Assuntos
Artrite Psoriásica/etiologia , Artrite Reumatoide/complicações , Síndrome de Felty/complicações , Espondilite Anquilosante/etiologia , Adalimumab , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/tratamento farmacológico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Quimioterapia Combinada , Síndrome de Felty/diagnóstico , Síndrome de Felty/tratamento farmacológico , Humanos , Masculino , Metotrexato/uso terapêutico , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico , Resultado do TratamentoRESUMO
We report a 40-year-old woman with onset of oligoarthritis shortly after initiating treatment with methimazole for Graves disease. Over the course of 7 years, her arthritis became progressively severe, leading to a diagnosis of seronegative rheumatoid arthritis. Treatment with disease-modifying antirheumatic agents and surgical intervention was contemplated. Ultrasound and magnetic resonance imaging revealed exuberant synovitis, involving right elbow and knees. Upon withdrawal of methimazole, prompt resolution of all signs and symptoms of arthritis was observed within several weeks. Following a MEDLINE search of available literature concerning antithyroid drug-induced arthritis, it is evident that this case represents the lengthiest duration of inflammatory arthropathy ever described in a patient that nonetheless was rapidly reversible with discontinuation of methimazole.
Assuntos
Antitireóideos/efeitos adversos , Artrite Reumatoide/induzido quimicamente , Metimazol/efeitos adversos , Adulto , Artrite Reumatoide/diagnóstico , Doença Crônica , Diagnóstico Diferencial , Feminino , Doença de Graves/tratamento farmacológico , HumanosRESUMO
This report describes a 32-year-old woman presenting since childhood with progressive calcium pyrophosphate disease (CPPD), characterized by severe arthropathy and chondrocalcinosis involving multiple peripheral joints and intervertebral disks. Because ANKH mutations have been previously described in familial CPPD, the proband's DNA was assessed at this locus by direct sequencing of promoter and coding regions and revealed 3 sequence variants in ANKH. Sequences of exon 1 revealed a novel isolated nonsynonymous mutation (c.13 C>T), altering amino acid in codon 5 from proline to serine (CCG>TCG). Sequencing of parental DNA revealed an identical mutation in the proband's father but not the mother. Subsequent clinical evaluation demonstrated extensive chondrocalcinosis and degenerative arthropathy in the proband's father. In summary, we report a novel mutation, not previously described, in ANKH exon 1, wherein serine replaces proline, in a case of early-onset severe CPPD associated with metabolic abnormalities, with similar findings in the proband's father.
Assuntos
Condrocalcinose/genética , Hipofosfatemia Familiar/genética , Mutação/genética , Proteínas de Transporte de Fosfato/genética , Adulto , Antirreumáticos/uso terapêutico , Pirofosfato de Cálcio/urina , Condrocalcinose/diagnóstico por imagem , Condrocalcinose/tratamento farmacológico , Condrocalcinose/urina , Quimioterapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Supressores da Gota/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Linhagem , Prednisolona/uso terapêutico , RadiografiaRESUMO
OBJECTIVE: To ascertain whether magnetic resonance angiography (MRA) can reliably detect synovial neovascularization in subjects with early inflammatory arthritis. METHODS: Subjects with 6 weeks to 6 months of clinical evidence of inflammatory hand arthritis had a radiograph, power Doppler ultrasound (PDU) scan, magnetic resonance imaging (MRI), and contrast enhanced MRA performed on the more symptomatic hand. Ultrasound examination of the wrist and 2nd-5th metacarpophalangeal (MCP) joints was scored for erosions, synovial thickening, and synovial blood flow. MRI were assessed using the OMERACT Rheumatoid Arthritis MRI Score (RAMRIS). MRA was used to assess the number of abnormal vessels in the 2nd-5th MCP and in the wrist. RESULTS: Of 30 subjects, 66.7% showed abnormal vasculature on MRA in the MCP and/or wrist; mean number of abnormal vessels was 5.24 (range 0-22). Number of abnormal vessels on MRA was strongly correlated with degree of blood flow seen in the corresponding area on PDU (r = 0.79, p Assuntos
Artrite/diagnóstico
, Vasos Sanguíneos/patologia
, Angiografia por Ressonância Magnética/métodos
, Membrana Sinovial/patologia
, Sinovite/patologia
, Adulto
, Artrite/diagnóstico por imagem
, Artrite/fisiopatologia
, Biomarcadores
, Velocidade do Fluxo Sanguíneo
, Vasos Sanguíneos/fisiopatologia
, Estudos Transversais
, Feminino
, Nível de Saúde
, Humanos
, Masculino
, Articulação Metacarpofalângica/diagnóstico por imagem
, Articulação Metacarpofalângica/patologia
, Projetos Piloto
, Prognóstico
, Radiografia
, Inquéritos e Questionários
, Membrana Sinovial/irrigação sanguínea
, Membrana Sinovial/diagnóstico por imagem
, Sinovite/diagnóstico por imagem
, Sinovite/fisiopatologia
, Ultrassonografia Doppler
, Articulação do Punho/diagnóstico por imagem
, Articulação do Punho/patologia
RESUMO
STUDY DESIGN: Report of 2 cases of sarcoidosis involving vertebrae successfully treated with tumor necrosis factor-α inhibitor (TNF-α antagonist). OBJECTIVE: To disseminate knowledge concerning successful treatment of sarcoidosis involving the axial skeleton with the use of TNF-α blockers. SUMMARY OF BACKGROUND DATA: Osseous sarcoidosis most commonly involves small bones of hands and feet; vertebral involvement is rare, and currently there is no consensus on optimal treatment. METHODS: Two cases are described detailing patients with extrapulmonary sarcoidosis involving vertebral bodies, retractable to conventional treatment, who were treated with TNF-α antagonists. RESULTS: We observed a remarkable response following the administration of TNF-α blockers in vertebral sarcoidosis with marked resolution of lytic lesions. The patients remained asymptomatic with no recurrence of their disease. CONCLUSION: Vertebral sarcoidosis is a rare manifestation of osseous sarcoidosis. Symptomatic patients are treated with various immunosuppressive therapies. We propose utilizing TNF-α blocking agents in patients who fail to respond to first-line therapy.
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Sarcoidose/tratamento farmacológico , Doenças da Coluna Vertebral/tratamento farmacológico , Coluna Vertebral/efeitos dos fármacos , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/imunologia , Adalimumab , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Feminino , Humanos , Infliximab , Pessoa de Meia-Idade , Radiografia , Sarcoidose/diagnóstico por imagem , Sarcoidose/patologia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/patologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologiaRESUMO
The choice to use MR imaging or ultrasound to depict tendon pathology has traditionally depended on the imager's level of experience and comfort with the modality, and less so the individual strengths of either modality. Although this may be an acceptable rationale, it does not fully take advantage of the strength of either modality or the potential benefits of combining both modalities. This article demonstrates the complementary roles of these two modalities through a variety of clinical examples, based on experience working in a subspecialty hospital dedicated to orthopedic and rheumatologic diseases.