Non-typhi Salmonella infection in patients with rheumatic diseases on TNF-alpha antagonist therapy.

OBJECTIVES: The morbidity and mortality of patients with rheumatic diseases has improved considerably following the use of biologic therapies. However, an increase in the frequency of bacterial infections has been observed in patients receiving these drugs. In the present study we aimed to establish the incidence and clinical manifestations of non-typhi Salmonella infection in a large cohort of patients with rheumatic diseases undergoing TNF-alpha antagonist therapy due to severe rheumatic diseases refractory to conventional therapies. METHODS: The rate of non-typhi Salmonella infection found in the Spanish Registry of Adverse Events of Biological Therapies in Rheumatic Diseases (BIOBADASER) was compared with that observed in a cohort of rheumatoid arthritis (RA) patients from the EMECAR (Morbidity and Clinical Expression of Rheumatoid Arthritis) Study, who were not treated with TNF-alpha antagonists. The rate found in the BIOBADASER registry was also compared with that available in a non-RA historic control cohort reported in a population from Huesca (Northern Spain). RESULTS: Seventeen cases of non-typhi Salmonella infection were observed in the series of patients exposed to anti-TNF-alpha therapies. The incidence rate of non-typhi Salmonella in BIOBADASER was 0.73 per 1000 patient-years (95% confidence interval [CI]: 0.45-1.17). The incidence rate in the EMECAR cohort was 0.44 per 1000 patient-years. The relative risk for non-typhi salmonellosis in RA patients exposed to TNF-alpha inhibitors compared to those not treated with biological therapies was 2.07 (95% CI: 0.27-15.73) (p=0.480) whereas the relative risk of non-typhi Salmonella infections in patients with rheumatic diseases undergoing TNF-alpha antagonist therapy compared with the non-RA Spanish control cohort was 0.63 (95% CI: 0.38-1.04) (p=0.07). Nine of the 17 patients with non-typhi salmonellosis presented a severe systemic infection. CONCLUSION: Incidence of non-typhi Salmonella infection is not increased significantly in rheumatic patients undergoing anti-TNF-alpha therapy when compared with RA patients undergoing conventional DMARD therapy or with the general population. Nevertheless, at least 50% of patients on TNF-alpha have severe complications once they develop non-typhi Salmonella infection. This fact suggests that anti-TNF-alpha therapies may predispose to salmonella dissemination rather than to infection.

[Bone Paget's disease in the young adult]. / Enfermedad de Paget ósea en el adulto joven.

FOUNDATION: Bone Paget's disease (BPD) is a focal disorder of bone remodeling of unknown etiology that affects mainly patients older than 50 years. BPD is after osteoporosis the most frequent osteopathy of the western world and was described for the first time in 1876 by Sir James Paget who called it osteitis deformans. PATIENTS AND METHODS: We present two patients with BPD younger than 40 years. In this report their clinical, analytical, diagnostic, and therapeutic manifestations are described, with the findings of bone biopsy in one of them. Is noteworthy to us the younger age of the patients, rare for this disease, which means that we have carried out the follow-up of the cases. CONCLUSION: In a young adult with high phosphatase alkaline values we will include BPD in the differential diagnosis.

[Spinal pseudoarthrosis in ankylosing spondylitis]. / Pseudoartrosis vertebral en la espondilitis anquilosante.

Spinal pseudoarthrosis is an uncommon complication in patients with advanced ankylosing spondylitis which consists in destruction of the discovertebral junction. Two cases of spinal pseudoarthrosis at the thoracolumbar level after a spontaneous fall are reported. Because of the neural arch involvement and the spinal cord compression a stabilization was required. Different imaging techniques are complementaries in the study of this entity, conventional radiographs and computed tomography may depicte bone abnormalities, but magnetic resonance allows a correct evaluation of spinal cord and soft tissue involvement.

Pseudoartrosis vertebral en la espondilitis anquilosante / Spinal pseudoarthrosis in ankylosing spondylitis

La pseudoartrosis vertebral es una espondilodiscitis aséptica que aparece como complicación tardía de la espondilitis anquilosante. Dos pacientes presentaron este proceso de destrucción discovertebral después de una caída espontánea. Los dos asociaron manifestaciones neurológicas por compresión medular, interviniéndose quirúrgicamente el primero. En el estudio de estas lesiones, las diferentes técnicas de imagen se complementan. Con radiología simple se puede identificar en algunos casos la afección discovertebral. La tomografía axial computerizada delimita mejor estas lesiones y revela la fractura del arco posterior. Por último, el estudio con resonancia magnética aporta sensibilidad para la detección precoz, descarta la existencia de partes blandas paravertebrales que puedan ser de otro origen e identifica la compresión del cordón medular. (AU)

Dolor lumbo-sacro atípico / Atypical lumbosacral pain

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[Pneumonitis caused by gold salts in psoriatic arthritis: report of 2 cases]. / Neumonitis por sales de oro en la artritis psoriásica: a propósito de dos casos.

