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Cutaneous Rosai Dorfman disease (CRDD) is a rare histiocytic disorder that shows distinctive clinical presentation and prognosis. Sufficient data is currently lacking regarding evidence-based management of CRDD. This systematic review aims to provide a comprehensive overview of CRDD, focusing on treatment approaches and outcomes. PubMed and Scopus databases were searched for studies on CRDD from June 1st, 2013 to May 31st, 2023. Articles describing cases of CRDD confirmed with histological examination were eligible for inclusion. All interventions for CRDD were analyzed. The primary outcome measure was the response of cutaneous lesions to treatment including complete response (CR), partial response (PR), and no response. The secondary outcome measures were mortality rate, relapse rate, and the occurrence of adverse events related to CRDD treatment. Eighty-seven articles describing 118 CRDD cases were included. The mean age was 48.2±16.8 years. The sex ratio (F/M) was 1.53. Nodular (46.6%) erythematous (45.3%) lesions, located on the face (38.1%) were the most prevalent presentations. Associated hematological malignancies were noted in 8 (6.8%) cases. Surgical excision was the most prevalent intervention (51 cases) with CR in 48 cases. Systemic corticosteroids were used in 32 cases with 20 CR/PR, retinoids in 10 cases with 4 CR/PR, thalidomide in 9 cases with 5 CR/PR, methotrexate in 8 cases with 7 CR/PR while observation was decided in 10 cases with 6 CR/PR. Factors independently associated with the absence of response to treatment were facial involvement (OR = 0.76, p = 0.014), and cutaneous lesion size (OR = 1.016, p = 0.03). This systematic review shows distinctive clinical characteristics of CRDD and provides insights into the appropriate management of the disease. It allowed a proposal of a treatment algorithm that should be interpreted in the context of current evidence and would help practitioners in treating this rare disease.
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Histiocitosis Sinusal , Humanos , Histiocitosis Sinusal/diagnóstico , Histiocitosis Sinusal/patología , Histiocitosis Sinusal/terapia , Histiocitosis Sinusal/tratamiento farmacológico , Pronóstico , Resultado del Tratamiento , Femenino , Piel/patología , Masculino , Persona de Mediana Edad , Corticoesteroides/uso terapéutico , Retinoides/uso terapéutico , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/terapia , Enfermedades de la Piel/patología , Enfermedades de la Piel/tratamiento farmacológico , Metotrexato/uso terapéutico , AdultoRESUMEN
INTRODUCTION: Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis involving the central nervous system in 5% of cases. Spinal location occurs in less than 1% of extranodal RDD and can be responsible for neurological manifestations. We present a systematic review of cases of isolated spinal RDD. We also report a new case of isolated spinal RDD revealed by spinal cord compression. MATERIALS AND METHODS: The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE and SCOPUS databases and included case reports and case series describing isolated RDD of the spine. RESULTS: There were 53 patients with isolated spinal RDD (including our case). The mean age was 35.85±16.48 years. Neurological deficit was the most frequent clinical presentation (89%). RDD lesions were mainly located in the thoracic spine (51%), then the cervical spine (32%). The lesion was reported to be extradural (57%), intradural extramedullary (26%), intramedullary (7%), and in the vertebral body (10%). Histological examination showed emperipolesis in 73%. Histocytes were positive for S-100 protein in 83%. Treatment was based on surgery 96%), radiotherapy, chemotherapy, and adjunctive steroid therapy were indicated in four, one, and eight cases. After a mean follow-up period of 14.84±13.00 months, recurrence of RDD was noted in 15%. CONCLUSION: Spinal RDD is a rare condition, requiring meticulous histological examination for accurate diagnosis. Complete surgical resection is the treatment of choice. Adjuvant chemotherapy and radiotherapy can also be indicated in patients demonstrating partial improvement following surgery.
