Chikungunya Fever: Comparison Study of Synovitis and Tenosynovitis of the Hands and Wrists Using Physical Examination, Ultrasound, and MRI Findings.

OBJECTIVES: To compare musculoskeletal changes on a physical examination (PE), ultrasound (US) and magnetic resonance imaging (MRI) of the hands and wrists of patients with Chikungunya fever (CF). METHODS: The sample consisted of 30 patients in the chronic phase of CF. The sites analyzed were the interphalangeal (IP), metacarpophalangeal (MCP) and wrist/mediocarpal (WMC) joints and periarticular soft tissue. The interval between the PE and imaging tests was 7 days, and the interval between US and MRI was 2 days. The kappa coefficient was calculated to estimate the agreement between the PE and US and MRI findings and between the US and MRI findings. RESULTS: Significant agreement was observed between PE and US in the diagnosis of synovitis. The only statistically significant agreement between US and MRI was the finding of flexor tenosynovitis; the agreement was moderate. CONCLUSIONS: US has great potential for use in diagnosing synovitis suspected based on a PE. The limited agreement observed between US and MRI, in turn, may suggest a complementary role of these methods.

Ultrasound of ankles in the diagnosis of complications of chikungunya fever.

OBJECTIVE: To describe the main ultrasound findings of chikungunya fever in the ankle. MATERIALS AND METHODS: This was a cross-sectional observational study involving 52 patients referred to the Hospital Universitário Pedro Ernesto and presenting with clinical and biochemical evidence of chikungunya fever. The examinations were performed by a radiologist with more than 20 years of experience in ultrasound. RESULTS: The predominant gender was female (in 88.5%), and the mean age was 58.4 years. The majority (61.5%) of the patients came from the northern part of the city of Rio de Janeiro, and 46.2% were using corticosteroids to treat inflammatory symptoms. The most common alterations observed by ultrasound were joint effusion (in 69.2%), tenosynovitis (in 59.6%), cellulitis (in 46.2%), Kager's fat pad thickening (in 29.9%), myositis (of the soleus or flexor hallucis longus muscle) (in 17.3%), retrocalcaneal bursitis (in 5.8%), tendon ruptures (in 3.8%), and increased vascular flow on power Doppler (in 3.8%). CONCLUSION: Signs of synovitis and tenosynovitis were the main ultrasound findings in a predominantly female population with a mean age of 58.4 years. Further studies are needed in order to define the role of ultrasound in the follow-up of such patients.

OBJETIVO: Descrever os principais achados ultrassonográficos da febre chikungunya no tornozelo. MATERIAIS E MÉTODOS: Estudo transversal e observacional com 52 pacientes encaminhados ao Hospital Universitário Pedro Ernesto com quadros clínico e laboratorial compatíveis com febre chikungunya. Os exames foram realizados por um radiologista com mais de 20 anos de experiência no método. RESULTADOS: Houve predomínio do sexo feminino (88,5%) e média de idade dos pacientes de 58,4 anos. A maioria dos doentes (61,5%) era proveniente da zona norte da cidade do Rio de Janeiro e fazia uso de esteroides (46,2%) para o tratamento dos sintomas inflamatórios. As alterações ultrassonográficas mais comuns foram: derrame articular (69,2%), tenossinovites (59,6%), celulite (46,2%), espessamento da gordura de Kager (29,9%), miosite (sóleo e/ou flexor longo do hálux) (17,3%), bursite retrocalcânea (5,8%), roturas tendíneas (3,8%) e hiperfluxo vascular pelo Doppler de amplitude (3,8%). CONCLUSÃO: Predominaram os sinais ultrassonográficos de sinovite e tenossinovite numa população majoritariamente do sexo feminino e com idade média de 58,4 anos. Sugere-se a realização de outros estudos para definição do papel da ultrassonografia no acompanhamento desses doentes.

Ultrasound of ankles in the diagnosis of complications of chikungunya fever / Ultrassonografia do tornozelo no diagnóstico das complicações da febre chikungunya

Abstract Objective: To describe the main ultrasound findings of chikungunya fever in the ankle. Materials and Methods: This was a cross-sectional observational study involving 52 patients referred to the Hospital Universitário Pedro Ernesto and presenting with clinical and biochemical evidence of chikungunya fever. The examinations were performed by a radiologist with more than 20 years of experience in ultrasound. Results: The predominant gender was female (in 88.5%), and the mean age was 58.4 years. The majority (61.5%) of the patients came from the northern part of the city of Rio de Janeiro, and 46.2% were using corticosteroids to treat inflammatory symptoms. The most common alterations observed by ultrasound were joint effusion (in 69.2%), tenosynovitis (in 59.6%), cellulitis (in 46.2%), Kager's fat pad thickening (in 29.9%), myositis (of the soleus or flexor hallucis longus muscle) (in 17.3%), retrocalcaneal bursitis (in 5.8%), tendon ruptures (in 3.8%), and increased vascular flow on power Doppler (in 3.8%). Conclusion: Signs of synovitis and tenosynovitis were the main ultrasound findings in a predominantly female population with a mean age of 58.4 years. Further studies are needed in order to define the role of ultrasound in the follow-up of such patients.

