Musculoskeletal manifestations in polymyalgia rheumatica and temporal arteritis.

OBJECTIVE: To evaluate the incidence and characteristics of musculoskeletal manifestations in polymyalgia rheumatica (PMR) and temporal arteritis (TA). METHODS: The records of 163 cases of PMR or TA diagnosed over a 15 year period in one area of Spain were reviewed for the presence and type of musculoskeletal manifestations. RESULTS: Of 163 patients, 90 had isolated PMR and 73 had TA. Eighteen of the 90 patients (20%) with isolated PMR developed distal peripheral arthritis either at diagnosis or during the course of the disease. When it occurred, synovitis was mild, monoarticular or pauci-articular, asymmetrical, transient, and not destructive. Other distal manifestations observed in these patients were carpal tunnel syndrome and distal extremity swelling with pitting oedema. In all cases these manifestations occurred in conjunction with active PMR. As expected, PMR was the most frequent musculoskeletal manifestation in patients with TA, occurring in 56% of cases. On the contrary, only 11% of patients with TA developed peripheral arthritis. An important finding was that peripheral arthritis in these patients appears to be linked only temporally to the presence of simultaneous PMR and is not observed in its absence. Distal extremity swelling or defined polyarthritis were not observed. CONCLUSION: The spectrum of distal musculoskeletal manifestations of PMR in our series is similar to that reported in other populations. By contrast, distal musculoskeletal symptoms are uncommon in TA. The almost complete absence of distal musculoskeletal manifestations in patients with pure TA suggests different mechanisms of disease in PMR and TA, supporting the view of two separate conditions or one common disease in which host susceptibility influences the clinical expression.

Reflex sympathetic dystrophy in hypophosphataemic osteomalacia with femoral neck fracture: a case report.

We report a male patient who presented with suspicion of skeletal metastases based upon an abnormal 99-mTc bone scan, which showed increased uptake at both femoral heads, left femoral neck, and several ribs. The images also suggested reflex sympathetic dystrophy, subcapital fracture of the left femur, and rib fractures. A diagnosis of hypophosphataemic osteomalacia was finally made.

Lack of association between infection and onset of polymyalgia rheumatica.

OBJECTIVE: The etiology of giant cell arteritis (GCA) is unknown, but its sudden onset and the wide variation in incidence reported from various parts of the world suggest a genetic predisposition and/or the influence of environmental factors, such as infectious agents or a seasonal effect. We analyzed the influence of season on GCA in our area over the period 1985-97, as well as the possible association between infection and onset. METHODS: Retrospective study of 143 cases of GCA diagnosed from 1985 to 1997. To evaluate seasonal variation in disease onset, the month of onset of the first symptoms related to GCA was used to calculate season-specific incidence rates. Differences between season incidence rates were assessed by chi-square test. To test for an association between infection and GCA onset, we considered only infections that occurred within 2 months before the onset of disease. Because of the difficulty in determining whether an infection was present using only the clinical and laboratory data recorded in patients' medical charts, we categorized the likelihood of patients having infection into 3 groups: no infection, probable infection, and definite infection. RESULTS: Between 1985 and 1997 (both years included), a total of 143 patients (88 women, 55 men) were diagnosed with GCA. Of these, 85 had isolated polymyalgia rheumatica (PMR), 22 had temporal arteritis (TA) without PMR, and 36 had PMR associated with TA. The main clinical features in our population were similar to those reported in other studies. We found no seasonal variation in disease onset during the 13 year period. Moreover, only one (0.7%) of 143 patients was categorized as a probable infection, whereas definite infection was not observed in any case. From these results, the hypothesis of an infectious cause for GCA seems highly improbable. CONCLUSION: We were unable to observe a seasonal pattern or an association between infection and the onset of GCA.

Longterm therapy in polymyalgia rheumatica: effect of coexistent temporal arteritis.

OBJECTIVE: To analyze the clinical course and duration of therapy in a series of 104 patients with polymyalgia rheumatica (PMR), identifying factors that influence prolonged steroid use and relapses. METHODS: Retrospective study of 104 cases of PMR diagnosed from 1985 to 1995. Patients were followed from time of diagnosis until either their death or December 31, 1995. To assess the effects of the coexistence of temporal arteritis (TA) on outcome in PMR, patients were grouped according to the absence or presence of arteritis. Kaplan-Meier survival analysis was performed to evaluate the duration of therapy, the incidence of prolonged remissions and relapses, and the average time to relapse. The log-rank test was used to test for significant differences between groups. Multivariate Cox proportional hazards regression models were used to identify variables associated with the occurrence of these events. RESULTS: Of 104 patients, 69 had pure PMR and 35 had both PMR and TA. Although some patients had limited disease requiring limited corticosteroid (CS) therapy (usually about 2 years), a significant number of patients had sustained disease requiring longterm treatment. Patients with simultaneous arteritis tended to have a longer duration of therapy, but no increased risk of relapse. By multivariate analysis, increasing age at diagnosis, female sex, higher baseline erythrocyte sedimentation rate, and lower daily CS dose were significant risk factors associated with long duration of therapy. No clinical feature predicted patients who were more likely to relapse. CONCLUSION: Although there was great individual patient variation, we found that typically CS therapy lasted at least 2 years. Our findings allow the identification of patients who are particularly predisposed to need prolonged and higher dose cumulative steroid therapy and merit preventive strategies to decrease the incidence of steroid related adverse events.

