who died (50 %). The univariate Cox regression analysis identified four variables associated with survival: Jo1 status, arthritis, extent of ground glass, and consolidation (inflammation) in high-resolution computed tomography (HRCT) and baseline forced vital capacity. The serological status of patients (Jo1-positive vs non-Jo1), the extent of lung inflammation in the HRCT scan, a low forced vital capacity, and arthritis are associated with survival in ASS patients.
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Autoanticuerpos/sangre , Enfermedades Pulmonares Intersticiales/sangre , Miositis/mortalidad , Capacidad Vital/fisiología , Adulto , Artritis/diagnóstico por imagen , Estudios de Cohortes , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Análisis de Regresión , Tasa de Supervivencia , Centros de Atención Terciaria , Tomografía Computarizada por Rayos XRESUMEN
UNLABELLED: The objective of the study was to evaluate work disability and its main associated factors in patients with early arthritis. Argentine Consortium for Early Arthritis (CONAART) is the first early arthritis cohort in Argentina. Patients with one or more swollen joints and less than 2 years of symptoms duration were followed up prospectively in 13 departments of rheumatology. Social, demographic, familiar, clinical, and laboratory data were recollected. At first year and every year, X-rays of hands and feet were performed and working status and pharmaco-economic data were recollected. Work status (employed, unemployed, retired) and type of work were assessed by direct interview using a predesigned questionnaire. Eight hundred forty-eight patients were included, rheumatoid arthritis (RA) = 483 (57 %)and undifferentiated arthritis (UA) = 365 (43 %), 694 (81.8 %) were women, median age was 46 years (interquartile range (IQR) 35-55.7) and median symptoms duration 7 months (IQR 3-12). Patients with RA had significantly higher disease activity, worse functional capacity and quality of life, and more severe radiological damage compared to UA patients. However work disability (unemployed patient) was comparable between groups (RA = 21 % versus UA = 18.6 % p = NS). In both groups, unemployed patients had higher disease activity score of 28 joints (DAS28), worse Health Assessment Questionnaire (HAQ) values, and less years of formal education (p value <0.005 in all comparisons). Radiological damage was greater in unemployed patients but this difference did not reach statistical significance. In multivariate analysis, disease activity was the main variable associated with unemployment in both groups. Joint involvement was the main cause of work disability in this cohort of patients with early arthritis, independently of the final diagnosis. KEY MESSAGES: 1. Work disability is higher in patients with inflammatory arthritis as compared to the general population. 2. Prevalence of work disability is comparable among patients with undifferentiated and rheumatoid arthritis. 3. Disease activity is the main disease variable associated with work disability.
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Artritis Reumatoide/epidemiología , Articulaciones del Pie/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Desempleo/estadística & datos numéricos , Adulto , Argentina , Artritis/diagnóstico por imagen , Artritis/epidemiología , Artritis Reumatoide/diagnóstico por imagen , Estudios de Cohortes , Evaluación de la Discapacidad , Escolaridad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Radiografía , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
Our objective was to analyze the effects of cigarette smoking on disease activity, functional capacity, radiographic damage, serology and presence of extraarticular manifestations in patients with rheumatoid arthritis and undifferentiated arthritis. This is a cross-sectional study of 1,305 patients (729 with rheumatoid arthritis and 576 with undifferentiated arthritis) from CONAART, the Argentine Consortium for Early Arthritis that includes patients older than 16 years with <2 years of disease. Sociodemographic data, clinical characteristics of the disease and smoking history were collected. In patients with rheumatoid arthritis the disease activity score of 28 joints was 5.4 ± 1.3 in current smokers, 5.2 ± 1.4 in former smokers and 5.1 ± 1.4 in never smokers (p = 0.011). The simple erosion narrowing score was higher in current smokers and former smokers than in never smokers (M 14.0, R Q 6.0-21.0; M 15.0, R Q 7.0-24.0; M 10.0, R Q 5.0-17.0; p = 0.006). Current smokers had higher rheumatoid factor titer (M 160.0, R Q 80.0-341.0) than former smokers (M 146.8, R Q 6.03-255.5) and never smokers (M 15.0, R Q 9.0-80.0) (p = 0.004). The variable independently associated with tobacco exposure was simple erosion narrowing score (OR = 1.03, 95 % CI 1.00-1.05; p = 0.012). In patients with undifferentiated arthritis, an association between smoking status and parameters of activity or radiographic damage was not observed. Neither was tobacco exposure related to the presence of extraarticular manifestations or to the degree of disability in any of the two groups of patients. No relation was found between disease activity and severity, and number of packs smoked per year. Tobacco.
