Quantification of bone marrow edema by MRI of the sacroiliac joints in patients diagnosed with axial spondyloarthritis: results from the ESPeranza cohort.

OBJECTIVE: To evaluate whether the quantification of bone marrow edema (BMO) of the sacroiliac (SI) joints by magnetic resonance imaging (MRI) improves capacity for axial spondyloarthritis (axSpA) classification in comparison with the assessment of sacroiliitis by Assessment of SpondyloArthritis international Society (ASAS) classification criteria. METHOD: This prospective study from the ESPeranza cohort involved 66 subjects with an available MRI of the SI joints at baseline. This subgroup includes patients with axSpA (n = 28), peripheral spondyloarthritis (n = 10), and other diagnoses that were not spondyloarthritis (n = 28). Measures of diagnostic usefulness [area under the curve (AUC), sensitivity, specificity, Youden's J statistic, positive and negative likelihood ratios (LR+ and LR-)] were calculated for MRI of the SI joints according to ASAS criteria and for MRI quantified by means of SCAISS (Spanish tool for semi-automatic quantification of sacroiliac inflammation by MRI in spondyloarthritis). This analysis was stratified in patients who were human leucocyte antigen (HLA)-B27 positive and negative. RESULTS: The AUC value with BMO quantification was 0.919 [95% confidence interval (CI) 0.799-1] for HLA-B27-positive patients and 0.884 (95% CI 0.764-1) for HLA-B27-negative patients. A SCAISS cut-off point of 80 units obtained a specificity of 94.4% and LR+ 7.5, while assessment by ASAS criteria showed a specificity value of 90% and LR+ 6.4. CONCLUSION: For patients with suspected axSpA, quantification of BMO improves the predictive capacity of MRI of the SI joints, for both HLA-B27-positive and HLA-B27-negative patients. Axial spondyloarthritis (axSpA) has a dramatic impact on physical function and quality of life (1). Despite its significant impact, patients with axSpA are normally diagnosed several years after presenting symptoms (2). In this respect, magnetic resonance imaging (MRI) of the sacroiliac (SI) joints has gained significance over the past decade, particularly in the early stages of the disease. Nowadays, imaging tests and human leucocyte antigen (HLA)-B27 testing are among the most important diagnostic procedures for patients with suspected axSpA.

Evaluación de un programa de formación multidisciplinar en resonancia magnética en espondiloartritis axial: Proyecto PROGRESSES / Evaluation of a multidisciplinary training program in magnetic resonance imaging of patients with axial spondyloarthritis: PROGRESSES Project

Objetivo: Analizar el impacto en la práctica diaria tras una formación multidisciplinar en resonancia magnética (RM) en espondiloartritis (EspA) axial. Métodos: Tras 2 años de talleres formativos para radiólogos y reumatólogos, se diseñó una encuesta para evaluar los cambios en: comunicación y colaboración entre servicios; interés y actualización de radiólogos en EspA axial y formación en RM entre los reumatólogos; número de RM realizadas; disposición de protocolos sobre requerimientos técnicos para el estudio por RM en EspA axial e informes estandarizados; evaluación y manejo de la EspA axial, y áreas de mejora. Resultados: Tras la realización de 50 talleres, contestaron la encuesta 96 reumatólogos y 51 radiólogos. Conclusiones: La formación multidisciplinar en RM en EspA axial entre radiólogos y reumatólogos parece influir positivamente en el trabajo conjunto, manejo y evaluación de los pacientes con EspA axial

Objective: To analyze the impact of a multidisciplinary training program in magnetic resonance imaging (MRI) for axial spondyloarthritis in daily clinical practice. Methods: After two years of training workshops for radiologists and rheumatologists, we designed a survey to assess changes in: 1) communication and collaboration between departments; 2) radiologists' interest and keeping up to date in axial spondyloarthritis and rheumatologists' training in MRI; 3) number of MRI studies done; 4) availability of protocols about technical requirements for studying axial spondyloarthritis by MRI and of standardized reporting templates; 5) evaluation and management of axial spondyloarthritis; 6) areas of improvement. Results: After 50 workshops, 96 rheumatologists and 51 radiologists completed the survey. Conclusions: Among radiologists and rheumatologists, multidisciplinary training in MRI for axial spondyloarthritis seems to have a positive influence on teamwork as well as on the management and evaluation of patients with axial spondyloarthritis

Evaluation of a multidisciplinary training program in magnetic resonance imaging of patients with axial spondyloarthritis: PROGRESSES Project. / Evaluación de un programa de formación multidisciplinar en resonancia magnética en espondiloartritis axial: Proyecto PROGRESSES.

