UVA-1 phototherapy as adjuvant treatment for eosinophilic fasciitis: in vitro and in vivo functional characterization.

INTRODUCTION: Eosinophilic fasciitis (EF) is a rare autoimmune disease causing progressive induration of dermal, hypodermal, and muscularis fascia. The exact pathogenesis is yet to be fully understood, and a validated therapy protocol still lacks. We here aimed to realize a clinical-functional characterization of these patients. MATERIALS AND METHODS: A total of eight patients (five males, 45 years average) were treated with adjuvant high-dose UVA-1 phototherapy (90 J/cm), after having received the standard systemic immunosuppressive protocol (oral methylprednisolone switched to methotrexate). Body lesion mapping, Localized Scleroderma Assessment Tool (LoSCAT), Dermatology Life Quality Index (DLQI), High-Resolution Ultrasound (HRUS) (13-17MHz), and ultra HRUS (55-70 MHz) were performed at each examination time taking specific anatomical points. Gene expression analysis at a molecular level and in vitro UVA-1 irradiation was realized on lesional fibroblasts primary cultures. RESULTS: The LoSCAT and the DLQI showed to decrease significantly starting from the last UVA-1 session. A significant reduction in muscularis fascia thickness (-50% on average) was estimated starting from 3 months after the last UVA-1 session and maintained up to 12 months follow-up. Tissues was detected by HRUS. The UVA-1 in vitro irradiation of lesional skin sites cells appeared not to affect their viability. Molecular genes analysis revealed a significant reduction of IL-1ß and of TGF-ß genes after phototherapy, while MMPs 1,2,9 gene expression was enhanced. COMMENT: These preliminary in vivo and in vitro findings suggest that UVA-1 phototherapy is a safe and useful adjuvant therapy able to elicit anti-inflammatory effects and stimulate tissue matrix digestion and remodeling at lesional sites.

Imatinib as a potentially effective therapeutic alternative in corticosteroid-resistant eosinophilic fasciitis.

Eosinophilic fasciitis (EF) is a rare condition in children that is typically treated with systemic corticosteroids. We present the case of a 9-year-old boy with biopsy-proven EF, refractory to systemic corticosteroids and methotrexate. The tyrosine kinase inhibitor imatinib was added as adjuvant therapy, leading to improvement in joint function and skin laxity. Our case is the first to suggest the anti-fibrotic properties of imatinib may benefit EF patients.

Characteristics of Japanese patients with eosinophilic fasciitis: A brief multicenter study.

Eosinophilic fasciitis is a relatively rare cutaneous fibrotic condition affecting the deep fascia of the extremities, with or without peripheral blood eosinophilia. To examine the characteristics of Japanese patients with eosinophilic fasciitis, we conducted a brief, multicenter, retrospective survey at seven university hospitals. In total, 31 patients were identified as having eosinophilic fasciitis, among whom 30 patients fulfilled the Japanese diagnostic criteria. The male : female ratio was 2.3:1, and the mean age was 47.7 years. Three of the patients were under 20 years old. The possible triggering factors included muscle training, sports, walking or sitting for a long time, physical work, insect bite and drug. Co-occurrence of morphea was observed in nine cases (29%), and malignancies were associated in three (two hematological malignancies and one internal malignancy). Immunological abnormalities in the serum showed positive antinuclear antibody, positive rheumatoid factor, increased aldolase levels and increased immunoglobulin G levels. The patients were treated with either monotherapy or combination therapy by oral prednisolone (20-80 mg/day), methotrexate (6-10 mg/week), cyclosporin (100-150 mg/day), mizoribine, infliximab and phototherapy. Methylprednisolone pulse therapy was performed in six cases. By contrast, spontaneous improvement due to resting only was observed in two cases, and skin hardening was improved by withdrawal of the anticancer drug in one case. This study suggests several characteristics of Japanese patients with eosinophilic fasciitis, namely male predominance, rare pediatric occurrence, immunological abnormalities and coexistence with morphea. Systemic prednisolone is the first-line therapy, but pulse therapy is occasionally required for severe cases. The triggering events of physical stress are not so frequent as have previously been reported, and various factors or even unknown factors may be associated with the induction of eosinophilic fasciitis.