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Artritis Reumatoide/epidemiología , Articulaciones del Pie/diagnóstico por imagen , Articulaciones de la Mano/diagnóstico por imagen , Fumar/epidemiología , Adulto , Factores de Edad , Anciano , Argentina/epidemiología , Artritis/diagnóstico por imagen , Artritis/epidemiología , Artritis/inmunología , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/inmunología , Sedimentación Sanguínea , Proteína C-Reactiva/inmunología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Factor Reumatoide/inmunología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Fumar/inmunologíaRESUMEN
In the northeast of Brazil, caprine arthritis-encephalitis (CAE) is one of the key reasons for herd productivity decreasing that result in considerable economic losses. A comparative study was carried out using computed radiography (CR), histological analysis (HA), and scanning electronic microscopy (SEM) of the joints of CAE infected and normal goats. Humerus head surface of positive animals presented reduced joint space, increased bone density, and signs of degenerative joint disease (DJD). The carpal joint presented no morphological alterations in CR in any of the animals studied. Tarsus joint was the most affected, characterized by severe DJD, absence of joint space, increased periarticular soft tissue density, edema, and bone sclerosis. Histological analysis showed chronic tissue lesions, complete loss of the surface zone, absence of proteoglycans in the transition and radial zones and destruction of the cartilage surface in the CAE positive animals. Analysis by SEM showed ulcerated lesions with irregular and folded patterns on the joint surface that distinguished the limits between areas of normal and affected cartilage. The morphological study of the joints of normal and CAE positive goats deepened understanding of the alteration in the tissue bioarchitecture of the most affected joints. The SEM finding sustained previous histological reports, similar to those found for rheumatoid arthritis, suggesting that the goat infected with CAE can be considered as a potential model for research in this area.
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Virus de la Artritis-Encefalitis Caprina/fisiología , Artritis/patología , Cartílago Articular/patología , Encefalitis/patología , Enfermedades de las Cabras/patología , Infecciones por Lentivirus/veterinaria , Animales , Artritis/diagnóstico por imagen , Artritis/virología , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/ultraestructura , Cartílago Articular/virología , Encefalitis/diagnóstico por imagen , Encefalitis/virología , Enfermedades de las Cabras/diagnóstico por imagen , Enfermedades de las Cabras/virología , Cabras , Histología , Infecciones por Lentivirus/diagnóstico por imagen , Infecciones por Lentivirus/patología , Infecciones por Lentivirus/virología , Microscopía Electrónica de Rastreo , RadiografíaRESUMEN
OBJECTIVE: We assessed the prevalence of selected clinical and radiological features of tendinous and ligamentous derangements in a consecutive sample of patients with systemic lupus erythematosus (SLE). METHODS: Consecutive patients with SLE with no comorbidities attending a tertiary care center were prospectively assessed and underwent plain radiographic evaluation of the pelvis. Radiographs were analyzed by 2 blinded observers; radiographic sacroiliitis was graded 0 to IV. To better assess sacroiliac (SI) involvement, a computed tomography (CT) scan of the SI joints was performed in patients with grade III sacroiliitis. Hip joints and pubis were also assessed as described. RESULTS: Of the 192 included patients, 89% were female, mean age was 36 years, and mean disease duration was 10 years. Inflammatory low back pain was reported by 10% of patients. Sacroiliitis of any grade was observed in 31 patients (16%), and grade III (confirmed on CT scan) sacroiliitis was observed in 6% (95% CI 3% to 9%). Osteitis pubis was diagnosed in 6% (95% CI 3% to 10%) and coxofemoral migration in 8% (95% CI 2% to 9%). Jaccoud's arthropathy was found in 23%. Demographic and clinical variables were not statistically associated with radiographic sacroiliitis. CONCLUSION: Sacroiliitis and other tendinous and ligamentous derangements are not uncommon in patients with SLE. Based on these features and on previous reports, the term "SLE-related tendinous and ligamentous derangements" may be used to establish a common framework for further research and reporting.
