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1.
J Rheumatol ; 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31203214

RESUMO

OBJECTIVE: The assessment of the cardiovascular (CV) risk is recommended in patients with chronic inflammatory rheumatic diseases. The objectives of this study were to assess the CV risk profile in a cohort of patients with Psoriatic Arthritis (PsA), the presence of subclinical cardiovascular (CV) disease by carotid ultrasound (US), and to study its association to PsA features. METHODS: Cross-sectional multicentric descriptive study. The clinical CV risk was calculated with SCORE charts. Common carotid US was conducted to evaluate the carotid wall intima media thickness and the presence of atheroma plaques. Patients were reclassified upon US results. Multivariate analyses were performed to identify associations of US carotid abnormalities with the classical CV risk factors and PsA characteristics. RESULTS: 176 PsA patients were included. The SCORE estimated CV risk was intermediate in 65.3% of the patients. In the US study, 32% of the patients had abnormalities and finally 30.8% of the patients were upgraded and reclassified as very high risk due to the presence of atheroma. Subclinical CV disease was associated with age and dyslipidaemia but not with other risk factors. It was associated with axial disease in the subgroup with intermediate risk, and with CRP levels in patients with high risk. CONCLUSION: A considerable number of PsA patients have clinical estimated intermediate or high risk of a fatal CV event. Carotid US study detects subclinical vascular disease and may be useful to depict the real risk. The presence of atheroma is only partially explained by the classical CV risk factors.

2.
Arthritis Rheumatol ; 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31237427

RESUMO

OBJECTIVE: To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as first biologic drug in a large series of patients with refractory uveitis due to Behçet's disease (BD) for 1-year period. METHODS: Open-label multicenter study of IFX or ADA-treated patients with BD-uveitis refractory to conventional non-biologic treatment. IFX or ADA were chosen as first biologic treatment based on physician and patient agreement. Dosing schedule was: IFX: 3-5 mg/kg i.v. at 0, 2 and 6 weeks and every 4-8 weeks thereafter, and ADA: 40 mg/s.c./every other week without loading dose. Comparison between patients treated with IFX and patients treated with ADA was performed. RESULTS: 177 patients (316 affected eyes) were included. IFX was used in 103 and ADA in 74 cases. No significant differences at baseline were observed between IFX vs ADA groups regarding main demographic features, previous therapy and ocular severity. After one year of therapy, we observed an improvement in all ocular parameters in both groups. However, ADA therapy yielded better outcome in some parameters that in some cases yielded statistically significant differences: anterior chamber inflammation (78.18% in IFX-treated vs 92.31%in ADA-treated; p=0.06), vitritis (78.95% vs 93.33%; p=0.04), retinal vasculitis (97% vs 95%; p=0.28), macular thickness (264.89±59.74 vs 250.62±36.85; p=0.15), best-corrected visual acuity (0.67±0.34 vs 0.81±0.26; p=0.001), and drug retention (84.95% vs 95.24%; p=0.042). CONCLUSION: Although IFX and ADA yields efficacy refractory BD uveitis, ADA appears to be associated with better outcome than IFX after one-year follow-up. This article is protected by copyright. All rights reserved.

3.
Rheumatology (Oxford) ; 58(6): 1095-1098, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30690553

RESUMO

OBJECTIVES: CPP crystals can be polymorphic (rhomboidal, parallelepiped: R/P), but some look like needles and could be taken as MSU under the bright field microscope. Birefringence of CPP crystals is weaker or absent compared with MSU crystals, but we aim to evaluate whether the grade of birefringence varies regarding the shape of the CPP crystal. METHODS: SF samples from patients with demonstrated acute CPP crystal arthritis were analysed by two observers, using a simple polarized light microscope equipped with two viewing stations. The analysis was performed simultaneously but in a blinded manner. Shape (needles or R/P) and the intensity of birefringence (absent, weak, moderate or MSU-like) were registered. χ2 trend test was used to evaluate the distribution of birefringence regarding the crystal shape. RESULTS: Two-hundred and fifty CPP crystals from 25 SF samples were analysed, well balanced between R/P and needles. The intensity of birefringence significantly differs between R/P or needles in the registries of both observers. R/P most often showed any grade of birefringence compared with needles, while no cases of MSU-like birefringence were found in acicular crystals. Both observers showed high agreement both in crystal shape and in intensity of birefringence. CONCLUSION: CPP crystals birefringence varies according to shape. Needle-shaped CPP crystals did not show strong birefringence, thus reinforcing the value of examining the samples with both ordinary and simple polarized light microscopes in differentiating them from MSU.