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Histiocitosis Sinusal , Histiocitosis Sinusal/cirugía , Histiocitosis Sinusal/patología , Humanos , Adulto , Enfermedades de la Columna Vertebral/patología , Enfermedades de la Columna Vertebral/cirugía , Masculino , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/cirugía , Femenino , Persona de Mediana EdadRESUMEN
OBJECTIVES: We aimed to determine the discriminative values of pro-inflammatory cytokines to distinguish spondyloarthritis patients from healthy subjects and to assess the association between these cytokines and spondyloarthritis characteristics. METHODS: We conducted a case-control study, including 144 subjects matched for age and sex: 72 spondyloarthritis patients(G1) and 72 controls (G2). The disease activity was assessed using ASDAS-CRP and BASDAI. Structural damage was assessed using BASRI. The levels of interleukin (IL) IL-1, IL-6, IL-8, IL-17, IL-23, and tumor necrosis factor α(TNFα) were measured. RESULTS: Each group included 57 men. The mean age was 44.84 ± 13.42 years. Except for IL-8, all cytokine levels were significantly higher in patients compared to controls (IL-1: p = 0.05, IL-6: p = 0.021, TNFα: p = 0.039, IL-17 and IL-23: p < 0.001). Cutoff values of IL-17 and IL-23 distinguishing patients in G1 from those in G2 were 17.6 and 7.96 pg/mL, respectively. TNFα level correlated to BASDAI (p = 0.029) and BASRI (p = 0.002). Multivariate analysis showed that structural damage was associated with the male gender (p = 0.017), longer disease duration (p = 0.038), and high disease activity (p = 0.044). Disease activity was associated with longer disease duration (p = 0.012) and increased IL-6 levels (p = 0.05). CONCLUSION: Our study showed that IL-17 was the ablest to distinguish between spondyloarthritis patients and controls, suggesting that IL-17 may be helpful for the diagnosis of spondyloarthritis.
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Citocinas , Espondiloartritis , Humanos , Masculino , Adulto , Estudios de Casos y Controles , Espondiloartritis/diagnóstico , Espondiloartritis/sangre , Espondiloartritis/inmunología , Femenino , Persona de Mediana Edad , Citocinas/sangre , Biomarcadores/sangre , Mediadores de Inflamación/sangreRESUMEN
BACKGROUND: Hypoparathyroidism is a rare metabolic disorder that can be responsible for musculoskeletal manifestations. AIM: We present a systematic review of musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE database, including manuscripts describing musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. RESULTS: Musculoskeletal manifestations included myopathy, shoulder disorder, immune-negative non-erosive peripheral arthritis, axial involvement simulating spondylarthritis, and diffuse ligamentous ossifications. An association between hypoparathyroidism and spondyloarthritis or autoimmune diseases is possible. T-cell activation, seen in patients with hypoparathyroidism, may explain the co-occurrence of hypoparathyroidism with other autoimmune diseases. The treatment of these manifestations is based on calcium and active vitamin D supplementation. Parathyroid hormone may have an anabolic effect on muscle atrophy and muscle weakness. Parathyroid hormone can also promote bone formation and bone resorption by stimulating osteoclast differentiation by increasing RANKL (receptor activator for nuclear factor kappa-B ligand) expression. Therefore, hypoparathyroidism can be responsible for an increase in bone mineral density. However, the risk of fractures does not appear to be reduced due to changes in bone microarchitecture and the high risk of falls. Treatment with parathyroid hormone has been shown to improve bone microarchitecture. CONCLUSION: Our review showed that musculoskeletal manifestations are frequent in patients with hypoparathyroidism, including muscular, axial, peripheral articular, and entheseal manifestations.
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Hipoparatiroidismo , Hormona Paratiroidea , Humanos , Hipoparatiroidismo/complicaciones , Hormona Paratiroidea/sangre , Enfermedades Musculoesqueléticas/etiologíaRESUMEN
Acroparesthesia is a symptom characterized by a subjective sensation, such as numbness, tingling, prickling, and reduced sensation, affecting the extremities (fingers and toes). Despite its frequency, data regarding its diagnostic approach and management are scarce. The etiological diagnosis of acroparesthesia is sometimes challenging since it can be due to abnormality anywhere along the sensory pathway from the peripheral nervous system to the cerebral cortex. Acroparesthesia can reveal several diseases. It can be associated with rheumatic complaints such as arthritis or myalgia. Further cautions are required when paresthesia is acute (within days) in onset, rapidly progressive, severe, asymmetric, proximal, multifocal, or associated with predominant motor signs (limb weakness) or severe dysautonomia. Acroparesthesia may reveal Guillain-Barré syndrome or vasculitis, requiring rapid management. Acroparesthesia is a predominant symptom of polyneuropathy, typically distal and symmetric, often due to diabetes. However, it can occur in other diseases such as vitamin B12 deficiency, monoclonal gammopathy of undetermined significance, or Fabry's disease. Mononeuropathy, mainly carpal tunnel syndrome, remains the most common cause of acroparesthesia. Ultrasonography contributes to the diagnosis of nerve entrapment neuropathy by showing nerve enlargement, hypoechogenic nerve, and intraneural vascularity. Besides, it can reveal its cause, such as space-occupying lesions, anatomical nerve variations, or anomalous muscle. Ultrasonography is also helpful for entrapment neuropathy treatment, such as ultrasound-guided steroid injection or carpal tunnel release. The management of acroparesthesia depends on its causes. This article aimed to review and summarize current knowledge on acroparesthesia and its causes. We also propose an algorithm for the management of acroparesthesia.