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Artritis/epidemiología , Ligamentos , Lupus Eritematoso Sistémico/epidemiología , Tendinopatía/epidemiología , Tendones , Adulto , Artritis/diagnóstico por imagen , Femenino , Humanos , Ligamentos/diagnóstico por imagen , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/epidemiología , Lupus Eritematoso Sistémico/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteítis/diagnóstico por imagen , Osteítis/epidemiología , Prevalencia , Hueso Púbico/diagnóstico por imagen , Radiografía , Articulación Sacroiliaca/diagnóstico por imagen , Tendinopatía/diagnóstico por imagen , Tendones/diagnóstico por imagenRESUMEN
In this second part of the review of multicentric reticulohistiocytosis, the authors discuss its association with other diseases, in particular, cancer, and laboratory and therapeutic aspects of this incapacitating and disfiguring disease. Histopathologic aspects are characteristic: dense mononuclear infiltrate with typical multinucleated cells that contain periodic acid-Schiff-positive and diastasis-resistant material, conferring a "ground glass" aspect when stained with hematoxylineosin.
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Artritis/patología , Huesos/patología , Histiocitosis de Células no Langerhans , Articulaciones/patología , Piel/patología , Antígenos CD/análisis , Artritis/diagnóstico por imagen , Enfermedades Autoinmunes/complicaciones , Huesos/diagnóstico por imagen , Proliferación Celular , Histiocitos/metabolismo , Histiocitosis de Células no Langerhans/etiología , Histiocitosis de Células no Langerhans/patología , Histiocitosis de Células no Langerhans/terapia , Humanos , Microscopía Electrónica , Neoplasias/complicaciones , RadiografíaRESUMEN
The authors present part I of a review of multicentric reticulohistiocytosis, a rare systemic proliferative disease of histiocytes of unknown cause. It is clinically characterized by cutaneous and mucosal nodules and by osteoarticular lesions. The disease occurs in outbreaks that progress in severity, with spontaneous regression, but usually leaving incapacitating arthritis and disfiguring facial lesions. The authors discuss the historical, epidemiologic, and clinical aspects of this disease.
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Huesos/patología , Histiocitosis de Células no Langerhans , Articulaciones/patología , Macrófagos/fisiología , Membrana Mucosa/patología , Piel/patología , Artritis/diagnóstico por imagen , Artritis/patología , Movimiento Celular , Proliferación Celular , Diagnóstico Diferencial , Histiocitosis de Células no Langerhans/diagnóstico , Histiocitosis de Células no Langerhans/epidemiología , Histiocitosis de Células no Langerhans/patología , Humanos , RadiografíaRESUMEN
We describe the case of a young woman with systemic lupus erythematosus (SLE) who presented with painful acute swelling and limited motion of the elbow. Analysis of synovial fluid exhibited a noninflammatory cell count, negative cultures, amorphous nonbirefringent particles, and a positive Alizarin red S staining. X-rays showed calcifications, spurring, sclerosis, and despite the short duration of symptoms, loss of radial-humeral and cubital-humeral joint spaces. The diagnosis of an acute attack within a chronic degenerative arthropathy of the elbow associated with hydroxyapatite crystals was established. Such crystal-induced arthropathy can be an occasional explanation for acute arthritis in SLE.
