Interobserver reliability of Masei index validation by a multicenter collaborative group of rheumatologists.

MASEI is the main validated ultrasound score for the evaluation of enthesis. The lack of studies facing the agreement to achieve for the interpretation of the MAdrid Sonographic Enthesis Index (MASEI) among researchers from different centers in multicenter studies is of concern. The aim of this multicenter was to evaluate the interobserver reliability of MASEI. An experienced ultrasonographer-rheumatologist performed ultrasound scans of the areas included in MASEI index in three patients with Ankylosing Spondylitis and Psoriatic Arthritis. Videos were captured. The videos were then evaluated by 24 rheumatologists of the ultrasound working group of the Catalan Society of Rheumatology (EcoCAT). A face-to-face training meeting was held. Ten days after the workshop, the study participants evaluated the videos. A reliability assessment was performed. The ICC for the MASEI scores after the workshop was of 0.97 (95% CI 89-99). Reliability did not vary statistically with examiner experience. Globally, no problems of reliability by structures were seen, and all the ICCs were above 0.90 and improved slightly after the educational program. However, the correlation observed between examiners at plantar aponeursis and triceps tendon was weak. The small variability observed in the results of the index validation in our study, suggests that the MASEI index is reproducible by different observers when those are well trained and show awesome results of the enthesis when examined by ultrasound.

Artritis séptica politópica: análisis de 19 casos / Polyarticular septic arthritis: analysis of 19 cases

Objetivo: El 15% de las artritis sépticas corresponde a formas poliarticulares, si bien son escasas las series publicadas. Evaluamos las características de los enfermos con artritis séptica poliarticular recogidos en un servicio de reumatología. Material y método: Análisis retrospectivo de las artritis piógenas con afección oligoarticular o poliarticular. Se incluye únicamente a los enfermos con aislamiento del germen en el líquido articular. Se analizan las variables clínicas, analíticas y radiológicas de la serie. Resultados: Se registraron 19 casos (14 varones y 5 mujeres) con una media de edad de 55 años. La media del tiempo hasta el diagnóstico fue 6 días. La articulación afectada con mayor frecuencia fue la rodilla, seguida del tobillo. La media de focos infecciosos por paciente fue 3 (intervalo, 2-6). Los factores de riesgo más frecuentes fueron la diabetes mellitus, la insuficiencia renal crónica, la hepatopatía crónica, la gota y la artritis reumatoide. Los gérmenes aislados fueron Staphylococcus aureus (47%), S. agalactiae (21%) y bacilos gramnegativos. Los hemocultivos fueron positivos en el 52,6%, y el 15,8% presentó shock séptico. La gammagrafía con 99Tc mostró la afección politópica cuando fue realizada. La duración media del tratamiento antibiótico fue 46±27 días. La evolución fue satisfactoria en el 52,6% y tórpida en el 26%, con mortalidad del 15,8% (3 casos). Se realizó artrotomía en el 21%. Conclusiones: La presencia de oligoartritis o poliartritis no excluye el diagnóstico de artritis infecciosa. Entre los factores de riesgo destacan las artropatías inflamatorias previas. S. aureus es el microorganismo causal más frecuente. La morbilidad y la mortalidad de esta forma de infección articular son importantes, por lo que debe mantenerse un alto índice de sospecha y realizar una exploración sistemática de todas las articulaciones (AU)

Objective: Polyarticular septic arthritis accounts for 15% of all septic arthritis, but there are few references in the literature. We describe characteristics of patients with polyarticular septic arthritis in a rheumatology service. Patients and method: Retrospective analysis of patients with septic arthritis involving more than one joint. Only patients with positive culture of synovial fluid were included. Clinical, analytical and radiological variables are reviewed. Results: 19 patients (14 male) had a polyarticular infection. Mean age was 55 years. Mean time from onset to diagnosis was 6 days. The knee was the most commonly involved joint, followed by ankle. The mean number of joints involved per patient was 3. Risk factors included diabetes, chronic renal or hepatic disease, gout and rheumatoid arthritis. Most commonly isolated agents were S. aureus (47%) and S. agalactiae (21%). Blood cultures were positive in 52,6% and 15.8% had septic shock. Scintygraphic bone scan showed a polyarticular uptake. Mean duration of antibiotic therapy was 46±27 days. Clinical outcome was good in 52,6%, complicated in 26%, and mortality rate was 15.8% (3 cases). Joint debridement was performed in 21%. Conclusions: Multiple joint involvement does not exclude the diagnosis of septic arthritis. Inflammatory arthritis is an important risk factor. S. aureus in the main infectious agent. The morbidity and mortality of this condition are important, so we need to maintain a high index of suspicion for the condition (AU)