4.
Reumatol Clin ; 2018 Dec 03.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30522944

RESUMO

AIMS: To describe the methodology of REAPSER (Spanish Registry of Recent-onset Psoriatic Arthritis), its strengths and limitations. The aim of this study is to identify prognostic factors for the clinical and radiographic course in a cohort of patients with psoriatic arthritis (PsA) diagnosed within 2years of symptom evolution. METHODS: Multicenter, observational and prospective study (with 2-year follow-up including annual visits). Baseline visit intended to reflect patient situation before the disease course was modified by treatments prescribed in rheumatology departments. Patients were invited to participate consecutively in one of their routine visits to the rheumatologist. 211 patients were included. Following data were collected: sociodemographic variables; employment situation; family history; personal history and comorbidities; anthropometric data; lifestyle; use of healthcare services; clinical situation at the time of PsA diagnosis; joint involvement and spinal pain; pain and overall assessment; enthesitis, dactylitis and uveitis; skin and nail involvement; functional situation and quality of life; radiographic evaluation; analytical determinations; treatment; axial and peripheral flare-ups. CONCLUSIONS: The REAPSER study includes a cohort of patients with recent-onset PsA, before the disease course was modified by disease-modifying antirheumatic drugs prescribed in rheumatology departments. Exhaustive information collected in each visit is expected to be an important data source for future analysis.

5.
PLoS One ; 13(10): e0205751, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30312342

RESUMO

BACKGROUND: Diagnostic delay is well-known in spondyloarthritis and studies have demonstrated a longer deferral in women. The aim of this study was to explore whether diagnostic delay of spondyloarthritis depends on clinical manifestations expressed by patients according to sex or whether it is related to a doctor's misdiagnosis bias. METHODS: A cross-sectional study of 96 men and 54 women with spondyloarthritis was performed at Alicante University General Hospital in Spain using a semistructured interview and clinical records. Comparative sex analysis were done via Student's T and Mann-Whitney U tests for parametric and nonparametric continuous variables, chi-square and Fisher's exact tests for unpaired categorical variables, and McNemar's test for paired ones. FINDINGS: The median diagnostic delay in women 7.5 (11.5) years is higher than men 4 (11) years, with a difference close to statistical significance (p = 0.053). A total of 30.2% of men received a first correct diagnosis of spondyloarthritis versus 11.1% of women (p = 0.016), indicating that men have higher probability of not having a misdiagnosis of spondyloarthritis (odds ratio = 3.5; 1.3-9). Eleven different health services referred male patients to the rheumatology clinic but only six in the case of female. No sex differences were detected in patients' manifestations of back pain at onset. However, medical records registered differences (women 44.4%, men 82.1%; p < 0.001). There were differences between patients (women 57.7%, men 35.2%; p = 0.008) and medical records in peripheral signs/symptoms at onset (women 55.6%, men 17.9%; p < 0.001). CONCLUSION: The few differences of self-reported manifestations between both sexes with spondyloarthritis as compared with their clinical records (more axial pain in men and more peripheral pain in women) suggests that the professionals' annotations reflect what they expect according to Literature, which could explain the higher misdiagnosis and diagnostic delay in women with spondyloarthritis.

6.
J Rheumatol ; 44(10): 1429-1435, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28668807

RESUMO

OBJECTIVE: To illustrate the experiences and contextual support perceived by men and women with spondyloarthritis (SpA) in relation to their demanding productive and reproductive roles. METHODS: A quantitative-qualitative study of 96 men and 54 women with SpA was conducted at the Alicante University General Hospital, in a Spanish Mediterranean city, from March 2013 to February 2014. Descriptive and qualitative content analyses compared working lives and family/partner relationships of male and female patients. RESULTS: Working life: both women (55.6%) and men (51.04%) were similarly affected, but women had worse disease activity (5.4 vs 4.0, p = 0.01) and less antitumor necrosis factor-α therapy (56.7% vs 77.6%, p < 0.05). Different patterns were found by gender: women mostly practiced presenteeism whereas men practiced absenteeism, women took antiinflammatories prior to work and men after work, employers suggested more frequently the beneficial actions for men, and some women withdrew permanently from the labor market. Family/partner relationships: women were more affected (57.4%) than men (41.7%), with worse results for diagnostic delay (11.2 vs 6.4 yrs, p = 0.02), disease activity (5.8 vs 3.6, p < 0.001), and physical function (5.2 vs 3.8, p = 0.02). Gender role conflicts emerged, with women developing strategies to face compulsory housework whereas men avoided them; women regretted neglecting their children and men not sharing leisure activities with them. CONCLUSION: Our study highlights the vital complexity in which patients with SpA are immersed, especially for women in a country where a mix of new and traditional gender roles coexist. Awareness of its existence is crucial when professionals strive to provide healthcare focused on their well-being in addition to medical therapy.