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Artritis/etiología , Artritis/metabolismo , Durapatita/metabolismo , Articulación del Codo , Lupus Eritematoso Sistémico/complicaciones , Adulto , Artritis/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , RadiografíaRESUMEN
OBJECTIVE: To study the articular inflammatory manifestations of leprosy. METHODS: Sixty patients with leprosy from a public clinic in São Paulo, Brazil, participated in a study regarding their articular manifestations. The diagnosis and classification of leprosy were established by the clinical picture, skin smears, skin biopsy, and delayed hypersensitivity test to Mycobacterium leprae antigens (Mitsuda test). According to the Madrid and Ridley-Jopling classifications, 46 patients had lepromatous leprosy, 7 had borderline leprosy, 4 had tuberculoid leprosy, and 3 had indeterminate leprosy. History, general and articular examinations, and roentgenograms were employed and complemented in several cases by scintigraphic examinations with technetium methylene diphosphonate and computed tomographic studies. RESULTS: Three patients were excluded from study due to an association with a rheumatic disease. Among the 57 remaining patients, 44 had peripheral arthritis characterized by involvement of small joints (23/44), large joints (4/44), or both (17/44). The mean duration of arthritis was 11 years (range 1 mo to 51 yrs). Arthritis was detected in all subtypes of patients with leprosy. Supplementary radiological evaluation established the extent of inflammation and diagnosis of sacroiliitis. The diagnosis of sacroiliitis, based on the presence of sclerosis, erosions, and narrowing of the cartilage space in the sacroiliac joints, was established in 35 of 55 radiographs. Sacroiliitis varied from grade I to III, according to the Bennet and Wood classification, and was bilateral in most cases (30/35). There was no significant correlation between low back pain and the finding of sacroiliitis. CONCLUSION: Articular inflammatory manifestations may exist in patients with different forms of leprosy, and can follow a chronic course. In addition, sacroiliitis is a common, previously unrecognized manifestation in patients with leprosy.
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Artritis/etiología , Lepra/complicaciones , Adulto , Anciano , Artritis/diagnóstico por imagen , Artrografía , Huesos/diagnóstico por imagen , Enfermedad Crónica , Femenino , Cadera/diagnóstico por imagen , Humanos , Lepra/clasificación , Lepra/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Mycobacterium leprae/inmunología , Cintigrafía , Articulación Sacroiliaca/diagnóstico por imagen , Esclerosis/etiologíaRESUMEN
The goal of this work was to evaluate clinico-radiological correlation of enthesitis in SNSA patients, selected for presenting at least one radiological enthesopathy. Out of 50 patients with SNSA, 40 were selected for having had at least one radiological enthesitis. In a cross-sectional study, 32 males and 8 females, whose mean age was 40.4 years and mean disease duration 13 years, were evaluated. Nineteen patients had ankylosing spondylitis, 15 psoriatic arthritis and 6 Reiter's syndrome. Sites evaluated were pelvis and lower limbs. Radiological enthesopathies were identified by the presence of calcifications, new bone formation and/or erosions in tendinous and ligamentous insertion sites, and clinical enthesitis due to pain or tenderness and/or swelling at such locations. The site most commonly involved radiologically was the sciatic tuberosity in 33/40 cases, followed by the calcaneus with 12/40 on its inferior and 11/40 on its posterior aspect. Fifteen patients (37%) presented clinical manifestations at tendinous insertion sites, but clinico-radiological correlation was found in only 4 (22%). We conclude that clinical and radiological manifestations correlate poorly in SNSA enthesitis, perhaps due to the wide diversity of developmental stages of the disease.
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Artritis/diagnóstico por imagen , Pierna/diagnóstico por imagen , Huesos Pélvicos/diagnóstico por imagen , Enfermedades Reumáticas/diagnóstico por imagen , Adolescente , Adulto , Tobillo/diagnóstico por imagen , Artritis Psoriásica/diagnóstico por imagen , Artritis Reactiva/diagnóstico por imagen , Estudios Transversales , Femenino , Pie/diagnóstico por imagen , Humanos , Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Espondilitis Anquilosante/diagnóstico por imagenRESUMEN
The objective of this work was to evaluate the frequency and features of Jaccoud's syndrome of the hands in patients with overlap syndrome. Twenty-three patients with overlap syndrome were prospectively evaluated by means of a complete physical examination, serological assessment, and hand X-rays. The presence of Jaccoud's syndrome was defined by Kahn's criteria. Patients with or without Jaccoud's arthropathy were compared in their clinical, serological and radiological features. Five out of 23 patients (21.7%) presented Jaccoud's syndrome. Clinical and serological features of patients with or without the syndrome proved similar except for alignment abnormalities, which by definition were more frequent in the group with Jaccoud. A significantly greater number of patients meeting diagnostic criteria for SLE were observed in the Jaccoud group (80% versus 21%; p = 0.03). There was no other disease or associated condition such as chronic renal failure or high-dose steroid treatment concomitant with the development of Jaccoud's syndrome. It may be concluded that in patients with overlap syndrome, Jaccoud' arthropathy seems to be more frequent in patients who meet criteria for SLE.