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Síndrome del Túnel Carpiano , Parestesia , Humanos , Parestesia/complicaciones , Síndrome del Túnel Carpiano/complicaciones , Dedos , Sistema Nervioso Periférico , Ultrasonografía/efectos adversosRESUMEN
INTRODUCTION: There are conflicting findings on the link between liver fibrosis and cumulative methotrexate dosages. We aimed to determine the frequency of liver fibrosis in rheumatoid arthritis patients treated with methotrexate and to identify its associated factors. METHODS: We conducted a cross-sectional study over 9 months (April-December 2021), including rheumatoid arthritis patients treated with methotrexate. Demographic and clinical data were collected. Liver stiffness was assessed by FibroScan. Fibrosis and significant liver fibrosis were defined as liver stiffness higher than 6 and 7.2 kPa, respectively. Liver tests, albuminemia, lipid profile, and blood glycemia were measured. Metabolic syndrome was also evaluated. Statistical analyses were performed using SPSS. RESULTS: We included 21 men and 47 women. The mean age was 51.60 ± 1.82 years. The mean disease duration was 8.29 ± 6.48 years. The mean weekly intake of methotrexate was 13.76 ± 3.91 mg. The mean methotrexate duration was 4.67 ± 4.24 years. The mean cumulative dose was 3508.87 ± 3390.48 mg. Hypoalbuminemia and metabolic syndrome were found in 34% and 25% of cases. We noted increased alkaline phosphatase levels in four cases. The mean liver stiffness was 4.50 ± 1.53 kPa. Nine patients had liver fibrosis, and four had significant fibrosis. Associated factors with liver fibrosis were as follows: age ≥ 60 years (OR:22.703; 95%CI [1.238-416.487]; p = 0.035), cumulated dose of methotrexate ≥ 3 g (OR: 76.501; 95%CI [2.383-2456.070]; p = 0.014), metabolic syndrome (OR: 42.743; 95%CI [1.728-1057.273]; p = 0.022), elevated alkaline phosphatase levels (OR: 28.252; 95%CI [1.306-611.007]; p = 0.033), and hypoalbuminemia (OR: 59.302; 95%CI [2.361-1489.718]; p = 0.013). CONCLUSION: Cumulating more than 3 g of methotrexate was associated with liver fibrosis in rheumatoid arthritis patients. Having a metabolic syndrome, higher age, hypoalbuminemia, and elevated alkaline phosphatase levels were also likely to be independently associated with liver fibrosis. Key points ⢠Rheumatoid arthritis patients require monitoring hepatic fibrosis when the cumulated dose of methotrexate is above 3 g. ⢠Metabolic syndrome is a risk factor for liver fibrosis, suggesting that its management is necessary to prevent this complication. ⢠Hypoalbuminemia and elevated alkaline phosphatase levels (twice the upper limit) in rheumatoid arthritis patients treated with methotrexate were associated with liver fibrosis.
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Artritis Reumatoide , Hipoalbuminemia , Síndrome Metabólico , Masculino , Humanos , Femenino , Persona de Mediana Edad , Metotrexato/efectos adversos , Síndrome Metabólico/inducido químicamente , Síndrome Metabólico/complicaciones , Hipoalbuminemia/inducido químicamente , Hipoalbuminemia/complicaciones , Hipoalbuminemia/tratamiento farmacológico , Estudios Transversales , Fosfatasa Alcalina , Artritis Reumatoide/complicaciones , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/inducido químicamente , Cirrosis Hepática/inducido químicamente , Cirrosis Hepática/complicaciones , Hígado/diagnóstico por imagenRESUMEN
We read with interest the published manuscript by Konsta et al1 assessing the prevalence of hip involvement in patients with ankylosing spondylitis (AS) and its associated factors. Hip involvement was found in 38% of cases, and it was associated with the presence of syndesmophytes and peripheral arthritis.