[Secondary amyloidosis in rheumatoid arthritis. A clinical study of 29 patients]. / Amiloidosis secundaria a la artritis reumatoide. Estudio clínico de una serie de 29 casos.

BACKGROUND: To study the clinical features, outcome and response to therapy in 29 cases of rheumatoid arthritis (RA) with secondary amyloidosis (AA). PATIENTS AND METHOD: Twenty-nine patients with RA and AA who were diagnosed during 11 years. RESULTS: The mean age and the mean duration of RA were 63 +/- 12 years and 15 +/- 7 years respectively. The most common initial clinical feature was renal involvement (83%). Nineteen patients were treated with methotrexate. The mean survival time was 42 +/- 8 months. Eleven patients (38%) have deceased. CONCLUSION: Our data confirms that AA in RA is a serious complication with a bleak prognosis. A normal renal function is a good prognosis indicator.

[Are food intake and life styles related with bone mass in fertile women?]. / Hay relación entre los hábitos alimenticios y estilo de vida con la masa ósea en mujeres fértiles?

BACKGROUND: To study the relationship between current and adolescent calcium intake and bone mineral density (BMD) in 76 premenopausal women of 42 y. with regular menses and without pathologies associated with body weight, body morphology or BMD. METHODS: Was measured: the lumbar and femoral BMD by dual energy X-Ray absorptiometer, calcium and protein intake by a week frequencies questionnaire, and calciuria. Obesity, exercise, alcohol, tobacco and family history of osteoporosis were considered. Levels of BMD < -1SD was considered as osteopenia. RESULTS: Calcium intake average was 989 mg/day, 62% by dairy. Twenty-five percent presented osteopenia in some bone site. BMD was not correlated with calcium or protein intake, calcium/protein nor calciuria. No differences was found between normal and osteopenic group for any of the studied variables, except lower body mass index in the femoral osteopenic group. Those women who decreased the calcium intake from adolescence had 8.2% less femoral BMD tha those who increased the consumption (p = 0.05). CONCLUSION: Current and adolescent calcium intake, family history of osteoporosi calciuria, and exercise have not found useful as screening of osteopenia in premenopausal women with moderated exercise level and low consumption of alcohol and tobacco.

[Reactive arthritis. Prospective clinico-microbiologic study]. / Artritis reactivas. Estudio prospectivo clínico-microbiológico.

We study with a prospective design all reactive arthritis diagnosed at the Service of Rheumatology in Bellvitge Hospital during a thirty months period, from August 1985 to February 1988; in order to describe its clinical features, etiological factors and prognosis. Thirty patients who fulfilled the admission criteria were admitted to the study. A previously designed protocol of clinical, serological and microbiologic study was applied to all. A microorganism was identified in 21 patients. In 14 cases it was Yersinia enterocolitica, in 4 Chlamydia trachomatis, in 2 Salmonella enteritidis and in 1 a group A beta-hemolytic Streptococcus. The averaged length of the disease was 7.6 +/- 8 months.

Role of technetium-99m diphosphonate and gallium-67 citrate bone scanning in the early diagnosis of infectious spondylodiscitis. A comparative study.

A comparative study of the parts played by technetium-99m diphosphonate and gallium-67 citrate bone scanning in the early diagnosis of infectious spondylodiscitis is presented. Nineteen patients were included in the study. All patients (11 men aged 19-70 years and eight women aged 18-72 years) had a history of back pain varying in duration from one to 15 weeks. A 99mTc diphosphonate bone scan was positive in 17 patients. The two patients with negative results had less than two weeks of back pain. The 67Ga citrate bone scan showed uptake in all patients.

Pyogenic arthritis caused by Streptococcus milleri in a nonimmunocompromised host.

We describe a case of pyogenic arthritis caused by S. milleri (S. anginosus) in a non-immunocompromised host. No other septic focus was found. S. milleri is now widely recognized as an important cause of pyogenic infection, though it eluded suspicion for many years. The rarity of reports of articular infections by S. milleri might be due to problems associated with its recognition.