Assuntos

RESUMO

To assess the inter- and intra-observer reproducibility of musculoskeletal ultrasonography among rheumatologist in detecting inflammatory and morphostructural changes in small joints of the hands in patients with rheumatoid arthritis (RA). Five members of the "Escuela de Ecografía del Colegio Mexicano de Reumatología" tested their inter- and intra-observer reliabilities in the assessment of basic sonographic findings of joint inflammation and bone erosion. Their results were compared to those obtained by a group of international experts from European League Against Rheumatism. A clinical rheumatologist evaluated eight RA patients. Five Siemens Acuson Antares ultrasound machines (7-13 MHz linear probes) were used. The OMERACT preliminary definitions of joint effusion, synovial hypertrophy, bone erosions and tenosynovitis were adopted. Inter-observer and intra-observer agreement was calculated by overall agreement and kappa statistics. Mean kappa value for joint effusion was good, 0.654 (85%); synovial hypertrophy, 0.550 (77.2%); power Doppler signal, 0.550 (82.5%); bone erosions, 0.549 (81%); and tenosynovitis, 0.500 (91.5%). Mean and overall intra-observer agreement for semiquantitative score was good for joint effusion, 0.630 (77.2%) and bone erosions, 0.605 (56.25%); and moderate to synovial hypertrophy, 0.476 (65%) and power Doppler signal, 0.471 (80%). Mean kappa value for joint effusion was 0.381 (95%), synovial hypertrophy, 0.447 (72%); power Doppler signal, 0.496 (81%); bone erosions, 0.294 (81%); and tenosynovitis, 0.030 (66%). Mean and overall inter-observer agreement for semiquantitative score was poor for joint effusion, 0.325 (57%) and bone erosions, 0.360 (43%); and moderate to synovial hypertrophy, 0.431 (55%) and power Doppler signal, 0.496 (81%). Intra-observer variability reached the highest levels of agreement. Factors related to the experience of the rheumatologist, the time spent in each examination and knowledge of the software ultrasound equipment could influence the lower level of inter-observer agreement in this study.

Assuntos

RESUMO

There is little evidence about the comparative efficacy of corticosteroids in the treatment of painful shoulder. The main aim was to compare the efficacy of methylprednisolone (MTP) versus triamcinolone (TMC) in the treatment of painful shoulder using an ultrasound-guided injection. Patients with painful shoulder due to subacromial bursitis and partial or full-thickness rotator cuff tears demonstrated by musculoskeletal ultrasound received a guided-injection of MTP acetate 40 mg (12 patients) or TMC acetonide 40 mg (12 patients). Range of motion and pain visual analogue scale were registered at 10 and 30 min, 1 and 2 weeks postinjection. Two weeks postinjection, both groups reported a mean improvement in range of motion (33%) and relief of pain (61%). Relief of pain of 50% or more was observed in 92% of patients in MTP group and 50% of TMC group (p = 0.02). Two months postinjection, 50% of the patients in MTP group and 25% in TMC group reported total relief of pain (p = 0.3). Patients with painful shoulder receiving an ultrasound-guided injection of MTP or TMC have a rapid and sustained overall response. Relief of pain tends to be more rapid with MTP than TMC.

Assuntos

RESUMO

Introducción. La osteomielitis de rótula es una infección poco frecuente que afecta principalmente a los niños. En la mayoría de los casos la causa es Staphylococcus aureus. El diagnóstico se sospecha si hay dolor e hinchazón perirrotuliano, celulitis, bursitis prerrotuliana (séptica o no), o artritis séptica que no responde al tratamiento estándar. Caso clínico. Paciente diabético tipo 1 de 14 años de edad con dolor e inflamación de la rodilla izquierda por una herida superficial con un objeto metálico punzante sin respuesta a antibióticos orales y antiinflamatorios. Se confirmó infección de articulación y de rótula por gammagrafía y ultrasonido músculo-esquelético, así como por estudio histológico del tejido sinovial obtenido por cirugía. El cultivo reveló Pseudomonas aeruginosa. El tratamiento con ceftazidima seguido de ciprofloxacina fue efectivo con resolución del proceso infeccioso. Conclusión. Se requiere de un alto nivel de sospecha y de un abordaje exhaustivo para el diagnóstico de osteomielitis de rótula, asociado o no a artritis séptica.

Introduction. Osteomyelitis of the patella is an infrequent infection that predominantly affects children. The most frequent microorganism is Staphylococcus aureus. Diagnosis should be considered in patients with pain and swelling around the patella, cellulitis, prepatellar bursitis (septic or not), and in patients with septic arthritis with no response to the standard treatment. Case report. We report the case of a 14-year-old male patient with type 1 diabetes mellitus with pain and swelling of the left knee after being injured with a sharp metallic object. No response was obtained with oral antibiotics and anti-inflammatory drugs. Surgery, gammagraphy, and musculoskeletal ultrasound, together with the histology, confirmed septic arthritis of the knee and osteomyelitis of the patella due to Pseudomonas aeruginosa. Treatment with ceftazidime and subsequent ciprofloxacin resulted in total remission of symptoms. Conclusion. A high level of suspicion and an exhaustive approach are required for definitive diagnosis of osteomyelitis of the patella, associated or not with septic arthritis.