Silver acupuncture for myofascitis: A protocol for systematic review and meta-analysis.

BACKGROUND: This systematic review aims to evaluate the effectiveness and safety of silver acupuncture in treatment of myofascitis. METHODS: Electronic databases of all silver acupuncture for myofascitis will be searched at PubMed, Cochrane Library, Springer, Embase, China National Knowledge Infrastructure, Wanfang, and Chinese Biological Medical disc from inception to March 31, 2020, with language restricted in Chinese and English. The primary outcome is visual analog scale, a short pain scale with sensitivity and comparability. Secondary outcomes included Clinical Assessment Scale for Cervical Spondylosis, Japanese Orthopaedic Association Scores, Oswestry dysfunction index, American Orthopaedic Foot and Ankle Society-Ankle Hindfoot scale, Foot and Ankle Ability Measure, The Cumberland ankle instability tool, Pittsburgh sleep quality index, self-rating anxiety scale, self-depression rating scale, and follow-up relapse rate. The systematic review and searches for randomized controlled trials of this therapy for myofascitis. The Cochrane RevMan V5.3 bias assessment tool is implemented to assess bias risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). Mean difference, standard mean deviation, and binary data will be used to represent continuous results. RESULTS: This study will provide a comprehensive review and evaluation of the available evidence for the treatment of myofascitis with this therapy. CONCLUSION: This study will provide new evidence to evaluate the effectiveness and side effects of silver acupuncture for myofascitis. Due to the data are not personalized, no formal ethical approval is required. ETHICS AND DISSEMINATION: There is no requirement of ethical approval and it will be in print or disseminated by electronic copies. PROSPERO REGISTRATION NUMBER: CRD42020151476.

[Clinical observation of mild to moderate lumbodorsal fascitis treated with distal acupoints along meridian plus exercising combined with penetration needling on yang meridians of back].

OBJECTIVE: To compare the therapeutic effect between distal acupoints along meridian plus exercising combined with penetration needling on yang meridians of back and simple penetration needling on yang meridians of back for mild to moderate lumbodorsal fascitis. METHODS: A total of 60 patients with mild to moderate lumbodorsal fascitis were randomized into an observation group and a control group, 30 cases in each one. In the control group, penetration needling on yang meridians of back was applied at acupoints of the Governor vessel (T2-L5) and the first line of bladder meridian, penetration needling was performed from the top down along the governor vessel and the first line of bladder meridian of the lumbar back pain (from one acupoint down to another acupoint), until there was no pain. In the observation group, distal acupoints along meridian plus exercising were adopted on the base of treatment in the control group. The distal acupoints along meridian plus exercising was applied at Cuanzhu (BL 2) for 30 min, at the same time, lumbar back anteflexion, hypsokinesis and turning sides were used in combination for 10 min. And then penetration needling on yang meridians of back was performed. The treatments were given once a day, 5 consecutive treatments a week, 1 week as a course and 2 courses were required. The visual analogue scale (VAS) score and Oswestry disability index (ODI) before treatment, after treatment and 1-month in follow-up were observed in the two groups, and the clinical effects were compared. RESULTS: Compared before treatment, the VAS score and ODI were reduced after treatment in the two groups (P<0.01). The changes of the VAS score and ODI in the observation group were larger than those in the control group (P<0.01, P<0.05). In follow-up, the VAS score and ODI in the observation group were lower than those in the control group (P<0.05). The total effective rate in the observation group was 90.0% (27/30), which was superior to 83.3% (25/30) in the control group (P<0.05). CONCLUSION: Distal acupoints along meridian plus exercising combined with penetration needling on yang meridians of back have a better therapeutic effect than simple penetration needling on yang meridians of back in the treatment of mild to moderate lumbodorsal fascitis.