Resumo Objetivo: Descrever os principais achados ultrassonográficos da febre chikungunya no tornozelo. Materiais e Métodos: Estudo transversal e observacional com 52 pacientes encaminhados ao Hospital Universitário Pedro Ernesto com quadros clínico e laboratorial compatíveis com febre chikungunya. Os exames foram realizados por um radiologista com mais de 20 anos de experiência no método. Resultados: Houve predomínio do sexo feminino (88,5%) e média de idade dos pacientes de 58,4 anos. A maioria dos doentes (61,5%) era proveniente da zona norte da cidade do Rio de Janeiro e fazia uso de esteroides (46,2%) para o tratamento dos sintomas inflamatórios. As alterações ultrassonográficas mais comuns foram: derrame articular (69,2%), tenossinovites (59,6%), celulite (46,2%), espessamento da gordura de Kager (29,9%), miosite (sóleo e/ou flexor longo do hálux) (17,3%), bursite retrocalcânea (5,8%), roturas tendíneas (3,8%) e hiperfluxo vascular pelo Doppler de amplitude (3,8%). Conclusão: Predominaram os sinais ultrassonográficos de sinovite e tenossinovite numa população majoritariamente do sexo feminino e com idade média de 58,4 anos. Sugere-se a realização de outros estudos para definição do papel da ultrassonografia no acompanhamento desses doentes.

Síndrome de Sapho: relato de caso clínico / SAPHO syndrome: clinical case report

El síndrome de SAPHO es una condición relativamente rara, la cual designa varios desordenes que gana su nombre del epónimo por la sinovitis, acné, pustulosis, hiperostosis, osteítis. Relato de caso. Masculino, 15 años de edad, blanco, estudiante que hace dos años se encuentra en tratamiento por acné conglobata, que hace dos meses evoluciona con artralgia en pierna izquierda, tarsitis derecha y lumbalgia inflamatoria. Al examen físico se encuentra, palidez cutánea, pies invertidos y planos, rodillas en valgo, sacroileítis acentuada a la izquierda, tarsitis derecha, dolor en entesis (calcáneos) piel con lesiones cutáneas acneiformes extensas en rostro, dorso y tórax anterior. Exámenes complementarios: anemia normocitica y normo crómica, RX: sacro iliacas con señales de sacroileítis bilateral con psuedo alargamiento en la parte izquierda. USG de los pies normales, fondo de ojo: normal, HLAB27: negativa. Se inició indometacina y fisioterapia. Discusión: cuadro clínico de acné, artropatía inflamatoria característica del síndrome SAPHO, tratamiento conservador.

SAPHO syndrome is a relatively rare condition which designates several disorders that gain its name from the eponymous by synovitis, acne, pustular, hyperostosis, osteitis. Case report. Male, 15 years old, white, student who two years ago is in treatment for acne conglobata, who two months ago evolves with left leg arthralgia, right tarsitis and inflammatory low back pain. Physical examination includes skin paleness, inverted and flat feet, valgus knees, left sore sacroiliitis, right tarsitis, pain in entesis (calcaneus) skin with extensive acneiform skin lesions on face, dorsum and anterior thorax. Complementary examinations: normocytic anemia and normal chromosome, RX: iliac sacrum with signs of bilateral sacroiliitis with psuedo elongation in the left side. USG of normal feet. Fundus of eye: normal, HLAB27: negative. Indomethacin and physiotherapy were started. Discussion: clinical picture of acne, inflammatory arthropathy characteristic of SAPHO syndrome, conservative treatment.

Infliximab-induced autoantibodies: a multicenter study.