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INTRODUCTION AND OBJECTIVES: There are controversial results regarding the value of serum IL-8 and TNFα in patients with non-specific low back pain. This study aimed to compare pro-inflammatory cytokines between patients with non-specific back pain and pain-free controls. MATERIALS AND METHODS: We conducted a case-control study including 106 participants: 46 patients with chronic non-specific low back pain (G1) and 60 pain-free controls (G0). The interleukin (IL-)6, IL-8, IL-17, IL-23, IL-22, and Tumor necrosis factor α (TNFα) were measured. We collected demographic and clinical data, including age, gender, low back pain duration and radicular pain. The pain degree was assessed using the Visual Analogic Scale. RESULTS: The mean age was 43.17±8.7 years in G1. Radicular pain was found in 37 cases with a Visual Analogic Scale of 3.03±2.5mm. The magnetic resonance imaging was performed in (G1), showing disk herniation and degenerative disk disease in 54.3% (n=25) and 45.7% of cases (n=21), respectively. The IL-8 was higher in G1 (18.84±44.64 versus 4.34±1.23pg/mL, p:0.033). IL-8 levels correlated with TNFα (0.942, p<10-3), IL-6 (0.490, p=0.011) and Visual Analogic ScaleRadicular-pain (r:0.297, p:0.047). IL-17 was higher in patients with restricted lumbar spine mobility (9.64±20.77 versus 1.19±2.54pg/mL, p:0.014). CONCLUSIONS: Our results provide evidence that IL-8 and TNFα play a role in low back pain and radicular pain due to disk degeneration or herniation. These findings could potentially be used by future studies to develop new non-specific low back pain therapeutic strategies.
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Citocinas , Dolor de la Región Lumbar , Humanos , Adulto , Persona de Mediana Edad , Interleucina-17 , Interleucina-8 , Factor de Necrosis Tumoral alfa , Estudios de Casos y Controles , Vértebras LumbaresRESUMEN
OBJECTIVES: Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease. It can be responsible for several rheumatological manifestations. AIMS: This article aimed to review and summarize current knowledge on musculoskeletal diseases associated with Parkinson's disease and their management. METHODS: We conducted a narrative review of musculoskeletal features associated with Parkinson's disease. RESULTS: Rheumatological manifestations of Parkinson's disease include postural disorders (antecollis, cervical kyphosis, cervical positive sagittal malalignment, camptocormia, Pisa syndrome, scoliosis), bone disorders (osteoporosis, bone fractures), and joint disorders (frozen shoulder, hand, and foot deformities). Rheumatological manifestations lead to physical disability, long-term pain, and impaired quality of life. However, the management of these manifestations is not yet codified. It can associate botulinum toxin, thoraco-pelvic anterior distraction, orthosis, orthopedic surgical correction, pallidotomy, or deep brain stimulation in patients with camptocormia. Therapeutic management of osteoporosis includes calcium and vitamin D intake and bisphosphonates. CONCLUSION: Rheumatological manifestations are common in Parkinson's disease. Optimal care of patients with Parkinson's disease should include attention to management of postural, bone, and joint disorders since it remains a major cause of functional impairment and disability.
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Osteoporosis , Enfermedad de Parkinson , Enfermedades Reumáticas , Humanos , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/tratamiento farmacológico , Calidad de Vida , Osteoporosis/complicaciones , Enfermedades Reumáticas/complicacionesRESUMEN
Schwannoma are tumors of Schwann cells of the peripheral nerve sheath. Sacral location is rarely reported especially in spondyloarthritis patients. Herein, we report a case of uncommon pygalgia in a 25-year-old man with history of a non-radiographic axial spondyloarthritis and in whom the diagnosis of sacral Schwannoma was established.