Síndrome sarcoidosis-linfoma / Sarcoidosis-lymphoma syndrome

La combinación de sarcoidosis y linfoma (síndrome sarcoidosis-linfoma) es poco frecuente pero bien conocida. Algunas manifestaciones pueden ser comunes y es un reto para el clínico establecer el diagnóstico diferencial entre ambas entidades o de su verdadera coexistencia. En estos casos ni la presentación clínica ni los parámetros de laboratorio son específicos, por lo que es esencial el estudio anatomopatológico de una adenopatía para llegar al diagnóstico definitivo. El síndrome sarcoidosis-linfoma podría aparecer como consecuencia de algunas alteraciones inmunitarias que acontecen en la sarcoidosis y en algunos pacientes con una neoplasia sólida o hemática que reciben quimioterapia. Se presenta un caso de síndrome sarcoidosis-linfoma y se analizan los aspectos clave en el diagnóstico de esta forma clínica (AU)

Sarcoidosis may occur in association with lymphoma (sarcoidosis-lymphoma syndrome), it is an uncommon but well-known association. Some clinical features can be similar and clinicians have the challenge to differentiate between these two diseases or prove their co-existence. Clinical and laboratory data are not characteristic in any of them, and an anatomopathological study of lymphadenopathy is necessary to establish the diagnosis. The sarcoidosis-lymphoma syndrome could occur as a result of a disturbance in the host immune system in sarcoidosis and in some patients with solid tumors or hematologic malignancies who have received chemotherapy. We present a case report of a patient with sarcoidosis-lymphoma syndrome (AU)

[Polyarticular septic arthritis: analysis of 19 cases]. / Artritis séptica politópica: análisis de 19 casos.

OBJECTIVE: Polyarticular septic arthritis accounts for 15% of all septic arthritis, but there are few references in the literature. We describe characteristics of patients with polyarticular septic arthritis in a rheumatology service. PATIENTS AND METHOD: Retrospective analysis of patients with septic arthritis involving more than one joint. Only patients with positive culture of synovial fluid were included. Clinical, analytical and radiological variables are reviewed. RESULTS: 19 patients (14 male) had a polyarticular infection. Mean age was 55 years. Mean time from onset to diagnosis was 6 days. The knee was the most commonly involved joint, followed by ankle. The mean number of joints involved per patient was 3. Risk factors included diabetes, chronic renal or hepatic disease, gout and rheumatoid arthritis. Most commonly isolated agents were S. aureus (47%) and S. agalactiae (21%). Blood cultures were positive in 52,6% and 15.8% had septic shock. Scintygraphic bone scan showed a polyarticular uptake. Mean duration of antibiotic therapy was 46±27 days. Clinical outcome was good in 52,6%, complicated in 26%, and mortality rate was 15.8% (3 cases). Joint debridement was performed in 21%. CONCLUSIONS: Multiple joint involvement does not exclude the diagnosis of septic arthritis. Inflammatory arthritis is an important risk factor. S. aureus in the main infectious agent. The morbidity and mortality of this condition are important, so we need to maintain a high index of suspicion for the condition.

[Sarcoidosis-lymphoma syndrome]. / Síndrome sarcoidosis-linfoma.

Sarcoidosis may occur in association with lymphoma (sarcoidosis-lymphoma syndrome), it is an uncommon but well-known association. Some clinical features can be similar and clinicians have the challenge to differentiate between these two diseases or prove their co-existence. Clinical and laboratory data are not characteristic in any of them, and an anatomopathological study of lymphadenopathy is necessary to establish the diagnosis. The sarcoidosis-lymphoma syndrome could occur as a result of a disturbance in the host immune system in sarcoidosis and in some patients with solid tumors or hematologic malignancies who have received chemotherapy. We present a case report of a patient with sarcoidosis-lymphoma syndrome.

[Adult onset Still's disease: review of 26 cases]. / Enfermedad de Still del adulto: revisión de 26 casos.

BACKGROUND AND OBJECTIVE: We intended to describe the clinical characteristics, treatment and evolution of 26 patients with adult onset Still's disease. PATIENTS AND METHOD: This was a retrospective study (1984-2004). The clinical records of patients with adult onset Still's disease were reviewed. RESULTS: Twenty six patients were included. Most frequent clinical characteristics were: fever (100%), arthritis (81%), rash (92%) sore throat (92%) and lymphadenopathy (42%). Aspirin controlled the disease in 27% of patients, prednisone was needed in 70% and methotrexate was added in 50% cases. A monocyclic course was seen in 54% and polycyclic in 46% patients. CONCLUSIONS: The clinical characteristics were similar to previous series. A febrile polyarthritis was the most frequent presentation form. A polycyclic course was found in 58% of cases and it seems to be associated with poor prognosis and need for aggressive treatment.

Una causa infrecuente de suboclusión intestinal en una paciente con artritis reumatoide / No disponible

No disponible

Bursitis séptica por Serratia marcescens / Septic bursitis due to Serratia marcescens

No disponible