The gold-salts compounds have been used for the treatment of rheumatoid arthritis and of psoriatic arthritis, they are generally tolerates and when have adverse effects they are minor. The gold-induced lung toxicity is a infrequent adverse effect of patients with rheumatoid arthritis characterized by three types: interstitial penumonitis, bronchiolitis obliterans with organizing pneumonia and bronchiolitis obliterans, usually the first is the more frequent. The diagnostic is supported by the clinical manifestations, chest roentgenogram, bronchoalveolar lavage fluid and chest computed tomography scan. Biopsy study of the lung, is only needed for exclusion of other pulmonary disease. The gold-induced lung toxicity in the psoriatic arthritis is rarelly described, we report two cases with gold-induced pneumonitis with benign clinical course after cessation of therapy and treatment with corticosteroids.

Neumonitis por sales de oro en la artritis psoriásica: a propósito de dos casos / Pneumonitis by chrysotherapy in psoriatic arthritis: two cases reports

Las sales de oro se utilizan para tratar la artritis reumatoide y la artritis psoriásica, generalmente son bien toleradas y cuando aparecen efectos secundarios suelen ser menores. La neumopatía por sales de oro es un efecto tóxico infrecuente que suele presentarse en los pacientes con artritis reumatoide, expresandose de tres formas diferentes: como neumonitis intersticial, bronquiolitis obliterante con neumonia organizada y bronquiolitis obliterante, siendo la primera su forma habitual de presentación. El diagnóstico se realiza por la clínica, radiología de tórax, el LBA, y la TAC torácica, practicando la biopsia pulmonar sólo en los casos que se quieran excluir otros procesos pulmonares. En la artritis psoriásica sólo hay publicados algunos casos de neumopatía por sales de oro. Se presentan dos pacientes con neumonitis por aurotiomalato que evolucionaron favorablemente después de suspender el tóxico y ser tratadas con corticoides (AU)

[Acute polyarthritis associated with parvovirus B19 infection]. / Poliartritis aguda asociada a infección por parvovirus B19.

We describe one female with acute polyarthritis and transitory rash. The arthritis of sudden onset, is localized in large and small joints and accompanied by significant stiffness, particularly noted in early morning. The symptoms only improvement a few with nonsteroidal anti-inflammatory drugs and the arthritis resolved within a few days. The diagnosis is based in the presence of anti-B19 IgM. The differential diagnosis of the acute polyarthritis is extensive, serological test should be made when we suspect the presence of a viral arthritis.

Poliartritis aguda asociada a infección por parvovirus B19 / Acute polyarthritis associated with parvovirus B19 infection

Presentamos el caso de una mujer con poliartritis aguda por parvovirus B19 que se acompañó al inicio de un exantema fugaz. La artritis de aparición brusca afectó a grandes y pequeñas articulaciones con rigidez preferentemente matinal. Los síntomas fueron tratados con AINE con respuesta irregular y remitió completamente en varios días sin secuelas y sin apreciarse recidiva posterior. El diagnóstico se realizó por la determinación de anticuerpos IgM anti PV-B19. En las poliartritis agudas donde el diagnóstico diferencial es amplio, hay que pensar en la presencia de los virus, y para ello, realizar una búsqueda sistemática ayudados por las manifestaciones clínicas y complementado por las técnicas serológicas (AU)

[Atypical algodystrophy of the knee: apropos 2 partial cases]. / Algodistrofia atípica de rodilla: a propósito de dos casos con forma parcial.

Algodystrophy is a common entity which may present in many clinical contexts. Its early diagnosis and therapy are of great prognostic interest. Apart from the typical complete forms there are some other atypical forms, such as partial knee algodystrophy, of difficult diagnosis. Its inclusion in the differential diagnosis of gonalgia occurring in patients attended under many medical specialties is therefore necessary. Two atypical cases of knee algodystrophy in its partial form are reported. One of these cases relapsed at the heterolateral knee after 18 months of the initial presentation; this second episode was also a partial form, a fact which we have not seen reported. The reported cases are here discussed and the scarce literature is reviewed, commenting on the difficulty of the early diagnosis compared with other entities which may mimic the clinical picture, radiological and scanning features of algodystrophy, such as aseptic osteonecrosis or stress fracture. The diagnostic algorithm is discussed, pointing to the usefulness of magnetic resonance (MR) in difficult cases to rule out other entities which would entail different therapeutic modalities.

[The SAPHO syndrome or psoriatic arthritis: a complicated differential diagnosis. Apropos 3 cases]. / Síndrome SAPHO o artritis psoriásica: un diagnóstico diferencial complicado. A propósito de tres casos.

SAPHO syndrome is characterized by osteoarticular involvement of ventral chest wall in the form of sternocostoclavicular osteoarthritis and hyperostosis and skin changes such as palmoplantar pustulosis and acne. Occasionally, psoriatic lesions and sacroiliitis are observed. However, despite the higher frequency of psoriasis in this syndrome, its inclusion in psoriatic arthropathy spectrum is not clearly established. The authors report three cases of SAPHO syndrome in psoriatic patients commenting on the difficulty in differentiating this entity from psoriatic arthritis as well as its relationship with seronegative spondyloarthropathies. This disease has been described mainly in Japan and only a few cases of this disease have been reported in the European or American literature.