The purpose of this study was to assess autoantibody incidence in patients treated with infliximab for various diseases, and the development of autoimmune diseases using a multicenter, longitudinal, open-label, phase IV observational study. All patients received anti-tumor necrosis factor (anti-TNF) according to local treatment guidelines. The autoantibodies assessed before and after infliximab treatment were ANA, anti-Sm, anti-dsDNA, anticardiolipin IgM/IgG, anti-Scl70, anti-centromere B, anti-chromatin, anti-ribosomal P, anti-Sm-RNP, anti-RNP A, anti-RNP 68 kD, anti-La/SSB, anti-Ro/SSA 52 kD and 60 kD, and anti-Jo1. ANA was determined by indirect immunofluorescence on HEp-2 cells (INOVA); the remaining was assessed using BioPlexTM 2200. The Fisher exact test, Wilcoxon test, and the McNemar were used when appropriate.Two hundred eighty-six patients were included (139 with rheumatoid arthritis, 77 with ankylosing spondylitis, 29 with inflammatory bowel disease, 27 with psoriatic arthritis, and 14 with psoriasis), 167 females and 119 males, with mean age of 46.3 years. Subjects received at least five infusions of infliximab (6-month treatment). A significant difference was observed in antinuclear antibody (ANA) detection between samplings (p = 0.001). Among patients that had ANA before treatment (n = 92), six became ANA-negative, 48 had increased titers, 29 maintained, and nine decreased titers after treatment; a total of 186 patients had a positive ANA after treatment. Fine speckled nuclear pattern was most commonly observed (both before and after infliximab treatment). The number of patients with anti-dsDNA had a statistically significant increase (p = 0.003). No significant differences were noted for anticardiolipin and the remaining autoantibodies tested. Among the 286 patients included in the study, only one (0.35 %) showed clinical signs of drug-induced lupus, presenting elevated ANA and anti-dsDNA titers that normalized once treatment was discontinued. Infliximab induced the formation of autoantibodies in the combined population (ANA and anti-dsDNA with no apparent clinical importance).

Antisynthetase Syndrome: two case report and literature review.

Antissintetase Syndrome (ASS) is characterized by myositis, Raunaud's phenomenon, fever, intertitial lung disease, mechanic's hands and arthropathy associated with the presence of antibodies against tRNA synthetase, especially anti-Jo-1. This article aims to review the literature on ASS and report two cases where the first is a patient with polymyositis who developed subluxation on the proximal interphalangeal joint of bilateral first right finger after a few years of the disease, associated with pulmonary manifestations and positive anti-JO-1. In the second case, we present a patient with dermatomyositis, who developed a subluxation of the two first fingers, anti-Jo1 positive and chest CT changes, but without clinical evidence of pulmonary involvement. These cases reveal the importance of performing early diagnosis. The authors describe two cases of this rare syndrome, emphasizing the severity of interstitial lung disease and arthritis.

Síndrome Antissintetase: relato de dois casos e revisão da literatura / Antisynthetase Syndrome: two case reports and literature review

A Síndrome Antissintetase (SAS) é caracterizada por miosite, fenômeno de Raynaud, febre, doença pulmonar intersticial, artropatia e mãos de mecânico associados à presença de anticorpos contra a sintetase do RNAt especialmente anti-Jo-1. Este artigo tem como objetivo revisar a literatura sobre SAS e relatar dois casos, sendo o caso 1 de uma paciente com Polimiosite que desenvolveu, após alguns anos de doença, subluxação da articulação interfalangeana proximal do primeiro quirododáctilo direito, associada a manifestações pulmonares e anti-Jo-1 positivo. O caso 2 é de uma paciente com Dermatomiosite que evoluiu com subluxação dos dois primeiros quirodáctilos, anti-Jo-1 positivo e alterações pulmonares intersticiais na TC de tórax, porém assintomática. Esses casos demonstram a importância do diagnóstico precoce. Os autores descrevem dois casos dessa síndrome rara, enfatizando a sua gravidade do ponto de vista pulmonar e articular.

Antisynthetase Syndrome (ASS) is characterized by myositis, Raynaud's phenomenon, fever, interstitial lung disease, mechanic's hands and arthropathy associated with the presence of antibodies against tRNA synthetase, especially anti-Jo-1. This article aims to review the literature on ASS and report two cases where the first is a patient with polymyositis who developed subluxation on the proximal interphalangeal joint of bilateral first right finger after a few years of the disease, associated with pulmonary manifestations and positive anti-JO-1. In the second case, we present a patient with dermatomyositis, who developed a subluxation of the two first fingers, anti-Jo1 positive and chest CT changes, but without clinical evidence of pulmonary involvement. These cases reveal the importance of performing early diagnosis. The authors describe two cases of this rare syndrome, emphasizing the severity of interstitial lung disease and arthritis.

Systematic review of infliximab-induced autoantibodies and systemic lupus erythematosus.

