Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis.

OBJECTIVES: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.

Bilateral hand dactylitis: An unusual presentation of the great imitator: Tuberculosis.

The incidence of tuberculosis in developed countries has decreased over the years due to the use of effective tuberculosis drugs and improvements in socio-economic conditions. However, with the ease of global transport and increased travel to countries with high tuberculosis prevalence, the reduction in extrapulmonary tuberculosis cases has been less significant compared with the overall decrease in tuberculosis cases. Extrapulmonary tuberculosis can manifest in a variety of ways. Tuberculous dactylitis, a rare form of tuberculous osteomyelitis, was first described by Rankin in 1886. It mainly affects the short tubular bones in the hands and feet of children and is sometimes called 'spina ventosa'. A 42-year-old male patient initially presented to an external centre reporting swelling and pain in the hand joints of one year's duration. Despite one year of treatment with leflunomide and methylprednisolone (16 mg) and a history of methotrexate use during this period, he experienced no improvement. The patient's condition worsened after the start of sulfasalazine. Dermatological examination was performed due to the presence of haemorrhagic crusted papules and plaques on the ventral surface of both hands. A wound culture was taken, but no bacterial growth was observed. One week after the initial evaluation, the patient complained of persistent foul-smelling nasal discharge, which led to an evaluation by the infectious disease department. At this time, the Quantiferon test was positive. Mycobacterial culture on Days 1 and 3 showed growth of the Mycobacterium tuberculosis complex.

Manifestaciones articulares en la acromegalia: implicaciones diagnósticas y terapéuticas de la coexistencia de la artropatía acromegálica y artritis reumatoide / Articular manifestations in acromegaly: diagnostic and therapeutic implications of the coexistence of acromegalic arthropathy and rheumatoid arthritis

La presencia de artropatía en los pacientes con acromegalia puede ser debida a la recurrencia de la acromegalia o a la existencia de una enfermedad articular inflamatoria como la artritis reumatoide (AR). Existen pocas publicaciones que evalúen la coexistencia de AR y acromegalia. La presentación de dos casos con la coexistencia de AR y artropatía acromegálica permite evaluar las claves para su diagnóstico diferencial y sus implicaciones en el tratamiento. El diagnóstico de AR en los pacientes con acromegalia requiere de una alta sospecha clínica, por lo que debería ser considerado en aquellos casos en los que no se consiga un adecuado control de los síntomas. El retraso en el diagnóstico y tratamiento de la AR puede incrementar el daño articular y posiblemente empeora el pronóstico funcional de los pacientes

The presence of arthropathy in patients with acromegaly may suggest recurrence of acromegaly or the existence of an inflammatory joint disease such as rheumatoid arthritis (RA). Few publications have evaluated the coexistence of RA and acromegaly. Two cases were presented with a coexistence of RA and acromegalic arthopathy, which enabled us to evaluate the key factors in differential diagnoses and the implications for treatment. Diagnosis of RA in patients with acromegaly requires a high level of clinical suspicion, and should therefore be considered in cases where adequate symptom control is not achieved. Delay in the diagnosis and treatment of RA can increase joint damage and possibly worsen a patient's functional prognosis

Varón con nódulos de Garrod y camptodactilia / A man with Garrod's pads and camptodactyly

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Response of three digital anesthetic technics in horses with forelimb hoof lameness / Resposta de três técnicas anestésicas digitais em equinos com claudicação dos membros anteriores ligada ao casco

The presented study aimed to assess objectively the response of distal interphalangeal joint (DIJ), navicular bursa (NB) and deep digital flexor tendon sheath (DDFTS) anesthesia in horses with forelimb hoof lameness; and evaluate if the presence of radiographic abnormalities on navicular bone could interfere on blocks' results. Fifteen horses with lameness improvement above 70% after palmar digital nerve (PDN) block were selected for this study. Blocks were assessed separately on five consecutive trials at seven different time-points. The fifth trial was performed to evaluate the influence of exercise on preexisting lameness. Most of horses (73.33%) presented pain related to the podotrochlear apparatus based on clinical and lameness exam and blocks' responses. NB and DIJ anesthesia differed on the frequency of horses with lameness improvement above 70% only at 10min (p=0.03), and both differed from DDFTS block until 30'(p<0.05). The blocks' response was variable along the time and the highest means for NB, DIJ and DDFTS were observed at 5-10 minutes ('), 15-20' and 10-15' respectively.Exercise had low interference on lameness intensity since no improvement above 50% was observed and an increase on lameness intensity over time was identified in seven horses. Variable grades of navicular bone radiographic lesions were observed in 14 horses, although these lesions had no interference on blocks' response (p>0.05). The NB and DIJ blocks had similar responses and both were superior to DDFTS anesthesia, coincident with a major prevalence of podotroclear apparatus abnormalities in this equine population.(AU)