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Osteoarticular manifestations such as arthritis and bone pain are scarce among adults with acute lymphoblastic leukemia (ALL). We present a systematic review of osteoarticular first clinical manifestation related to ALL in adults, and we report a case of an adult patient with a B-cell ALL revealed by refractory pygalgia and arthritis. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE database, including case reports and case series describing osteoarticular manifestations revealing ALL in adults. There were 29 patients with osteoarticular manifestations, revealing ALL (including our case). The mean age was 34.00 ± 13.29 years. Osteoarticular manifestations were peripheral articular signs (7 cases), axial manifestations (17 cases), and osteolytic lesions (21 cases). Vertebral fractures were reported in 4 cases. MRI was performed in 15 cases, showing heterogeneous signal changes in the vertebra, skull, and sacroiliac bones. It showed avascular necrosis of the femoral head in one case. PET scan, performed in 7 cases, showed diffuse or localized FDG uptakes in the bone marrow. Hypercalcemia was noted in 9 cases. The treatment was based on chemotherapy (23 patients) and radiotherapy (4 cases). During the follow-up, remission was noted in 14 cases, death in 9 cases, and was not available in 6 patients. Our review showed that axial manifestations, joint swelling, bone pain, and hypercalcemia could be the first and only symptoms of ALL in adults, making the diagnosis of ALL difficult to recognize, leading to a diagnosis delay. Key Points ⢠Acute lymphoblastic leukemia in adults revealed by osteoarticular manifestations can be misdiagnosed as rheumatic diseases. ⢠Axial manifestations, joint swelling, bone pain, and hypercalcemia could be the first and only symptoms of acute lymphoblastic leukemia in adults. ⢠Complete blood count and calcium blood test should be performed as first-line investigations in adults with axial or peripheral articular symptoms. ⢠Physicians should be aware of this clinical presentation to avoid diagnosis delay and improve prognosis.
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Artritis , Enfermedades Óseas , Artropatías , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , Adulto , Adulto Joven , Persona de Mediana Edad , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Artritis/complicaciones , Artropatías/complicaciones , Enfermedad Aguda , Dolor/complicacionesRESUMEN
PURPOSE: Reactive arthritis is acute aseptic arthritis occurring 1 to 4 weeks after a distant infection in a genetically predisposed individual. It may occur after COVID-19 infection. We summarize, in this article, the current findings of reactive arthritis following COVID-19 infection. METHODS: A literature search has been performed from December 2019 to December 2021. We included case reports of reactive arthritis occurring after COVID-19 infection. We collected demographic, clinical, and paraclinical data. RESULTS: A total of 22 articles were reviewed. There were 14 men and 11 women with a mean age of 44.96 + 17.47 years. Oligoarticular involvement of the lower limbs was the most frequent clinical presentation. The time between arthritis and COVID infection ranged from 6 to 48 days. The diagnosis was based on clinical and laboratory findings. The pharmacological management was based on non-steroidal anti-inflammatory drugs in 20 cases. Systemic or local steroid therapy was indicated in 13 patients. Sulfasalazine was indicated in two cases. Alleviation of symptoms and recovery were noted in 22 cases. The mean duration of the clinical resolution was 16 + 57 days. CONCLUSION: The diagnosis of reactive arthritis should be considered in patients with a new onset of arthritis following COVID-19 infection. Its mechanism is still unclear.
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Artritis Reactiva , COVID-19 , Masculino , Humanos , Femenino , Adulto , Persona de Mediana Edad , Artritis Reactiva/diagnóstico , Artritis Reactiva/tratamiento farmacológico , Artritis Reactiva/epidemiología , COVID-19/complicaciones , Antiinflamatorios no Esteroideos/uso terapéutico , Sulfasalazina/uso terapéuticoRESUMEN
OBJECTIVES: The role of IL-22 in radiographic axial spondyloarthritis is not fully elucidated. Thus, there is a need for new insights into this cytokine in this disease. We aimed to compare interleukin (IL)-22 level between spondyloarthritis, nonspecific-low back pain patients, and pain-free controls, and to evaluate associations between this cytokine and spondyloarthritis characteristics. METHODS: We conducted a case-control study including 62 patients with radiographic axial spondyloarthritis (G1), 46 with nonspecific low back pain (G2), and 42 healthy volunteers (G3). IL-22 was measured using Enzyme-linked immunosorbent assay. We evaluate disease activity and structural damage of spondyloarthritis. RESULTS: IL-22 level was higher in G1 than in G2 and G3 (38±40 versus14.42±8.17 versus14.3±18.67 pg/mL, p<0.01). IL-22 discriminated patients in G1 from G2 with a cutoff of 22.28pg/mL (Sensitivity: 62.9%, Specificity: 97.8%, area under the curve (AUC): 0.808). IL-22 cutoff of 19.27pg/mL discriminated patients in G1 from G3 (Sensitivity: 67%, Specificity: 94.3%, AUC: 0.855). No associations were found between IL-22 levels and disease activity and structural damage. CONCLUSIONS: Our study showed that IL-22 level was higher in radiographic axial spondyloarthritis patients compared to controls. It was also able to differentiate G1 patients from G2 and G3. This finding suggests that the IL-22 pathway showed to play a pathological role in spondyloarthritis.