The present systematic review aims to discuss infliximab-induced autoantibodies and subsequent onset of systemic lupus erythematosus (SLE) through the analyses of primary reports measuring autoantibodies both before and after the administration of infliximab for the treatment of several diseases - e.g., rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and Crohn's disease. Our literature search was performed in nine databases - PubMed, Science Direct, Scopus, Web of Knowledge, Scirus, Cochrane, EMBASE, Scielo and LILACS, and the search query retrieved 998 primary reports, from which 24 articles were selected and further narrowed down to 14, based on our inclusion criteria. Two independent reviewers performed the article selection and a third reviewer solved discrepancies. Our inclusion criteria comprised primary reports of phase IV clinical trials with duration of at least three months. In total, 760 patients were evaluated and the most prevalent assays performed in the studies were anti-nuclear antibodies (ANA), anti-double stranded DNA antibodies (anti-dsDNA), and antibodies to saline-extracted antigens (ENA panel). Of all patients evaluated, 10 (1.3%) showed clinical signs and laboratorial evidence of infliximabinduced SLE.

Revisão sistemática da indução de autoanticorpos e lúpus eritematoso pelo infliximabe / Systematic review of infliximab-induced autoantibodies and systemic lupus erythematosus

Nesta revisão sistemática abordamos a indução de autoanticorpos e lúpus eritematoso pelo infliximabe, analisando estudos que dosaram vários autoanticorpos antes e após o uso do infliximabe em diversas doenças (artrite reumatoide, espondilite anquilosante, artrite psoriásica e doença de Crohn). Nossa busca foi realizada em nove bases de dados (Pub-Med, ScienceDirect, Scopus, Web of Knowledge, Scirus, Cochrane, EMBASE, Scielo e LILACS). Foram encontradas 998 referências; 24 artigos foram separados na íntegra, dos quais 10 foram excluídos por não entrarem em nossos critérios de seleção. A escolha dos artigos foi realizada por dois revisores, e as divergências foram resolvidas por um terceiro revisor. Incluímos estudos de fase IV, com no mínimo três meses de duração. No total foram estudados 760 pacientes; o fator antinuclear, o anticorpo anti-DNA de dupla hélice e os antígenos extraídos pela salina foram os mais verificados. De todos os pacientes, apenas 10 (1,3%) apresentaram manifestações clínico-laboratoriais de lúpus induzido por infliximabe.

The present systematic review aims to discuss infliximab-induced autoantibodies and subsequent onset of systemic lupus erythematosus (SLE) through the analyses of primary reports measuring autoantibodies both before and after the administration of infliximab for the treatment of several diseases - e.g., rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and Crohn's disease. Our literature search was performed in nine databases - PubMed, Science Direct, Scopus, Web of Knowledge, Scirus, Cochrane, EMBASE, Scielo and LILACS, and the search query retrieved 998 primary reports, from which 24 articles were selected and further narrowed down to 14, based on our inclusion criteria. Two independent reviewers performed the article selection and a third reviewer solved discrepancies. Our inclusion criteria comprised primary reports of phase IV clinical trials with duration of at least three months. In total, 760 patients were evaluated and the most prevalent assays performed in the studies were anti-nuclear antibodies (ANA), anti-double stranded DNA antibodies (anti-dsDNA), and antibodies to saline-extracted antigens (ENA panel). Of all patients evaluated, 10 (1.3%) showed clinical signs and laboratorial evidence of infliximabinduced SLE.

Atualização em dermatomiosite / Updating in dermatomyositis

JUSTIFICATIVA E OBJETIVOS: A dermatomiosite é umadoença sistêmica crônica, de etiologia desconhecida, que se caracterizapor acometimento inflamatório da pele e dos músculos.O diagnóstico baseia-se nos achados clínicos e laboratoriais. Os corticoides são a terapia mais utilizada. As causas de óbito maisfrequentes são neoplasia maligna, septicemia e fibrose pulmonar.O objetivo deste estudo foi efetuar uma ampla revisão de literatura com foco no reconhecimento dos principais achados clínicos e no tratamento desta doença.CONTEÚDO: A dermatomiosite é uma doença sistêmica crônica que se caracteriza por acometimento inflamatório da pele e dos músculos. Possui duas formas principais: miopática, maisfrequente, onde se encontram lesões musculares e cutâneas; e amiopática, somente com lesões cutâneas. O sexo feminino é o mais afetado, e a idade média do diagnóstico é 40 anos. Manifestações cutâneas são observadas em todos os pacientes. Das alterações sistêmicas, a manifestação muscular mais frequente é a perda de força proximal, e a manifestação pulmonar mais comum é a pneumopatia intersticial. Podem ser observadas neoplasias durante o seguimento da doença, sendo mais frequentes nos pacientes acima de 60 anos. A desidrogenase lática é a enzima muscular alterada na maioria dos casos. O diagnóstico da dermatomiositepode ser realizado por exame anatomopatológico de biópsia muscular,além de eletroneuromiografia. Os corticoides são os mais utilizados. As causas de óbito mais frequentes são neoplasia maligna,septicemia e fibrose pulmonar. Não há causa conhecida. Odiagnóstico baseia-se nos achados clínicos e laboratoriais.CONCLUSÃO: Através da analise dos dados bibliográficos foi possível concluir que a dermatomiosite é uma doença de diagnóstico predominantemente clínico. Os exames laboratoriais e de imagem constituem importantes confirmadores do quadro, mas nunca são identificadores isolados, sendo sempre a clínica, soberana no diagnóstico desta doença.(...)