O presente estudo avaliou, de forma objetiva, as respostas do bloqueio da articulação interfalangeana distal (AID), da bursa do navicular (BN) e da bainha do tendão flexor digital profundo (BTFDP) em equinos com claudicação ligada ao casco nos membros torácicos; além de analisar a influência das alterações radiográficas do osso navicular no resultado dos bloqueios. Quinze cavalos, que apresentaram uma melhora da claudicação acima de 70% após o bloqueio do nervo digital palmar, foram selecionados para este estudo. Os bloqueios foram avaliados separadamente em cinco turnos consecutivos e em sete tempos diferentes. O quinto turno foi utilizado para analisar a influência do exercício sobre a claudicação preexistente. A maioria dos cavalos (73,33%) apresentou dor relacionada à porção palmar do casco, com base nos achados do exame clínico em movimento e nas respostas dos bloqueios. As anestesias da BN e da AID apresentaram diferença quanto à frequência de cavalos com melhora da claudicação acima de 70% apenas aos 10min (p=0.03), e ambos diferiram do bloqueio da BTFDP até os 30min (p<0.05). A resposta dos bloqueios foi variada ao longo do tempo, e as maiores médias de melhora da claudicação para os bloqueios BN, AID e BTFDP foram observadas aos 5-10min, 15-20min e 10-15min, respectivamente. O exercício teve pequena interferência na intensidade da claudicação, uma vez que nenhuma melhora acima de 50% foi observada e sete cavalos aumentaram a intensidade da claudicação ao longo do tempo. A presença de diferentes graus de lesão radiográfica do osso navicular foi observada em 14 cavalos, porém essas lesões não interferiram na resposta dos bloqueios (p>0,05). Os bloqueios da BN e da AID apresentaram respostas semelhantes, e ambos foram superiores ao bloqueio da BTFDP, coincidindo com uma marcada prevalência de doença do aparato podotroclear nesta população de equinos.(AU)

Síndrome de Vaughan-Jackson, a propósito de un caso / Vaughan-Jackson syndrome: presentation of a case

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Acrometástasis como presentación inicial de un adenocarcinoma de pulmón en una mujer joven / Acrometastasis as the initial presentation of lung adenocarcinoma in a young woman

No disponible

Periostitis reactiva de la mano / Reactive periostitis of the hand

No disponible

Tratamiento del Hallux Rigidus. A propósito de un caso / Treatment of Hallux rigidus. A propos of a case

En este artículo se describió la definición, la anatomía, la etiología, la clínica, el diagnóstico y las estrategias terapéuticas utilizadas en la actualidad, ya sean conservadoras o quirúrgicas, del Hallux Rígidus. En él se presentó la resolución de un caso clínico atendido en nuestra consulta donde la paciente presentaba dolor unilateral en el recorrido del Músculo Tibial Posterior de un año de evolución y ausencia total de la movilidad de la primera articulación metatarso-falángica del pie izquierdo. Se le diagnosticó de Hiperpronación de Retropié Bilateral y de Hallux Rígidus secundario del pie izquierdo. El objetivo principal fue reducir la sintomatología que presentaba la paciente, a su vez, conseguir disminuir la hiperpronación del retropié y favorecer una mayor funcionalidad en el primer segmento dígito-metatarsal(AU)

This article describes the definition, anatomy,etymology, clinical, diagnostic and the therapeutic strategies currently used, both chirurgic and palliative, for Hallux Rigidus. The methodology used to describe all of the above terms was the resolution of a real clinical case at the University of Barcelona Podiatrist Hospital during my last year of studies forthe degree of Podiatry at the same University. The patient who agreed to be part of the study suffered from unilateral pain in posterior tibial muscle and total lack of mobility of the first articulation metatarsal-phalanges of the left foot. The symptoms appeared a year before this study was conducted. The diagnosis of the patient was bilateralr-pronation of the bilateral and with secondary Hallux Rigidus in the left foot. The main objective of the study was to reduce the symptoms suffered by the patient; the secondary objective was to find an appropriate treatment that would reduce the patient’s overpronation to gain some functionality of the first segment(AU)

Efeito analgésico do laser de baixa intensidade (LILT) na artrite reumatóide aguda / Effect analgesic of low intensity laser (LILT) in rheumatoid arthritis acute

Introdução - Avaliar a efetividade da laserterapia de baixa intensidade (LILT) na promoção da analgesia em portadores de artrite reumatóide. Material e Métodos - Dez sujeitos, portadores de artrite reumatóide (05 pertencentes ao grupo irradiado e 05 pertencentes ao grupo placebo) foram submetidos à 10 sessões de LILT, divididas em 5 semanas (2 sessões/semana). O Questionário de Dor Br-MPQ foi aplicado no início e ao final do protocolo. Resultados - Obteve-se um resultado significativo de menor algia no grupo controle (80%) e um resultado de maior algia no grupo irradiado(40%), o que não se implica em um resultado efetivo ao estudo. Conclusão - A LILT (904 nm) não foi efetiva na analgesia em portadores com artrite reumatóide.