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Espondiloartritis Axial , Dolor de la Región Lumbar , Espondiloartritis , Espondilitis Anquilosante , Humanos , Estudios de Casos y Controles , Interleucinas , Citocinas , Interleucina-22RESUMEN
PURPOSE: Foot entheses involvement is a common manifestation of spondyloarthritis. The superiority of ultrasonography examination in foot entheses damages detection has been reported. We aimed to compare the ultrasonography findings of foot entheses between spondyloarthritis patients. and healthy controls and to identify factors associated with enthesitic heel involvement. METHODS: We conducted a cross-sectional study including 37 patients with axial spondyloarthritis (G1) and 37 healthy subjects matched by age and gender (G0). The following pro-inflammatory cytokines were measured: Interleukin (IL-)1, IL-6, IL-17, and IL-23. A blind ultrasonography of foot entheses was performed to examine calcaneal tendon (CT) and plantar fascia (PF). RESULTS: The mean age was 44.62 ± 12.31 years. Non-steroidal anti-inflammatory drugs were taken in 92% of patients. Clinical heel enthesopathy was noted in 10 patients (27%) of G1. No participant has enthesitic pain in G0. Ultrasonography changes in CT and PF were more frequent in G1 than G0 (p = 0.001 and p = 10-3, respectively). In the PF, tendon thickening was significantly higher in G1 than G0 (p = 0.03). Power Doppler in both enthesitic sites was exclusively observed in G1 (p = 10-3). Regarding associated factors, CT enthesophytes were less frequent in patients taking non-steroidal anti-inflammatory drugs continuously or having regular physical activity. PF structural damages were associated with higher erythrocyte sedimentation rate (p = 0.02), higher IL-23 level (p = 0.01), and higher disease activity (p = 0.04). CONCLUSION: Ultrasonography lesions of heel entheses were frequent in spondyloarthritis. Disease activity and inflammatory markers were higher in patients with heel enthesitis. Non-steroidal anti-inflammatory drugs intake and regular physical activity may prevent enthesophytes' occurrence.
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Espondiloartritis Axial , Entesopatía , Espondiloartritis , Humanos , Adulto , Persona de Mediana Edad , Talón/diagnóstico por imagen , Talón/patología , Estudios Transversales , Ultrasonografía , Espondiloartritis/diagnóstico por imagen , Espondiloartritis/tratamiento farmacológico , Espondiloartritis/complicaciones , Entesopatía/diagnóstico por imagen , Entesopatía/complicaciones , Entesopatía/patología , Antiinflamatorios , Interleucina-23RESUMEN
BACKGROUND: Matrix metalloproteinases, as components of the proteolytic system, are deemed to be implicated in the pathogenesis and progression of several rheumatic diseases. Their role in spondyloarthritis has been investigated by several studies. OBJECTIVE: This article aims to review and summarize the current knowledge related to metalloproteinases in patients with spondyloarthritis. METHODS: To examine the association between matrix metalloproteinases and spondyloarthritis, we conducted a narrative review using a literature search in SCOPUS for English-language sources. The search included studies published from the database inception to December 2020. RESULTS: A total number of 74 articles were included. It was found that levels of matrix metalloproteinases 3 were higher in radiographic axial spondyloarthritis patients and seemed to play a role in the progression of joint damage. The levels of matrix metalloproteinases 1, 2, and 9 were upregulated in psoriatic arthritis patients compared to psoriasis and could identify psoriasis patients who would develop rheumatic manifestations. The levels of matrix metalloproteinases correlated significantly with disease activity in ankylosing spondylitis and decreased upon treatment with Tumor Necrosis Factor inhibitors (TNFi). CONCLUSION: Excessive matrix metalloproteinases activity is associated with articular destruction. Their levels can reflect disease activity, structural damage, and response to TNFi in patients with spondyloarthritis. Nevertheless, further studies are needed to confirm these results.