Assuntos
Absenteísmo , Identidade de Gênero , Disparidades em Assistência à Saúde , Espondilartrite/diagnóstico , Adulto , Diagnóstico Tardio , Eficiência , Família/psicologia , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores Sexuais , Espanha , Espondilartrite/tratamento farmacológico , Espondilartrite/psicologia
7.
J Rheumatol ; 44(2): 174-183, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27980009

RESUMO

OBJECTIVE: To identify empirical evidence of diagnostic delay in spondyloarthritis (SpA), determine whether sex-related differences persist, and conduct an analysis from that perspective of the possible causes, including the influence of quality research, in this group of inflammatory rheumatic diseases. METHODS: A systematic review was done of delay in diagnosis of SpA in MEDLINE and EMBASE and other sources. Study quality was determined in line with the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement. A metaanalysis of 13 papers reporting sex-disaggregated data was performed to evaluate sex-related differences in diagnostic delay. The global effect of diagnostic delay by sex was calculated using means difference (D) through a fixed effects model. RESULTS: The review included 23,883 patients (32.3% women) from 42 papers. No significant differences between the sexes were detected for symptoms at disease onset or during evolution. However, the mean for delay in diagnosis of SpA showed sex-related differences, being 8.8 years (7.4-10.1) for women and 6.5 (5.6-7.4) for men (p = 0.01). Only 40% of papers had high quality. A metaanalysis included 12,073 participants (31.2% women). The mean global effect was D = 0.6 years (0.31-0.89), indicating that men were diagnosed 0.6 year (7 months) before women. CONCLUSION: Delay in diagnosis of SpA persists, and is longer in women than in men. There are no significant sex-related differences in symptoms that could explain sex-related differences in diagnostic delay. Methodological and possible publication bias could result in sex-biased medical practice.


Assuntos
Espondilartrite/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Diagnóstico Tardio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
8.
Reumatol. clín. (Barc.) ; 12(2): 81-84, mar.-abr. 2016. ilus
Artigo em Espanhol | IBECS | ID: ibc-150873

RESUMO

Introducción. A pesar de las medidas de cribado de tuberculosis (TB) siguen detectándose casos en pacientes tratados con anti-TNF-α y cribado inicial negativo, algunos tras largo tiempo de tratamiento, lo que apunta más a una nueva infección. Objetivos. Describir los casos que presumiblemente han desarrollado primoinfección tuberculosa durante el tratamiento con fármacos anti-TNF-α. Métodos. Revisión retrospectiva (1999-2012), seleccionando según los siguientes criterios: a) tratamiento anti-TNF-α; b) cribado de TB inicial negativo; c) TB diagnosticada durante tratamiento anti-TNF-α, y d) sospecha de primoinfección tuberculosa (tras mínimo 12 meses de anti-TNF-α). Se han revisado sus variables clínicas, epidemiológicas, terapéuticas y de desenlace. Resultados. Dos casos de primoinfección tuberculosa de 771 pacientes tratados con anti-TNF-α (0,2%). Una mujer de 41 años y 35 meses de tratamiento con adalimumab y un varón de 37 años y 107 meses de tratamiento con infliximab. La mujer presentó una neumonía y el varón una TB diseminada. Conclusiones. Durante la terapia anti-TNF-α persiste el riesgo de TB a pesar de cribado inicial negativo, por lo que el grado de sospecha debe ser elevado durante todo el tratamiento (AU)


Introduction. Despite screening for latent tuberculosis (TB), new cases of TB infection are detected in patients treated with anti-TNF-α and negative initial screening, some of them after long treatment, which points more to a new infection. Objectives. To describe the cases that have presumably developed a primary tuberculous infection during treatment with anti-TNF-α drugs. Methods. Retrospective audit (1999-2012). Inclusion criteria were: a) anti-TNF-α treatment; b) initial latent TB screening negative; c) TB diagnosed during anti-TNF-α treatment; d) suspected primary TB infection (diagnosis after at least 12 months on anti-TNF-α). Clinical, epidemiological, therapeutic and outcome variables were reviewed. Results. Two cases of primary TB infection were found out of of 771 anti-TNF-α treated patients (0.2%). One woman aged 41 suffered TB pneumonia after 35 months of treatment with adalimumab, and a male aged 37 who developed disseminated TB after 107 months of treatment with infliximab. Conclusions. Although uncommon, during TNF antagonist therapy, TB risk persists despite negative initial screening, so clinicians should be aware of TB during the entire treatment (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Fator de Necrose Tumoral alfa/uso terapêutico , Infliximab/uso terapêutico , Pneumonia/complicações , Pneumonia/tratamento farmacológico , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Imunossupressão/instrumentação , Imunossupressão/métodos , Imunossupressão , Tuberculose Latente/tratamento farmacológico , Estudos Retrospectivos , Ensaios de Seleção de Medicamentos Antitumorais/métodos , Programas de Rastreamento/métodos , Tuberculose Latente/fisiopatologia
9.
Reumatol Clin ; 12(2): 81-4, 2016 Mar-Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26099453

