Long-term experience of bosentan for treating ulcers and healed ulcers in systemic sclerosis patients.

OBJECTIVES: Our objective was to evaluate the efficacy and tolerability of bosentan in patients with systemic sclerosis (SSc) who develop ulcers and healed ulcers. We also wanted to analyse the effect of bosentan on other skin and general outcome measurements. METHODS: In the present prospective, observational, non-controlled study, we followed all patients with SSc who started treatment with bosentan for ischaemic ulcers and healed ulcers from January 2003 to June 2006 in our centre. We recorded skin and general outcome measurements at baseline and at 6 months. RESULTS: Fifteen patients were included. After a median follow-up of 24.7 months (range: 4-36), there was a significant decrease in the number of ulcers. A trend towards efficacy was seen in the number of healed ulcers and in the severity of ulcers. No significant effect was seen in other skin and general outcome measurements. Toxicity related to bosentan included mild transitory events and one toxic hepatitis. CONCLUSION: Bosentan may be a safe long-term alternative for treating the recurrence of skin ulcers and healed ulcers in SSc patients.

Mujer con osteoporosis con dolor en región ilíaca / Woman with osteoporosis and pain in the iliac region

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[Bone ultrasound in healthy women and bone mass related factors]. / Medición ultrasónica del hueso en mujeres sanas y factores relacionados con la masa ósea.

BACKGROUND: Bone mineral density (BMD) has been related with age, hormonal status, body mass index (BMI) and life style. We have evaluated the influence of these factors on BMD in healthy women, without risk factors for osteoporosis, using ultrasound measures. PATIENTS AND METHODS: We have selected 255 women (136 premenopausal and 119 postmenopausal). We measured the weight and height. Other factors related to BMD were assessed with a clinical questionnaire. With an ultrasonic bone contact analyser broadband ultrasonic attenuation (BUA) and speed of sound (VS) were obtained. RESULTS: Premenopausal women had mean (SD) BUA and VS values (73.4 [13.1] and 1,617.2 [30.4], respectively) significantly higher than postmenopausal women (BDA 64.1 [14.9] and VS 1,601.1 [34.5]; p < 0.001). No relationship between BUA, VS and the style of life related variables was found. Age and weight were significant predictors of BUA in all women in multiple regression model, and the length of lactation in premenopausal women. The association of BUA with age were significantly stronger (p < 0.05) in postmenopausal women. CONCLUSIONS: Age and body weight were the factors more strongly associated with ultrasonic measures in healthy women. The effect of age was different depending on menopausal status. No relation has been found between life habits and bone mass.

Rheumatoid nodulosis: report of a case with evidence of intraosseous rheumatoid granuloma.

We describe a patient who had multiple subcutaneous rheumatoid nodules associated with episodes of acute intermittent arthritis and subchondral cystic lesions of the small bones of the hands and feet; this condition is termed "rheumatoid nodulosis." The patient had a cystic lesion in communication with the joint cavity, rheumatoid granulomas, and evidence of a central zone of necrosis opening toward the joint space. His case is compared with 8 previously reported cases, and possible etiologies of the subchondral bone cyst formation in rheumatoid nodulosis are discussed.

Toxic oil syndrome: a syndrome with features overlapping those of various forms of scleroderma.

Thirty-two toxic oil syndrome (TOS) patients were selected because they presented with scleroderma-like changes and were observed during the first 36 months of evolution of the disease. Initially, these patients presented with a noncardiogenic pulmonary edema, eosinophilia, arthralgia/arthritis, peripheral edema, and myositis. Histologic investigations showed a widespread chronic interstitial infiltrate with lymphocytic vasculitis. They subsequently developed peripheral neuropathy, joint contractures, scleroderma-like changes, Raynaud phenomenon, pulmonary hypertension, sicca syndrome, and liver disease. Biopsy studies during this stage showed fibrosis and obliterating arteriopathy. Late features of TOS are musculoskeletal pain, cramps, livedo reticularis, carpal tunnel syndrome, and digital tuft changes. TOS is a new chemically induced scleroderma-like syndrome with features overlapping those of eosinophilic fasciitis, systemic sclerosis, and forms of localized scleroderma.