Myalgia and chronic fatigue syndrome following immunization: macrophagic myofasciitis and animal studies support linkage to aluminum adjuvant persistency and diffusion in the immune system.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multifactorial and poorly undersood disabling disease. We present epidemiological, clinical and experimental evidence that ME/CFS constitutes a major type of adverse effect of vaccines, especially those containing poorly degradable particulate aluminum adjuvants. Evidence has emerged very slowly due to the multiplicity, lack of specificity, delayed onset, and frequent medical underestimation of ME/CFS symptoms. It was supported by an epidemiological study comparing vaccinated vs unvaccinated militaries that remained undeployed during Gulf War II. Affected patients suffer from cognitive dysfunction affecting attention, memory and inter-hemispheric connexions, well correlated to brain perfusion defects and associated with a stereotyped and distinctive pattern of cerebral glucose hypometabolism. Deltoid muscle biopsy performed to investigate myalgia typically yields macrophagic myofasciitis (MMF), a histological biomarker assessing longstanding persistency of aluminum agglomerates within innate immune cells at site of previous immunization. MMF is seemingly linked to altered mineral particle detoxification by the xeno/autophagy machinery. Comparing toxicology of different forms of aluminum and different types of exposure is misleading and inadequate and small animal experiments have turned old dogma upside down. Instead of being rapidly solubilized in the extracellular space, injected aluminum particles are quickly captured by immune cells and transported to distant organs and the brain where they elicit an inflammatory response and exert selective low dose long-term neurotoxicity. Clinical observations and experiments in sheep, a large animal like humans, confirmed both systemic diffusion and neurotoxic effects of aluminum adjuvants. Post-immunization ME/CFS represents the core manifestation of "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA).

Clinical observation of mild to moderate lumbodorsal fascitis treated with distal acupoints along meridian plus exercising combined with penetration needling on meridians of back / 中国针灸

OBJECTIVE@#To compare the therapeutic effect between distal acupoints along meridian plus exercising combined with penetration needling on meridians of back and simple penetration needling on meridians of back for mild to moderate lumbodorsal fascitis.@*METHODS@#A total of 60 patients with mild to moderate lumbodorsal fascitis were randomized into an observation group and a control group, 30 cases in each one. In the control group, penetration needling on meridians of back was applied at acupoints of the Governor vessel (TL) and the first line of bladder meridian, penetration needling was performed from the top down along the governor vessel and the first line of bladder meridian of the lumbar back pain (from one acupoint down to another acupoint), until there was no pain. In the observation group, distal acupoints along meridian plus exercising were adopted on the base of treatment in the control group. The distal acupoints along meridian plus exercising was applied at Cuanzhu (BL 2) for 30 min, at the same time, lumbar back anteflexion, hypsokinesis and turning sides were used in combination for 10 min. And then penetration needling on meridians of back was performed. The treatments were given once a day, 5 consecutive treatments a week, 1 week as a course and 2 courses were required. The visual analogue scale (VAS) score and Oswestry disability index (ODI) before treatment, after treatment and 1month in followup were observed in the two groups, and the clinical effects were compared.@*RESULTS@#Compared before treatment, the VAS score and ODI were reduced after treatment in the two groups (<0.01). The changes of the VAS score and ODI in the observation group were larger than those in the control group (<0.01, <0.05). In follow-up, the VAS score and ODI in the observation group were lower than those in the control group (<0.05). The total effective rate in the observation group was 90.0% (27/30), which was superior to 83.3% (25/30) in the control group (<0.05).@*CONCLUSION@#Distal acupoints along meridian plus exercising combined with penetration needling on meridians of back have a better therapeutic effect than simple penetration needling on meridians of back in the treatment of mild to moderate lumbodorsal fascitis.

