Can ultrasound-detected subclinical synovitis be an indicator of flare recurrence in juvenile idiopathic arthritis remission patients on tapered TNFi?

OBJECTIVES: Subclinical synovitis is often detected by musculoskeletal ultrasound (MSUS) in juvenile idiopathic arthritis (JIA) patients in clinical remission. The main objective of this prospective, observational, longitudinal, multicentre study was to evaluate the predictive value of MSUS-detected subclinical synovitis in relation to flares at 12 months following TNFi tapering in a JIA population in stable clinical remission. METHODS: We included 56 JIA patients in stable remission undergoing TNFi therapy tapered at baseline and in some cases at 6 months. We performed baseline and 6-month MSUS assessment on B-mode (BM) and power Doppler (PD) mode of 22 joints and 8 tendons. RESULTS: Eighteen patients (32.1%) experienced a flare during the 12-month study period. BM synovitis was frequent (83.9%) but PD synovitis was scarcely found (8.9%). There were no significant differences in MSUS findings between patients who experienced a flare and those who remained in remission. Only 5 patients had positive for PD synovitis, in joints with BM synovitis grades 2 or 3, and none experienced a flare. Concomitant methotrexate (MTX) was more frequent in patients who were successfully tapered (71.1% vs. 27.8%; p=0.002) and patients older than 12 experienced a greater number of flares and earlier onset. CONCLUSIONS: Subclinical synovitis, as detected by MSUS, proved not to be a predictor of flares. Those patients on a TNFi-tapered concomitant methotrexate regimen experienced the fewest flares although flare risk increased with age.

Osteoma osteoide de rodilla simulando artritis psoriásica juvenil / Osteoid osteoma of the knee mimicking juvenile psoriatic arthritis

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Hypertrophic osteoarthropathy with acro-osteolysis in a patient with primary pulmonary hypertension.

Hypertrophic osteoarthropathy is an entity characterized by a triad of periostitis of long bones, clubbing and arthritis. Radiologically there are two patterns, one characterized by new bone formation which predominates in patients with pulmonary disease, and another by acro-osteolysis that is most frequently associated with congenital heart disease. We report the case of a 30-year-old man diagnosed with primary pulmonary hypertension for two years, developing hypertrophic osteoarthropathy with a mixed radiological pattern.

Meningoencefalitis por Listeria monocytogenes durante el tratamiento con rituximab y micofenolato de mofetilo en una paciente con lupus eritematoso sistémico de inicio pediátrico / Listeria monocytogenes meningoencephalitis during the treatment with rituximab and mycophenolate mofetil in a patient with pediatric-onset systemic lupus erythematosus

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Deformidad de Madelung adquirida en la artritis idiopática juvenil poliarticular con factor reumatoide positivo / Acquired Madelung’s deformity in rheumatoid factor-positive polyarticular juvenile idiopathic arthritis

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Hiperplasia nodular regenerativa hepática como complicación tardía de la artritis idiopática juvenil de inicio sistémico / Nodular regenerative hyperplasia of the liver as a complication of long-standing systemic-onset juvenile idiopathic arthritis

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Osteoartropatía hipertrófica con acro-osteolisis y neoformación ósea en un paciente con hipertensión pulmonar primaria / Hypertrophic osteoarthropathy with acro-osteolysis in a patient with primary pulmonary hypertension

La osteoartropatía hipertrófica es una entidad caracterizada por la tríada de periostitis de huesos largos, acropaquias y artritis. Radiológicamente se distinguen 2 patrones; uno caracterizado por neoformación ósea que predomina en pacientes con patología pulmonar, y otro por acro-osteolisis que se asocia más frecuentemente con cardiopatías congénitas. Presentamos el caso de un varón de 30 años diagnosticado de hipertensión arterial pulmonar primaria desde los 2 años, que desarrolló una osteoartropatía hipertrófica con un patrón radiológico mixto (AU)

Hypertrophic osteoarthropathy is an entity characterized by a triad of periostitis of long bones, clubbing and arthritis. Radiologically there are two patterns, one characterized by new bone formation which predominates in patients with pulmonary disease, and another by acro-osteolysis that is most frequently associated with congenital heart disease. We report the case of a 30-year-old man diagnosed with primary pulmonary hypertension for two years, developing hypertrophic osteoarthropathy with a mixed radiological pattern (AU)

Espondiloartritis en la infancia: formas de presentación, diagnóstico y tratamiento / No disponible

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