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Psoriasis , Espondiloartritis , Humanos , Espondiloartritis/patología , Pronóstico , Biomarcadores , Metaloproteinasas de la MatrizRESUMEN
Reactive arthritis is a rare form of spondyloarthropathies occurring after genital or enteric infection. It is most often self-limited but can progress to chronic spondylarthritis. We report the case of a 30-year-old man who presented with acute arthritis occurring 2 months after an episode of urethral discharge. Physical examination revealed polyarthritis, dactylitis, sacroiliac joint involvement, and plantar papulosquamous plaques. The human leukocyte antigen B27 was positive. Detection of Chlamydia trachomatis and Gonococcus in the first catch urine specimen was negative. Hepatitis B and C, Chlamydia trachomatis, human immunodeficiency virus, and syphilis serologic test results were negative. Pelvic magnetic resonance imaging revealed left sacroiliitis. The patient was treated with antibiotics, diclofenac, and sulfasalazine. After 6 months of follow-up, a significant clinical improvement was obtained without remission, suggesting an evolution to chronic spondylarthritis. Diagnosis of Reactive arthritis is difficult since microbiologic examinations are commonly negative. This disease should be considered in patients with rheumatologic manifestations occurring after a urogenital or enteric infection, mainly when associated with skin manifestations and human leukocyte antigen B27.
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Context: Chronic rheumatic diseases seem to be associated with a higher risk of developing cardiovascular diseases. The link between cytokines and lipid profile in spondyloarthritis is not well elucidated. Aims: We aimed to assess the relationship between cytokines and obesity, lipid profile and atherogenic indexes in spondyloarthritis. Methods and Material: We conducted a cross-sectional study including 45 patients with axial radiographic spondyloarthritis. For each patient, we measured the following pro-inflammatory cytokines: interleukin (IL-) 1, IL-8, IL-6, IL-17, IL-23 and tumor necrosis factor a (TNFa), and anti-inflammatory cytokines: IL-10. We also measured total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLc) and low-density lipoprotein cholesterol (LDLc). We calculated the following ratios: TC/HDLc, TG/HDLc, LDLc/HDLc and Log[TG/HDLc]. Statistical Analysis Used: SPSS. Results: The mean age was 46 ± 11.9 years. IL-8 levels were increased in obese patients (P = 0.003). IL-8 and IL-22 levels were significantly higher in patients with abdominal obesity (P = 0.024 and P = 0.042, respectively). IL-6 levels were lower in patients with hypercholesterolemia (P = 0.009). IL-1 levels correlated to TG (r = 0.413; P = 0.005). IL-1 and IL-6 were correlated to TG/HDLc (IL-1: r = 0.484, P = 0.001; IL-6; r = 0.700, P = 0.012) and Log[TG/HDLc] (IL-1: r = 0.354; P = 0.012; IL-6: r = 0.309, P = 0.041). IL-10 level was correlated to TC/HDLc (r = 0.333, P = 0.027) and LDLc/HDLc (r = 0.342, P = 0.023). Conclusions: IL-8 and IL-22 were higher in patients with abdominal obesity, highlighting the contribution of the adipocytes to the secretion of pro-inflammatory cytokines. The correlation between cytokines and atherogenic indexes suggests the role of these cytokines in the occurrence of cardiovascular diseases in spondyloarthritis.
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Synovial hemangioma is a rare benign vascular tumor responsible for chronic knee pain and swelling. Given its non-specific symptoms, synovial hemangioma is often misdiagnosed. We report a case of synovial hemangioma of bilateral knee joints occurring in a young military man.
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Melanotic lupus erythematosus (LE) is a rare and newly described form of chronic cutaneous LE. In this review, we have synthesized existing data on the epidemiologic, clinical, histologic, and immunologic features of melanotic LE. We performed a systematic review using PubMed to identify eligible publications. Eight contributions fulfilled the eligibility criteria and were included in the qualitative synthesis. Twenty-eight patients with a mean age of 57.7 years were included. All patients had medium to dark skin phototypes. The lesions presented either as solitary and localized, poorly limited, round, or oval patches (50%) or as a more diffuse or generalized, sometimes reticulated, hyperpigmentation (50%). Patients diagnosed with systemic LE accounted for 14% of included cases. Antinuclear antibodies were positive in 10.7% of cases. Hydroxychloroquine and topical steroids were the most commonly used treatments. Complete resolution of the lesions was noted in 27.27% of cases. No patient experienced atrophy, destruction, or deformity of the skin. Melanotic LE appears to affect mainly patients with dark phototypes. It is characterized by late age at the onset of disease and an overall good prognosis.