Diagnostic criteria, severity classification and guidelines of eosinophilic fasciitis.

We established diagnostic criteria and severity classification of eosinophilic fasciitis because there is no established diagnostic criteria or widely accepted severity classification of the disease. Also, there has been no clinical guideline for eosinophilic fasciitis, so we established its clinical guideline ahead of all over the world. In particular, the clinical guideline was established by clinical questions based on evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of eosinophilic fasciitis.

Evidence Refuting the Existence of Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA).

Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) was described in 2011. Over time the condition and its triggers have broadened to include several autoimmune disorders, the macrophagic myofasciitis syndrome, the Gulf war syndrome, the sick building syndrome, siliconosis, and the chronic fatigue syndrome. The aluminum-containing adjuvants in the hepatitis B vaccine and the human papillomavirus vaccine in particular have been stated to be the major causes of the disorder. Here, we review the specificity of the diagnostic criteria for ASIA. We also examine relevant human data, pertaining to causation, particularly from patients undergoing allergen-specific immunotherapy (IT). Patients undergoing allergen-specific IT receive 100 to 500 times more injected aluminum over 3 to 5 years, compared with hepatitis B and human papillomavirus vaccine recipients. In a large pharmacoepidemiological study, in contrast to case series of ASIA, patients receiving aluminum-containing allergen IT preparations were shown to have a lower incidence of autoimmune disease. In another clinical trial, there were no increases in exacerbations in a cohort of patients with systemic lupus erythematosus immunized with the hepatitis B vaccine. Current data do not support the causation of ASIA by vaccine adjuvants containing aluminum, which should be of reassurance to patients undergoing routine immunizations as well as to those undergoing allergen-specific IT.

[Autoimmune/inflammatory syndrome induced by adjuvants. A new clinical entity?] / Síndrome autoinmune/inflamatorio inducido por adyuvantes. ¿Una nueva entidad clínica?

Recently Shoenfeld and Agmon-Levin proposed a new clinical entity called autoimmune/inflammatory syndrome induced by adjuvants (ASIA), which includes four clinical entities called: 1) siliconosis, 2) Gulf War syndrome, 3) macrophage myofasciitis) and 4) post-vaccination phenomenon associated with adjuvants. They all have a common denominator: a prior exposure to immunoadjuvants, and, in addition, they also share several clinical criteria associated to chronic inflammation and autoimmune reactions. This proposal still needs to be validated by the scientific community, but nowadays is a topic of hot discussion in the literature and in various international conferences. In this revision article, we analyze the characteristics of this syndrome, the current mechanisms possibly involved in the pathogenesis, and the more recent reports regarding ASIA associated to vaccine and some foreign substances.

Recientemente Shoenfeld y Agmon-Levin han propuesto una nueva entidad clínica denominada síndrome autoinmune/inflamatorio inducido por adyuvantes (ASIA, por sus siglas en inglés), el cual incluye cuatro entidades denominadas: 1) siliconosis, 2) síndrome de la guerra del Golfo, 3) miofascitis macrofágica y 4) fenómeno posvacunación asociado a adyuvantes. Todos ellos tienen un denominador común: una exposición previa a inmunoadyuvantes y además comparten varios criterios clínicos asociados a inflamación crónica y reacciones autoinmunes. Esta propuesta aún debe ser validada por la comunidad científica, pero hoy en día es un tema de intenso debate en la literatura biomédica y en varias conferencias internacionales. En esta revisión, se analizan las características de este síndrome, los mecanismos actuales posiblemente implicados en la patogénesis y los más recientes informes sobre ASIA asociada a vacunas y a algunas sustancias extrañas.

Morphea and Eosinophilic Fasciitis: An Update.

Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint contractures and limb length discrepancies. Eosinophilic fasciitis (EF, Shulman syndrome) is often regarded as belonging to the severe end of the morphea spectrum. The exact driving mechanisms behind morphea and EF pathogenesis remain to be elucidated. However, extensive extracellular matrix formation and autoimmune dysfunction are thought to be key pathogenic processes. Likewise, these processes are considered essential in systemic sclerosis (SSc) pathogenesis. In addition, similarities in clinical presentation between morphea and SSc have led to many theories about their relatedness. Importantly, morphea may be differentiated from SSc based on absence of sclerodactyly, Raynaud's phenomenon, and nailfold capillary changes. The diagnosis of morphea is often based on characteristic clinical findings. Histopathological evaluation of skin biopsies and laboratory tests are not necessary in the majority of morphea cases. However, full-thickness skin biopsies, containing fascia and muscle tissue, are required for the diagnosis of EF. Monitoring of disease activity and damage, especially of subcutaneous involvement, is one of the most challenging aspects of morphea care. Therefore, data harmonization is crucial for optimizing standard care and for comparability of study results. Recently, the localized scleroderma cutaneous assessment tool (LoSCAT) has been developed and validated for morphea. The LoSCAT is currently the most widely reported outcome measure for morphea. Care providers should take disease subtype, degree of activity, depth of involvement, and quality-of-life impairments into account when initiating treatment. In most patients with circumscribed superficial subtypes, treatment with topical therapies suffices. In more widespread disease, UVA1 phototherapy or systemic treatment with methotrexate (MTX), with or without a systemic corticosteroid combination, should be initiated. Disappointingly, few alternatives for MTX have been described and additional research is still needed to optimize treatment for these debilitating conditions. In this review, we present a state-of-the-art flow chart that guides care providers in the treatment of morphea and EF.

Evidence for the existence of nociceptors in rat thoracolumbar fascia.

Recently, the existence of nociceptive fibers in fascia tissue has attracted much interest. Fascia can be a source of pain in several disorders such as fasciitis and non-specific low back pain. However, little is known about the properties of fascia nociceptors and possible changes of the fascia innervation by nociceptors under pathological circumstances. In this histologic study, the density of presumably nociceptive fibers and free nerve endings was determined in the three layers of the rat TLF: inner layer (IL, covering the multifidus muscle), middle layer (ML) and outer layer (OL). As markers for nociceptive fibers, antibodies to the neuropeptides CGRP and SP as well as to the transient receptor potential vanilloid 1 (TRPV1) were used. As a pathological state, inflammation of the TLF was induced with injection of complete Freund's adjuvant. The density of CGRP- and SP-positive fibers was significantly increased in the inner and outer layer of the inflamed fascia. In the thick middle layer, no inflammation-induced change occurred. In additional experiments, a neurogenic inflammation was induced in the fascia by electrical stimulation of dorsal roots. In these experiments, plasma extravasation was visible in the TLF, which is clear functional evidence for the existence of fascia nociceptors. The presence of nociceptors in the TLF and the increased density of presumably nociceptive fibers under chronic painful circumstances may explain the pain from a pathologically altered fascia. The fascia nociceptors probably contribute also to the pain in non-specific low back pain.

Consenso sobre utilización de las infiltraciones en el deporte. Documento de Consenso de la Sociedad Española de Medicina del Deporte / Consensus on use of infiltration in sport. Document of Consensus of the Spanish Society of Sports Medicine