OBJECTIVE: To analyze the impact of a multidisciplinary training program in magnetic resonance imaging (MRI) for axial spondyloarthritis in daily clinical practice. METHODS: After two years of training workshops for radiologists and rheumatologists, we designed a survey to assess changes in: 1) communication and collaboration between departments; 2) radiologists' interest and keeping up to date in axial spondyloarthritis and rheumatologists' training in MRI; 3) number of MRI studies done; 4) availability of protocols about technical requirements for studying axial spondyloarthritis by MRI and of standardized reporting templates; 5) evaluation and management of axial spondyloarthritis; 6) areas of improvement. RESULTS: After 50 workshops, 96 rheumatologists and 51 radiologists completed the survey. CONCLUSIONS: Among radiologists and rheumatologists, multidisciplinary training in MRI for axial spondyloarthritis seems to have a positive influence on teamwork as well as on the management and evaluation of patients with axial spondyloarthritis.

Fumador con fenómeno de Raynaud y nódulos dolorosos en las piernas / Smoker With Raynaud Phenomenon and Painful Nodules on the Legs

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Fibromyalgia in patients with ankylosing spondylitis: prevalence and utility of the measures of activity, function and radiological damage.

OBJECTIVES: To determine the prevalence of fibromyalgia (FM) in ankylosing spondylitis (AS). To evaluate the effect of FM on the measures of activity in AS. To analyse predictive factors in order to identify this group of patients. PATIENTS AND METHODS: A cross-sectional study based on 462 patients with definite ankylosing spondylitis included in the REGISPONSER. Sociodemographic data, clinical features, Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS radiology index (BASRI), Stoke modified index (Sasss-m), laboratory data, Short-Format 12 (SF-12), AS specific quality of life (ASQoL), Fibromyalgia Impact Questionnaire (FIQ) and treatments used were all documented. To diagnose FM, the ACR 1990 criteria had to be fulfilled. All statistical tests were performed using STATA. RESULTS: The prevalence of fibromyalgia in all AS was 4.11%. Among the women with AS, the prevalence of FM increased to 10.83%. The BASDAI, BASFI and total BASRI were strongly influenced by the presence of FM. The inverse relationship between BASDAI or BASFI and total BASRI was taken to generate a ratio. Accordingly, if the patient presented BASDAI/BASRI ≥1.5 or BASFI/BASRI ≥1.08, the probability of having FM was very high. CONCLUSIONS: There is an increased risk of FM in females with AS. The fact of having FM distorts the measures of activity and functional damage of AS. As a result, it is possible that some patients with AS and FM are being overtreated. The BASDAI/BASRI and BASFI/BASRI ratios are very useful to identify these patients.

Relationship between spinal mobility and disease activity, function, quality of life and radiology. A cross-sectional Spanish registry of spondyloarthropathies (REGISPONSER).

OBJECTIVE: To determine the relationship between anthropometric measurements and disease activity, functional capacity, quality of life and radiology in Spanish patients with ankylosing spondylitis (AS). PATIENTS AND METHODS: A cross-sectional study was made of 842 patients with definite ankylosing spondylitis (REGISPONSER). Sociodemographic data, spinal mobility measurements, Bath AS disease activity index (BASDAI), nocturnal pain, Bath AS radiology index (BASRI), Bath AS functional index (BASFI), the Short-Format 12 (SF-12) and the AS specific quality of life (ASQoL) questionnaire were applied. Pearson correlation coefficient analysis and regression models were constructed. RESULTS: There was moderate correlation between fingertip-to-floor distance and lateral cervical rotation with the BASFI (p<0.01). Good correlation was evident between wall-occiput distance and lateral cervical rotation with the BASRI (p<0.01). Moderate correlation was found between chest expansion, the Schober modified test and fingertip-to-floor distance with the total BASRI (p<0.01). The anthropometric measurement with the lowest correlation value was lateral lumbar flexion. Significant association was found between the Schober modified test and BASFI, BASDAI and BASRI (R(2) = 0.37; p<0.001); chest expansion and BASFI, BASDAI and BASRI (R(2) = 0.25; p<0.001); wall-occiput distance and BASFI, BASRI and ASQoL (R(2) = 0.44; p<0.001); fingertip-to-floor distance and BASFI and BASRI (R(2) = 0.30; p<0.001); and lateral cervical rotation and BASFI and BASRI (R(2) = 0.34; p<0.001). CONCLUSION: In our study, wall-occiput distance and lateral cervical rotation showed the strongest correlation to BASRI. Similarly, fingertip-to-floor distance and lateral cervical rotation exhibited the closest correlation to BASFI.