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Artritis/clasificación , Enfermedades del Tejido Conjuntivo/complicaciones , Deformidades Adquiridas de la Mano/etiología , Adulto , Anciano , Artritis/diagnóstico por imagen , Artritis/epidemiología , Artritis/fisiopatología , Distribución de Chi-Cuadrado , Enfermedades del Tejido Conjuntivo/diagnóstico por imagen , Enfermedades del Tejido Conjuntivo/fisiopatología , Femenino , Deformidades Adquiridas de la Mano/diagnóstico por imagen , Deformidades Adquiridas de la Mano/fisiopatología , Humanos , Incidencia , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Fiebre Reumática/complicaciones , Fiebre Reumática/diagnóstico por imagen , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/diagnóstico por imagen , SíndromeRESUMEN
OBJECTIVE: To determine the prevalence of anterior and vertical atlantoaxial subluxation (AAS) and its neurological effect in a consecutive sample of Mexican patients with ankylosing spondylitis (AS). METHODS: Consecutive patients with a diagnosis of AS who attended 2 secondary care outpatient rheumatology clinic in the city of Guadalajara within a period of 6 mo were included in the study. Patients had prospective rheumatologic and neurologic assessments using structured questionnaires and examinations. Recorded variables included demographic data, disease characteristics, neurologic symptoms and signs, and axial mobility measurements. Somatosensory evoked potentials (SSEP) were performed in all patients. Patients also underwent standard cervical spine radiography with anteroposterior open mouth, and neutral, full flexion and extension lateral views. RESULTS: We studied 103 patients. Mean age was 35 yrs, 74% were male, and mean disease duration was 10 yrs (S/- SD 7.9). Anterior AAS was observed in 22 patients (21%, 95% CI 13-29%) and vertical AAS in 2 cases (2%, 95% CI 0-7%). Ossification of the posterior longitudinal ligament (OPLL) was present in 16 patients. Statistically significant associations were observed between anterior AAS and SSEP (p < 0.0001) and OPLL (p = 0.04). The degree of radiologic sacroiliitis was also associated with anterior AAS. After completion of the study, 2 patients required surgical fusion due to severe cervical cord compression. CONCLUSION: The prevalence of AAS and OPLL in this population was higher than previously reported in other settings. The association of anterior AAS with OPLL and radiological sacroiliitis could identify a subgroup of patients with more severe axial enthesopathy. Although clinically significant neurologic complications are not frequent in these patients, AAS may cause severe spinal cord compression requiring surgical fusion.
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Articulación Atlantoaxoidea/lesiones , Luxaciones Articulares/etiología , Enfermedades del Sistema Nervioso/etiología , Espondilitis Anquilosante/complicaciones , Adolescente , Adulto , Artritis/diagnóstico por imagen , Artrografía , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/patología , Femenino , Humanos , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/epidemiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Prevalencia , Articulación Sacroiliaca/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Eighteen patients with symptomatic radioscaphoid arthritis had scaphoid excision and capitolunate arthrodesis. Eight patients also had a silicone scaphoid replacement. The follow-up period averaged 3 years. Fusion was solid in 12 cases at an average of 8 weeks, and pain was significantly less at follow-up evaluation. Six patients had a pseudarthrosis and five had persistent pain. Immobilization in the pseudarthrosis group averaged 6 weeks, which was significantly less than the group that fused. Two patients underwent successful repeat fusions. Wrist extension averaged 26 degrees, flexion 34 degrees, radial deviation 11 degrees, and ulnar deviation 24 degrees. Grip strength averaged 25 kg. Presence of an implant had no significant effect on motion or strength. Pin track infection and pseudarthrosis were the main complications. Pain relief, functional motion, good strength, and patient satisfaction can be expected after scaphoid excision and solid capitolunate arthrodesis. Kirschner wires should be buried subcutaneously to avoid infection. The addition of a scaphoid implant offered no advantage over simple scaphoid excision.