Introduction - Evaluating the effectiveness of low power laser therapy in order to promote analgesic effect in rheumatoid arthritis bearers. Material and Methods - Ten subjects bearer of rheumatoid arthritis (05 belonging to radiated group and 05 belonging to placebo group) were evaluated in ten session of LILT, divided in five weeks (two session/week). The Brazilian version of Dor Br - MPQ questionnaire from McGill Pain Questionnaire was used and applied at the beginning and at the end of the protocol. Results - We got a pretty smaller result from the control group (80%) and a bigger result from the radiated group (40%), what does not mean an effective result to this study. Conclusion - The LILT (904 nm) was not effective in the analgesic effect in rheumatoid arthritis bearers.

Fibrohistiocitoma maligno (sarcoma pleomórfico indiferenciado de alto grado) sobre tofo gotoso / Malignant fibrous histiocytoma (undifferentiated high grade pleomorphic sarcoma) arising in a gouty tophus

La gota es una enfermedad por alteración del metabolismodel ácido úrico que puede producir graves lesiones articulares.Presentamos un caso clínico correspondiente a unvarón de 76 años con episodios de gota aguda desde hace 30años y presencia de tofos gotosos en manos y pies. Debidoal crecimiento rápido del tofo situado en la región dorsal dela articulación metacarpofalángica del 2.º y 3.er dedo de lamano izquierda, se hicieron estudios de imagen, observándoseuna imagen radiológica compatible con enfermedad dedepósito. Se procede a resecar la lesión, siendo necesaria laamputación del 2.º dedo por afectación de sus tendones. Enel examen de la pieza, se observaron dos zonas diferenciadas,una amarillenta y granular que microscópicamentecorrespondía a un típico tofo gotoso y otra zona blanquecinay carnosa que correspondía a una proliferación fusocelularmaligna de alto grado que inmunohistoquímicamentesólo expresaba CD68 y lisozima. Con estos hallazgos sehizo el diagnóstico de fibrohistiocitoma maligno sobre tofogotoso. El paciente fue reintervenido, encontrándose tumorresidual, remitiéndose al servicio de Oncología donde fuetratado con radioterapia y quimioterapia adyuvante. A los 5meses fue reintervenido por una recidiva en el antebrazoizquierdo, encontrándose actualmente libre de enfermedad

Gout is a uric acid metabolism disorder that is able toproduce severe joint injuries. We describe a case of a 76year old man with a history of acute gout attacks during 30years and tophaceous deposits in hands and feet. After aquick growth of a tophus located in his left hand dorsal 2ndand 3rd metacarpophalangical joint, radiological studieswere done. An image compatible with destructive uric aciddeposit illness was shown. Resection was made, findingtendons affected which made necessary 2nd finger amputation.Surgical specimen showed two differentiated areas: ayellowish and granular corresponding to the typical tophaceousdeposit and other fleshy and white corresponding to ahigh grade malignant fusocellular proliferation. Immunohistochemicalstudies showed only positivity for CD68 andlysozime in tumoral cells. The diagnosis of malignantfibrous histiocytoma associated to gouty tophus was made.Residual tumor was found after reintervention, and thepatient was sent to the Oncology Service for adjuvant radioand chemotherapy. Five months later, the patient was reoperatedfor recurrence of the tumor in the left arm, staying freeof disease at these moments

Quiste mucoide; ganglión de la articulación interfalángica distal dorsal, tratamiento quirúrgico / Mucoid cyst: a ganglion of the digital dorsal interphalangeal joint, surgical treatment

Se hace una revisión actualizada del tema para fundamentar el tratamiento quirúrgico como método de elección. El fundamento se basa en el concepto de que el llamado "quiste mucoide" es un ganglión localizado entre la articulación interfalángica distal y el pliegue proximal que se comunica con el espacio articular por intermedio de un pedículo demostrable por la inyección intraarticular de azul de metileno (test de Newmeyer) y por histología cuando éste es resecado. Para que el tratamiento quirúrgico sea completo se requiere la visualización directa del quiste y su pedículo. Los tratamientos a ciegas y focales sólo llevan a una solución transitoria y a recurrencias seguras

Quiste mucoide; ganglión de la articulación interfalángica distal dorsal, tratamiento quirúrgico / Mucoid cyst: a ganglion of the digital dorsal interphalangeal joint, surgical treatment

Se hace una revisión actualizada del tema para fundamentar el tratamiento quirúrgico como método de elección. El fundamento se basa en el concepto de que el llamado "quiste mucoide" es un ganglión localizado entre la articulación interfalángica distal y el pliegue proximal que se comunica con el espacio articular por intermedio de un pedículo demostrable por la inyección intraarticular de azul de metileno (test de Newmeyer) y por histología cuando éste es resecado. Para que el tratamiento quirúrgico sea completo se requiere la visualización directa del quiste y su pedículo. Los tratamientos a ciegas y focales sólo llevan a una solución transitoria y a recurrencias seguras (AU)

Manifestaciones clínicas articulares en la artritis reumatoide / Clinical articular manifestations in rheumatoid arthritis

No disponible

Tumor de celulas gigantes de vaina tendinosa / Giant cell tumor of the tendon sheath

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