BACKGROUND AND OBJECTIVES: The dermatomyosits is a systemic chronic disease, of unknown etiology, which is characterized for inflammatory attack of the skin and muscles. The diagnosis is based on clinical and laboratory finds. The corticosteroids are the most used therapy. The most frequent causes of death are: the malignant neoplasia, the septicemia and the pulmonary fibrosis. A bibliographical revision was carried out, with the objective of attracting attention of the doctors for the recognition of the principal clinical finds of this illness. CONTENTS: The dermatomyositis is a systemic chronic disease that is characterized by the inflammatory attack of the skin and muscles. It has two principal forms: miopatic that is more frequent, and presents muscular and skin injuries; and the amiopatic that presents skin injuries only. The feminine sex is more affected mainly at the middle age of 40s. Skin manifestations are observed in all the patients. Among the systemic alterations,the most frequent muscular demonstration is the loss of strength proximal, and the commonest pulmonary demonstration is interstitial pneumopathy. Neoplasis can be observed during the continuation of the disease, and is more frequent in the patients above 60 years old. The Lactic dehydrogenase means that the muscular enzyme is altered in most of the cases. The diagnosis of the dermatomyositis can be done for the muscular biopsy applyinganatomopatologic exam, besides electroneuromiography examination. The corticosteroids are the most used therapy. The most frequent causes of death are the malignant neoplasis, sepsis, and the pulmonary fibrosis and there is no known cause. The diagnosis is based on the clinical and laboratories finds.CONCLUSION: Through the analyzes of the bibliographical facts it is possible to conclude that dermatomiositis is a disease of predominantly clinical diagnosis.(...)

Manifestações articulares de neoplasias sólidas: a propósito de dois casos e revisão da literatura / Articular manifestation of solid neoplasias report on two cases and literature review

Foram atendidos dois pacientes com dores articulares intensas e diagnósticos de osteroartrose e tendinite. No entanto, a intensidade, ritmo e periodicidade da dor, bem como a falta de resposta aos tratamentos realizados, eram incompatíveis com tais diagnósticos. Uma rápida investigação mostrou tratar-se de neoplasias malígnas de próstata e de mama. Foram, então, encaminhados para tratamento especializado. Em casos de dores articulares ou periarticulares intensas, rebeldes a tratamento conservador, principalmente em idosos, o dignóstico de metástase óssea deve ser cogitado. Uma investigação inicial deve pesquisar: marcadores tumorais, fosfatases alcalina e ácida, cálcio, fósforo, hemograma, velocidade de hemossedimentação (VHS), eletroforese protéica, radiografias, cintilografia óssea e, por vezes, tomografia computadorizada e ressonância nuclear magnética

Infecção crônica pelo vírus C da hepatite: Manifestações reumáticas e alterações laboratoriais auto-imunes / Hepatitis C vírus cronic infections

A analise de sete pacientes com infecção crônica pelo vírus C da hepatite (VCH) demonstrou que cinco dos pacientes (71por cento) apresentaram artralgia ou artrite; fasciite palmar e plantar; mialgias e calcaneodina bilateral. Dois enfermos (28por cento) apresentarm crioglobulinemia positiva, sendo que um se queixava de mialgias em membros inferiores e o outro era assintomático. O fator reumatoide foi positivo em três doentes (42por cento) sem que apresentassem doença reumatóide. Em um deles a crioglobulinemia também foi positiva. Os auto-anticorpos antimicrossonal e antitireoglobulina foram detectados em três pacientes (42por cento) sem que houvesse quadro clínico de disfunção tireoideana. A pesquisa do FAN foi negativa nos sete pacientes e a dosagem do complemento C3 e C4, realizada em quatro pacientes, foi normal