RESUMO

INTRODUCTION: Despite screening for latent tuberculosis (TB), new cases of TB infection are detected in patients treated with anti-TNF-α and negative initial screening, some of them after long treatment, which points more to a new infection. OBJECTIVES: To describe the cases that have presumably developed a primary tuberculous infection during treatment with anti-TNF-α drugs. METHODS: Retrospective audit (1999-2012). Inclusion criteria were: a) anti-TNF-α treatment; b) initial latent TB screening negative; c) TB diagnosed during anti-TNF-α treatment; d) suspected primary TB infection (diagnosis after at least 12 months on anti-TNF-α). Clinical, epidemiological, therapeutic and outcome variables were reviewed. RESULTS: Two cases of primary TB infection were found out of of 771 anti-TNF-α treated patients (0.2%). One woman aged 41 suffered TB pneumonia after 35 months of treatment with adalimumab, and a male aged 37 who developed disseminated TB after 107 months of treatment with infliximab. CONCLUSIONS: Although uncommon, during TNF antagonist therapy, TB risk persists despite negative initial screening, so clinicians should be aware of TB during the entire treatment.


Assuntos
Adalimumab/efeitos adversos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Infliximab/efeitos adversos , Tuberculose/imunologia , Adulto , Feminino , Humanos , Tuberculose Latente/diagnóstico , Masculino , Sistema de Registros , Estudos Retrospectivos , Tuberculose/diagnóstico
11.
Rheumatology (Oxford) ; 53(12): 2223-31, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24996907

RESUMO

OBJECTIVE: The aim of this study was to assess the efficacy of anti-TNF-α therapy in refractory uveitis due to Behçet's disease (BD). METHODS: We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load. RESULTS: Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (s.d. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-α drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-α therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 µm] and 35 (49 eyes) had cystoid macular oedema (OCT>300 µm) that improved from 420 µm (s.d. 119.5) at baseline to 271 µm (s.d. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases. CONCLUSION: Anti-TNF-α therapy is effective and relatively safe in refractory BD uveitis.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Síndrome de Behçet/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Uveíte/tratamento farmacológico , Adalimumab , Adolescente , Adulto , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Síndrome de Behçet/complicações , Produtos Biológicos/efeitos adversos , Produtos Biológicos/uso terapêutico , Criança , Esquema de Medicação , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Infliximab , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Resultado do Tratamento , Uveíte/etiologia , Adulto Jovem
13.
Reumatol. clín. (Barc.) ; 8(3): 114-119, mayo-jun. 2012.
Artigo em Espanhol | IBECS | ID: ibc-100158

RESUMO

Objetivo. Describir la variabilidad en el manejo de las espondiloartritis (EsA) en España en términos de consumo de recursos sanitarios y la utilización de técnicas. Métodos. Revisión de 1.168 historias clínicas de pacientes con EsA atendidos en servicios de reumatología de hospitales españoles, seleccionadas aleatoriamente. Se analizaron las variables sociodemográficas y las variables relacionadas con el consumo de recursos sanitarios. Resultados. El número total de visitas médicas a reumatología fue de 5.908, con una tasa de 254 consultas/100 pacientes-año. El número total de visitas a enfermería reumatológica fue de 775, con una tasa de 39 visitas/100 pacientes-año, y se produjeron 446 ingresos, lo que representa una tasa de 22 por 100 pacientes-año. El número de ingresos debidos a la EsA fue de 89, con una tasa de 18 ingresos/100 pacientes-año. El total de visitas a otros especialistas fue de 4.307, con una tasa de 200/100 pacientes-año. El número total de cirugías ortopédicas fue de 41, lo que da lugar a una tasa de 1,8 cirugías/100 pacientes-año. Conclusiones. Los datos de visita al reumatólogo y de cirugía protésica de pacientes con EsA en España son similares a la mayoría de los estudios publicados en nuestro entorno; sin embargo, otros aspectos referentes al uso de recursos sanitarios son diferentes en comparación con otros países. Estos datos pueden contribuir para conocer y mejorar aspectos organizativos del manejo de la EsA en los hospitales españoles (AU)


