Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

[Efficacy of magnetotherapy in hand erosive osteoarthritis. A clinical trial]. / Eficacia de la magnetoterapia en artrosis erosiva de manos. Un ensayo clínico.

INTRODUCTION: Erosive arthritis is an unusual pathology. Despite using magnetotherapy as a treatment, there is no evidence supporting its use. The aim of the study is to evaluate magnetotherapy efficacy in patients suffering from hand erosive arthritis, compared to placebo, in terms of pain. Treatment safety will be also evaluated. METHOD: Prospective experimental double-blind randomized study consisting of an intervention group (IG: treatment with magnetotherapy: 15 20-minute-sesions 5 consecutive days per week) and a control group (CG: placebo). Treatment efficacy was evaluated at the end and 3 months after. We used Visual Analog Scale (VAS) for assess pain. Secondarily, functionality (The Disabilities of the Arm, Shoulder and Hand (DASH) score), rigidity (Modified Kapandji Index), grip strength (dynamometry) and quality of life (SF-36 questionnaire) were assessed. RESULTS: 29 patients were evaluated. Due to exclusion criteria, there were 19 patients left, all women with an average age of 59. After randomization, 10 were awarded to IG and 9 to CG, being both comparable groups. A higher percentage of patients with pain controlled (VAS<6) was found in IG post treatment and after 3-months (77.8% vs 33.3%, p=0.1 y 83.3% vs 33.3%, p=0.2; respectively). A tendency to decrease VAS for IG at 3-months (regression coefficient: -2.1 (95% CI: -5.7-1.5; p=0.2) was showed. There were no other statistically significant differences, except a higher dynamometry results in IG, in both hands (p<0.01 and p<0.04 respectively). There were neither adverse effects nor secondary effects. CONCLUSION: Magnetotherapy treatment for hand erosive arthritis patients is safe and probably leads to clinical improvement.

Abnormal bone scintigraphy and silent radiography in localized reflex sympathetic dystrophy syndrome.

Typical, definite forms of the reflex sympathetic dystrophy syndrome present no diagnostic problems, but the diagnosis of localized or very localized forms is very difficult. In the absence of characteristic roentgenographic evidence of acute, patchy, bony demineralization in the affected extremity, scintigraphy has proven to be a valuable examination. A retrospective analysis of 6 patients with a partial form of reflex sympathetic dystrophy with negative roentgenogram results who were evaluated by bone scintigraphy is presented. In the initial clinical stages, the predominant scintigraphic pattern was a very localized and intense hyperactivity in the internal femoral condyle and/or tibial plate of the affected joint on both blood pool and static images. The increased periarticular activity showed a marked decrease in association with remission of the clinical symptoms. In conclusion, bone scintigraphy was found to be a useful tool in the diagnosis and assessment of the therapeutic response genograms and increased periarticular radionuclide activity on scintigrams in the affected extremity are characteristic findings (Intenzo et al. 1989). Cases of reflex sympathetic dystrophy syndrome involving the hip (Lequesne and Mauger 1982) and the knee (Doury et al. 1987) have been reported, although the diagnosis at these sites is more difficult due to the absence of characteristic external signs. Localized or very localized forms of reflex sympathetic dystrophy (mainly involving the knee) with no radiological abnormalities throughout the course of the disease have been documented (Doury et al. 1979; Doury 1982). In these cases, bone scintigraphs proved to be a valuable examination to confirm the diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Muscle pathology in ankylosing spondylitis: clinical, enzymatic, electromyographic and histologic correlation.

We assessed muscle pathology in 30 patients with ankylosing spondylitis (AS) and 22 controls to assess if skeletal muscle is affected primarily by the inflammatory process of the disease. Investigations included a questionnaire on musculoskeletal discomfort, physical exercises, dynamometric measurements, EMG, and biopsy of the quadriceps muscle. Symptoms of muscular weakness were related with enthesopathic activity index. Plasma CK was higher in patients than in controls. A myopathic EMG pattern was found in 46.4% patients. Histological changes were found in 66% and did not correlate with symptomatology. Patients with AS with clinical muscular manifestations probably have intense enthesopathic inflammatory activity. It is suggested that muscles are secondarily affected as a consequence of pain inhibition and reduced activity.

[Syphilitic arthro-osteitis]. / Artroosteítis luética.

We report a black female with past history of sexual promiscuity who developed arthroosteitis of clavicula and sternoclavicular joint and cranial osteitis during secondary syphilis. Spirochaeta were identified in the material from osteoarticular biopsy. The patient was treated with benzathine penicillin, 2,400,000 U weekly for three weeks. There was a complete clinical recovery. We emphasize the uncommon occurrence of osteoarticular involvement in secondary syphilis and the exceptional character, according to the literature, of the finding of spirochaeta in the biopsy material. We discuss the differential diagnosis and we review the literature on secondary syphilis. We suggest that syphilis should be considered in the differential diagnosis of any acute arthritis or osteitis, particularly when the involved joint is the sternoclavicular and the patient is sexually promiscuous.