[Triple association: late-onset seronegative spondyloarthropathy, Paget's disease and giant cell arteritis]. / Triple asociación: espondiloartropatía seronegativa de inicio tardío, enfermedad de Paget y arteritis de células gigantes.

The diagnosis of several rheumatic diseases in one-self patient is frequent in practice. However, some associations are exceptional and their recognition is important for a correct treatment and prognostic. We present the case of an old patient in who we diagnose a late onset seronegative spondylarthropathy and a Paget's disease and that later it developed a giant cells arteritis. The association of ankylosing spondylitis with Paget's disease or with polymyalgia rheumatica, it has already been described in the literature, but our patient's triple association we have not found it.

[RS3PE syndrome or benign edematous polysynovitis in the elderly. Study of 8 cases]. / Síndrome RS3PE o polisinovitis edematosa benigna del anciano. Estudio de ocho casos.

BACKGROUND: The RS3PE syndrome is a recently described uncommon disorder in the elderly patient; in the initial reports, it was characterized by an excellent prognosis with total remission. In contrast with rheumatoid arthritis and polymyalgia rheumatic, it has been related to HLA B7. Further works have questioned its benign nature and even that it is a new entity. Our objective was to study the clinico-biological characteristics, therapy, and clinical course in patients with RS3PE attended at our clinic. METHODS: Retrospective descriptional study of patients with RS3PE attended in our clinic from January 1992 to December 1998 following the inclusion criteria proposed by Olivé et al. For all patients, the following determinations and studies were performed: complete blood count, ESR, serum biochemistry, two measurements of rheumatoid factor (RF), and X-ray. Class I HLA typing was determined in five cases. RESULTS: Eight patients were found (6 men and 2 women), with a mean age of 68.7 years. The arthritis was more common at MCP, wrists, shoulder, and PIF in hands. Four patients had tenosynovitis of the hand flexors. ESR (mean: 69.3) and RCP (mean: 49.7) were increased in most cases. Seven patients had leukocytosis. HLA B7 was positive for 4 out of five patients. All patients were treated with low-dose corticosteroids, with a mean length of 9.5 months. Three patients had relapses. During follow-up after therapy had been completed, none of the patients had other diseases. CONCLUSIONS: RS3PE syndrome involves elderly patients and its clinical course is characterized by sudden onset seronegative symmetrical polysynovitis, with pitting edema over the hand dorsum and less commonly over the pretibial region. In most cases, a marked acute-phase reaction and leukocytosis were observed. Therapy with low-dose corticosteroids is effective; sometimes however, it is necessary to add antimalarial agents. The three patients who relapsed had underlying diseases: chronic lymphocytic leukemia, Sjögren's syndrome, and liver cirrhosis, respectively. The diagnosis of RS3PE should be obtained a posteriori, after a prolonged follow-up of the patient. Atypical cases, with evolution towards other rheumatic or hematological disorders or as paraneoplastic manifestation, have been reported.

[Mediterranean boutonneuse fever as a cause of arthritis and false-positive serology for Borrelia burgdorferi]. / Fiebre botonosa mediterránea como causa de artritis y serología falsamente positiva para Borrelia burgdorferi.

Arthritis is a rare clinical manifestation of Mediterranean boutonneuse [correction of Botonous] Fever (MBF). We present the case of a female patient with MBF who was admitted with an acute monoarthritis with inflammatory fluid and, besides, had a false-positive serology to Borrelia burgdorferi, which we have not found published before. In the scientific literature reviewed we only found 12 cases of MBF and arthritis. We discuss its probable pathogenic mechanism and underline the scarce importance which has been given to this manifestation in the large MBF series.

[The reflex sympathetic dystrophy syndrome associated with breast cancer]. / Síndrome de distrofia simpática refleja asociado a cáncer de mama.

Reflex sympathetic dystrophy syndrome (RSDS) is a rare entity of unknown etiopathogenesis, associated to different precipitating factors such as malignant tumors of several localizations. A new clinical variety has been recently described which has been denominated palmar fasciitis and polyarthritis syndrome. We present here two patients with RSDS associated to breast cancer: one case presenting fasciitis and polyarthritis and another case also associated to polymyalgia rheumatica. We emphasize the importance of reducing the tumor mass in the treatment of this syndrome, as well as including it in the gammagraphic differential diagnosis of bone metastasis.

[Reiter's syndrome: considerations on the frequency and mid-term course of its juvenile form]. / Síndrome de Reiter: consideraciones sobre la frecuencia y la evolución a medio plazo de su forma juvenil.

Reiter's Syndrome (RS) is not common in children and adolescents. From 1982 to 1987 we have seen 13 pediatric patients (8 male and 5 female) with clinical manifestations that characterized RS. Age of onset was 13 years. Clinical findings have been arthritis (100%) involving the knee and ankle joints, heel pain (84%), lumbosacral pain (38%). One to three weeks before joint involvement, six patients (46%) complained of urethritis, 5 (38%) had enteritis and two patients had both. 46% of the patients had HLA-B27 antigen. Radiologic findings were sacroileitis in five patients and calcaneal spurs. All patients were treated with non-steroidal antiinflammatory therapy and, in general, there was a clinical remission in 1-3 months. Nevertheless, after 4 years of follow up, 2 patients had acute relapsing arthritis and 4 had chronic arthropathy. Three patients have developed secondary ankylosing spondylitis. RS is not all that infrequent in pediatric patients with joint involvements if one looks for urethritis, enteritis, eye involvement and cutaneous manifestations. The clinical course is favorable, but there might be some chronic or relapsing cases. Some patients can developed secondary ankylosing spondylitis. For that reason a prolonged follow up of these patients is necessary.