Objective. Our objective was to describe the variability in the management of spondyloarthritis (SA) in Spain in terms of healthcare resources and their use. Methods. A review of 1168 medical files of patients seen in randomly selected Spanish hospital rheumatology departments. We analyzed demographic variables and variables related to the consumption of health resources. Results. The total number of visits to rheumatology were 5,908 with a rate of 254 visits/100 patient-years. The total number of visits to rheumatology specialty nurses was 775, with a rate of 39 visits/100 patient-years, and there were 446 hospitalizations, representing a rate of 22 per 100 patient-years. The number of admissions due to SA was 89, with a rate of 18 admissions/100 patient-years. Total visits to other specialists was 4,307 with a rate of 200/100 patient-years. The total number of orthopedic surgeries was 41, which leads to a rate of 1.8 surgeries/100 patient-years. Conclusions. The data regarding visits to the rheumatologist and prosthetic surgery of patients with in Spain is similar to most studies published in our environment, however, other aspects concerning the use of health resources are different compared to other countries. This data may help to understand and improve organizational aspects of management of SA in Spanish hospitals (AU)


Assuntos
Humanos , Masculino , Feminino , Espondilartrite/epidemiologia , Espondilartrite/prevenção & controle , /estatística & dados numéricos , /normas , Espanha/epidemiologia , Análise Estatística , Estudos Transversais/métodos , Estudos Transversais , Comorbidade , Ortopedia/métodos , Ortopedia/tendências
14.
Reumatol Clin ; 8(3): 114-9, 2012 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22503152

RESUMO

OBJECTIVE: Our objective was to describe the variability in the management of spondyloarthritis (SA) in Spain in terms of healthcare resources and their use. METHODS: A review of 1168 medical files of patients seen in randomly selected Spanish hospital rheumatology departments. We analyzed demographic variables and variables related to the consumption of health resources. RESULTS: The total number of visits to rheumatology were 5,908 with a rate of 254 visits/100 patient-years. The total number of visits to rheumatology specialty nurses was 775, with a rate of 39 visits/100 patient-years, and there were 446 hospitalizations, representing a rate of 22 per 100 patient-years. The number of admissions due to SA was 89, with a rate of 18 admissions/100 patient-years. Total visits to other specialists was 4,307 with a rate of 200/100 patient-years. The total number of orthopedic surgeries was 41, which leads to a rate of 1.8 surgeries/100 patient-years. CONCLUSIONS: The data regarding visits to the rheumatologist and prosthetic surgery of patients with in Spain is similar to most studies published in our environment, however, other aspects concerning the use of health resources are different compared to other countries. This data may help to understand and improve organizational aspects of management of SA in Spanish hospitals.


Assuntos
Recursos em Saúde/estatística & dados numéricos , Espondiloartropatias , Adulto , Estudos Transversais , Feminino , Departamentos Hospitalares/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Reumatologia/estatística & dados numéricos , Espanha , Espondiloartropatias/diagnóstico , Espondiloartropatias/terapia
15.
Best Pract Res Clin Rheumatol ; 19(3): 371-86, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15939364

RESUMO

Synovial fluid (SF) accumulates in the joint cavity in different conditions; this review outlines the data from those analyses that help in their differential and definitive diagnosis. The gross appearance of the fluid can provide a quick bedside orientation with regard to the amount of inflammation present in the joint: totally transparent SF originates in non-inflammatory conditions--of which osteoarthritis is the most common--and the amount of turbidity grossly relates to the amount of inflammation. Most turbid to purulent fluids usually come from infected joints, but exceptions are not uncommon. The white cell count offers quantitative information, but the boundaries between non-inflammatory and inflammatory SF and between this and septic fluid are very hazy and figures have to be interpreted in the clinical setting. Detection and identification of monosodium urate (MSU) and calcium pyrophosphate dihydrate (CPPD) crystals allow a precise diagnosis of gout and CPPD crystal-related arthropathy. Only one in five CPPD crystals have sufficient birefringence for easy detection and they are easily missed if searched for only using a polarised microscope. Instructions for beginners are given. Proper microbiological studies of the SF is the key to the diagnosis of infectious conditions.


Assuntos
Artropatias/diagnóstico , Líquido Sinovial/química , Ensaios Clínicos como Assunto , Humanos , Artropatias/metabolismo , Coloração e Rotulagem/métodos
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