Carcinoma renal de istmo en riñón en herradura. A propósito de un caso / Herseshoes kidney isthmus carcinoma. A case report

El riñón en herradura ( RH) es la más común de las anomalías por fusión. La incidencia de carcinoma renal en RH suele ser similar a la del riñón normal. Dadas sus características anatómicas especiales, se deben tener en cuenta para su abordaje quirúrgico, así como para la realización de una posible cirugía conservadora. Presentamos un caso de carcinoma renal en istmo de RH en el que se realizó cirugía conservadora de ambas unidades renales (AU)

Horseshoe kidney is the most frequent fusion abnormality of the kidney. The incidence of renal carcinoma in patients with horseshoe kidney is similar to those with normal anatomy. Its special anatomical features must be borne in mind for both surgical approach and conservative surgery. We present a horseshoe kidney isthmus carcinoma case report in which we performed conservative surgery of both renal units (AU)

Pulmonary sarcoidosis in a patient with ankylosing spondylitis treated with infliximab.

We present a case of a 34 year-old male diagnosed with ankylosing spondylitis. After two years of treatment with infliximab, the patient developed a clinical picture compatible with stage II thoracic sarcoidosis. These findings resulted in the interruption of infliximab therapy. The patient was not administered new treatment since respiratory function testing did not confirm harmful repercussions. After a follow-up of 1 year, the patient is asymptomatic and radiologic tests show complete resolution of pulmonary infiltrates and mediastinal and bilateral hilar lymphad- enopathy.

Dolor en la espina ilíaca anterosuperior izquierda en una mujer de 29 años de edad / Pain in the left antero-superior iliac spine in a 29-year-old woman

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Endometriosis vesical: dos nuevos casos / Vesical endometriosis: report of two cases

La endometriosis en el aparato urinario es una patología infrecuente, siendo la vejiga el órgano afecto en la mayoría de las ocasiones. Se manifiesta clínicamente con urgencia, frecuencia, dolor hipogástrico y en ocasiones con hematuria. La cistoscopia es la prueba diagnóstica más fiable aunque el diagnóstico de confirmación es histológico. Presentamos 2 casos de endometriosis vesical en 2 mujeres jóvenes, una con antecedentes de manipulación ginecológica, en las que el tratamiento quirúrgico fue satisfactorio. Tras 1 y 3 años de seguimiento las pacientes permanecen asintomáticas

Endometriosis affecting the urinary tract is very rare and the most common site of involvement is urinary bladder. The clinical features are urgency and frequency, hipogastric pain and hematuria. Cistoscopic examination is the most valuable diagnostic test but definitive diagnosis requires histologic confirmation. We report 2 cases of endometriosis in 2 young women, one with previously cesarean section, in which surgical treatment was effective. After 1 and 3 years of follow-up respectively the patients remain assymptomatic

[Complex renal cyst. A new case]. / Quiste renal complejo. A propósito de un caso.

Approximately 15% of cases of renal cell carcinoma present cystic configuration on radiologic and pathologic examination. These lesions are often difficult to differentiate from the multiloculated renal cyst or other benign cystic lesions such as hemorrhagic cyst and so on. We report a case of multilocular cyst of the right kidney complicated with clear cell type renal cell carcinoma in which MRI suggested benign cyst. The diagnosis of complicated benign cyst must be proposed very cautiously and the persistence of doubtful images justifies surgical exploration.

Dolor y tumefacción de una interfalángica distal en una mujer con nódulos de Heberden / Pain and tumefaction of a distal interphalangeal joint in a woman with Heberden nodules in images

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Quiste renal complejo. A propósito de un caso / Complex renal cyst. A new case

Aproximadamente un 15% de los carcinomas renales presentan un aspecto quístico en las exploraciones radiológicas y estudio anatomopatológico. En ocasiones estos tumores son difíciles de diferenciar de los quistes renales multiloculados u otras lesiones benignas como quistes hemorrágicos. Presentamos un caso de quiste renal complejo en el que la RNM mostró un patrón de quiste simple. El diagnóstico y manejo de estas lesiones debe ser muy cuidadoso y si persisten las imágenes sospechosas está justificada la exploración quirúrgica

Approximately 15% of cases of renal cell carcinoma present cystic configuration on radiologic and pathologic examination. These lesions are often difficult to differentiate from the multiloculated renal cyst or other benign cystic lesions such as hemorrhagic cyst and so on. We report a case of multilocular cyst of the right kidney complicated with clear cell type renal cell carcinoma in which MRI suggested benign cyst. The diagnosis of complicated benign cyst must be proposed very cautiously and the persistence of doubtful images justifies surgical exploration

Dolor y tumefacción pretibial izquierda en una mujer con artritis reumatoide / Left pretibial pain and swelling in a woman with rheumatoid arthritis

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[Vesical endometriosis: report of two cases]. / Endometriosis vesical: dos nuevos casos.

Endometriosis affecting the urinary tract is very rare and the most common site of involvement is urinary bladder. The clinical features are urgency and frequency, hipogastric pain and hematuria. Cistoscopic examination is the most valuable diagnostic test but definitive diagnosis requires histologic confirmation. We report 2 cases of endometriosis in 2 young women, one with previously cesarean section, in which surgical treatment was effective. After 1 and 3 years of follow-up respectively the patients remain assymptomatic.