La infiltración es una opción terapéutica, utilizada para el tratamiento de diversas patologías, que consiste en la administración inyectada en localizaciones precisas de diferentes sustancias. Pueden tener un efecto analgésico y/o antiinflamatorio y curativo. Su uso es frecuente en el tratamiento de muchas lesiones de tejidos blandos como bursitis, sinovitis, fascitis plantar, esguinces, lesiones musculares, tendinopatías y lesiones condrales y deben de ir precedido del correspondiente diagnóstico. Casi todas las infiltraciones tienen efectos secundarios locales, leves y, en algunas ocasiones, sistémicos y pueden presentar algunas contraindicaciones específicas que dependen de la sustancia administrada. La mayor parte de los efectos adversos son debidos a uso inapropiado del medicamento. Los principios activos más utilizados son: Anestésicos locales que producen un alivio inmediato del dolor, como lidocaína y bupivacaína. Se pueden usar solos o en combinación con corticosteroides ejerciendo un efecto combinado analgésico inmediato del dolor local y un efecto terapéutico de mayor duración. Corticoides cuya propiedad fundamental es una acción antiinflamatoria muy potente. Los más utilizados son betametasona, metilprednisolona y triamcinolona. Ácido hialurónico, utilizado en el tratamiento de patologías articulares, especialmente la artrosis de rodilla y las condromalacias. Lubrifica las articulaciones y parece tener efectos directos sobre la función de las células sinoviales y el líquido sinovial. Escleroterapia, que es la introducción de una sustancia química en la luz de los vasos sanguíneos, provocando una obliteración y fibrosis secundaria. Está indicada fundamentalmente en las tendinopatías con proliferación vascular. Biorreguladores: Estimulan la curación al modular o activar diversas sustancias implicadas. Plasma rico en plaquetas: plasma autólogo que contiene más concentración de plaquetas que la sangre normal que segregan una gran cantidad de factores de crecimiento. Proloterapia, que consiste en la infiltración de sustancias que estimulan la regeneración y reparación de los tejidos. Otros: Antiinflamatorios no esteroideos, factores de crecimiento, células madre y terapias relacionadas

Infiltration is a therapeutic option used for the treatment of various diseases, which comprises injected administration into precise locations of different substances. They may have an analgesic and / or anti-inflammatory and healing effect. Its use is common in the treatment of many soft tissue injuries such as bursitis, synovitis, plantar fasciitis, sprains, muscle injuries, tendinopathies and chondral injuries and must be preceded by the appropriate diagnosis. Almost all local infiltrations have mild side effects and, sometimes, these may be systemic and may have some specific contraindications depending on the administered substance. Most of the adverse effects are caused by improper use of the drug. The most used active substances are: local anesthetics that produce immediate pain relief, such as lidocaine and bupivacaine. They can be used alone or in combination with corticosteroids producing an immediate analgesic combined effect on local pain and a therapeutic effect of longer duration. Corticosteroids, whose main property is a very powerful anti-inflammatory action. The most used are betamethasone, methylprednisolone and triamcinolone. Hyaluronic acid, used in the treatment of joint diseases, particularly knee osteoarthritis and chondromalacias/chondropathias . It lubricates joints and appears to have direct effects on the function of synovial cells and synovial fluid. Sclerotherapy, which is the introduction of a chemical substance in the light of the blood vessels, causing obliteration and secondary fibrosis. It is indicated mainly in tendinopathies with vascular proliferation. Biorregulators: They stimulate healing when modulate or activate various involved substances. Platelet-rich plasma: autologous plasma containing more platelet concentration that normal blood, secreting a large amount of growth factors. Prolotherapy, it consists in substances infiltration that stimulate regeneration and tissue repair. Other: Nonsteroidal anti-inflammatory drugs, growth factors, stem cells and related therapies

Atypical presentations of eosinophilic fasciitis.

Eosinophilic fasciitis is an uncommon connective tissue disease that may mimic and overlap with other sclerosing disorders such as morphea and lichen sclerosus. Herein, we report four patients (two men and two women, aged 16-64 yeas) with eosinophilic fasciitis. There was overlap with both morphea and lichen sclerosus in 2 patients and with morphoea alone in 1 patient. Magnetic resonance imaging (MRI) was used for diagnosis in three patients and for assessing treatment response in one patient. Eosinophilic fasciitis may co-exist with morhoea and lichen sclerosus. In view of the overlapping clinical and histopathological features of these disorders, MRI may be helful in delineating the conditions by detecting involvement of fascia.

[Autoimmune/infl ammatory syndrome induced by adjuvants, ASIA].

There have been many cases of the appearance of autoantibodies and symptoms of disease after exposure to adjuvants, not only after breast augmentation with silicone implants, but also as a very rare vaccination side effect, such as Gulf war syndrome or macrophagic myofasciitis syndrome. Diseases whose symptoms developed after such adjuvant exposure are called autoimmune/ in􀏐lammatory syndrome induced by adjuvants (ASIA). The group of adjuvants includes not only silicone implants, silica, squalen and aluminium, but also ink components used for making tattoos. Analyzing the available reports on the in􀏐luence of adjuvants on the development of autoimmune diseases, the conclusion is that apart from long -term silicone exposure, the coexistence of other factors such as genetic or environmental is also necessary. Metaanalyses clearly do not con􀏐irm an increased risk of developing autoimmune disease after breast augmentation with silicone implants, or tattooing, but it seems that among these patients there is a group that is more predestined to develop disease symptoms. In the general population the bene􀏐its of vaccination are obvious, and the risk of severe adverse events following immunisation is incomparably lower than the risk of developing a speci􀏐ic disease and its complications, also for patients with diagnosed autoimmune diseases. Because of data heterogeneity in previous studies and dif􀏐iculties in diagnosing ASIA it seems necessary to conduct further analyses of adjuvants' in􀏐luence on autoimmune disease development, and to re􀏐ine ASIA diagnostic criteria, which now allow too easy a diagnosis of this syndrome.

Fascitis eosinofílica. A propósito de un caso / Eosinophilic fasciitis. Apropos of a case

La fascitis eosinofílica es un síndrome esclerodermiforme poco frecuente y de etiología desconocida que afecta predominantemente a las extremidades. Se han barajado varias hipótesis sobre su etiología y en algunos casos se ha descrito antecedente traumático. Presentamos un caso de una paciente de 54 años que tras presentar traumatismo sobre las rodillas inicia un cuadro de mialgias, induración cutánea y retracción progresiva de diversas articulaciones iniciado en los miembros inferiores y posteriormente en los miembros superiores y en el tronco. Realizamos el seguimiento de la paciente, mostrando su manejo desde el punto de vista rehabilitador y evolución. La paciente mejoró tanto sus balances articulares como la marcha y el dolor. La fascitis eosinofílica es una enfermedad infrecuente en la que debemos realizar el diagnóstico diferencial con otros síndromes esclerodermiformes. La rehabilitación puede ayudar a reducir y evitar el progreso de las contracturas (AU)

Eosinophilic fasciitis is a rare scleroderma syndrome of unknown cause that predominantly affects the extremities. Several hypotheses have been proposed to explain its etiology and there have been reports of some patients with a history of trauma. We present the case of a 54-year-old woman who, after a knee injury, developed myalgia, progressive skin induration and retraction of various joints, starting in the lower limbs and spreading to the upper limbs and trunk. We describe the rehabilitation management and outcome of this patient. The patient showed improvement in both balance, joint pain, and gait. Eosinophilic fasciitis is a rare disease that requires a differential diagnosis with other scleroderma syndromes. Rehabilitation can help reduce and prevent progression of contractures (AU)

[Thinking of therapeutic mechanism of small knife needle in treating closed myofascitis].

The authors investigated and discussed therapeutic mechanism of small knife needle in treating closed myofascitis on the basis of pathomechanism of modern medicine and acupuncture theory of TCM among numbers of clinical cases and experimental data. Therapeutic mechanism lies in 6 aspects: (1) Relieve the energy crisis of tenderness point on muscular fasciae; (2) Affect nervous system and reduce induction of harmful stimulating signal; (3) Inhibit aseptic inflammatory reaction on muscular fasciae; (4) Regulate dynamic equilibrium of soft tissue by cutting scar and releasing the conglutination; (5) Increase patients' regional threshold of feeling; (6) Reduce tension and pressure of soft tissue of tenderness point so as to relieve extrusion of nervus cutaneous.