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1.
Zhonghua Nei Ke Za Zhi ; 59(2): 134-139, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074687

RESUMO

Objective: To investigate the clinical and imaging characteristics of infectious sacroiliitis. Methods: A total of 110 patients diagnosed with infectious sacroiliitis were retrospectively analyzed between 2008 and 2017.Clinical manifestations and therapeutic responses, laboratory tests such as HLA-B(27), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), T cell spot test for tuberculosis infection(TB-SPOT), Brucella agglutination test ect., blood culture of pathogens, pathological findings as well as magnetic resonance imaging were all recorded and analyzed. Results: Among the 110 patients, the male to female ratio was 44 to 66 with an average age 15-58(29.4±10.8) years and the course of disease 0.3-60 (5.7±13.2) months. As to the pathogens, 71 cases were pyogenic, 24 cases with tuberculous sacroiliitis, and 15 cases were brucellosis infections. The majority of patients (97.3%) had unilateral sacroiliac joint involvement. Ten (9.1%) patients suffered infectious sacroiliac arthritis after delivery. Hip pain was the main clinical manifestation (83/110,75.5%) and fever as the second (77/110,70.0%). HLA-B(27) was positive in 11 patients (10.0%). Both ESR and CRP were elevated in the majority. There were 103 patients receiving sacroiliac joint puncture biopsy. Seven patients were diagnosed through blood culture or brucellosis agglutination test. Bone marrow edema and osteolytic lesions in magnetic resonance imaging (MRI) were more common in pyogenic or tuberculous sacroiliitis than in brucellosis infections. Conclusion: Infectious sacroiliitis should be differentiated from spondyloarthritis, which develops more in female patients, with short disease duration and fever, mostlynegative HLA-B(27). The majority patients present unilateral sacroiliitis. Active inflammatory lesions are usually beyond sacroiliac joints with osteolytic changes in MRI examinations.


Assuntos
Artrite Infecciosa/diagnóstico , Infecções Bacterianas/complicações , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico , Adolescente , Adulto , Artrite Infecciosa/microbiologia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Biópsia , Brucella , Brucelose , Criança , Pré-Escolar , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Articulação Sacroilíaca/microbiologia , Sacroileíte/microbiologia , Adulto Jovem
2.
Int J Rheum Dis ; 22(12): 2213-2217, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31709741

RESUMO

A 36-year-old man was treated for several years with multiple agents for ankylosing spondylitis based on positive human leukocyte antigen-B27 and sacroiliitis. He was also diagnosed with osteoporosis and hypophosphatemia. Over these years, from being an avid runner, he became dependent on a walker for ambulation. The lack of treatment response and the low phosphorus were clues that eventually led to a diagnosis of tumor-induced osteomalacia. This case discusses the importance of not solely relying on genetic markers and sacroiliitis for diagnosing ankylosing spondylitis as other conditions can cause similar presentations.


Assuntos
Neoplasias Femorais/diagnóstico , Antígeno HLA-B27/genética , Osteomalacia/diagnóstico , Sacroileíte/diagnóstico , Espondilartrite/diagnóstico , Adulto , Diagnóstico Diferencial , Neoplasias Femorais/complicações , Neoplasias Femorais/cirurgia , Antígeno HLA-B27/imunologia , Humanos , Masculino , Osteomalacia/etiologia , Osteomalacia/genética , Osteomalacia/imunologia , Osteotomia , Valor Preditivo dos Testes , Sacroileíte/etiologia , Sacroileíte/genética , Sacroileíte/imunologia , Espondilartrite/genética , Espondilartrite/imunologia , Resultado do Tratamento
5.
Z Rheumatol ; 78(6): 568-576, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31375960

RESUMO

BACKGROUND: Early detection of patients with axial spondylarthritis (axSpA) in primary care is difficult. The combination of various parameters indicative of inflammatory back pain (AWARE criteria) was found to be beneficial in an initial study. OBJECTIVE: Review of the criteria for the identification of young patients with axSpA and chronic back pain (≥3 months of back pain). MATERIAL AND METHODS: In adult patients with chronic back pain and age at onset of symptoms <45 years, orthopedic surgeons documented various possible axSpA characteristics before referral to the rheumatologist. RESULTS: Overall, the data from 1306 patients were recorded. Of these, ultimately 500 patients were also seen by rheumatologists, 199 patients (39.8%) were diagnosed with axSpA while 301 (60.2%) had non-specific back pain. A total of 87 patients had ankylosing spondylitis (44%) and 112 non-radiographic axSpA (56%). The ASAS classification criteria were fulfilled by 226 patients (45.2%). The mean age of axSpA patients was 38 years, 56% were male with a mean duration of back pain of 98 months. The AWARE criteria had a sensitivity and specificity of 69.3% and 40.3% (n = 343), respectively, when ≥4/5 criteria were chosen. Positive imaging for sacroiliitis using magnetic resonance imaging (MRI) or X­ray was present in 77% of patients and positive HLA-B27 was identified in 59% of axSpA patients. The combination of positive imaging and HLA-B27 had the highest likelihood ratio for diagnosis of axSpA. CONCLUSION: Although the study design used here led to a preselection and thus to a bias in the statistical evaluation, the study confirmed the benefit of the AWARE criteria for the early detection of patients with axSpA. In further studies, the 2­stage approach with initially 3 clinical questions and then an optional HLA-B27 test is currently being investigated further.


Assuntos
Antígeno HLA-B27/análise , Atenção Primária à Saúde , Sacroileíte , Espondilartrite , Espondilite Anquilosante , Adulto , Feminino , Humanos , Masculino , Sacroileíte/diagnóstico , Espondilartrite/diagnóstico , Espondilite Anquilosante/diagnóstico
7.
An. pediatr. (2003. Ed. impr.) ; 91(1): 42-46, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186696

RESUMO

Introducción: La sacroileítis piógena (SIP) es una entidad infrecuente que representa del 1 al 2% del total de las infecciones articulares en la edad pediátrica. Su diagnóstico a menudo se complica y retrasa debido a la inespecificidad de sus síntomas, signos y exploración física. Además, la identificación microbiológica puede resultar difícil debido a la alta proporción de hemocultivos negativos y los riesgos implicados en la aspiración de líquido articular en esta localización. Pacientes y métodos: Revisión retrospectiva de las historias clínicas de todos los pacientes menores de 18 años ingresados en un hospital infantil terciario con SIP en el período 2008-2016. Resultados: Se identificaron 6 casos de SIP en niños. Los hemocultivos fueron negativos, y la identificación del agente etiológico requirió aspiración de líquido sinovial en un paciente con infección por Aggregatibacter aphrophilus y pruebas específicas para la detección de agentes menos frecuentes en los pacientes restantes: Kingella kingae (n = 2), Brucella melitensis (n = 1) y Bartonella henselae (n = 1). Los pacientes recibieron regímenes de antibioterapia específica, y todos presentaron una evolución favorable y libre de secuelas durante el seguimiento. Conclusiones: A pesar del reducido tamaño muestral, nuestro estudio puso de relieve la baja efectividad del hemocultivo en el diagnóstico de la SIP pediátrica. También evidenció la necesidad de mantener un elevado índice de sospecha de los agentes atípicos y de emplear precozmente métodos diagnósticos apropiados, como las pruebas de imagen y la reacción en cadena de la polimerasa (PCR) en muestras de sangre, así como la prescripción de antibioterapia efectiva


Introduction: Pyogenic sacroiliitis (PSI) is a rare condition that amounts to 1% to 2% of all joint infections in the paediatric age group. Its diagnosis is often difficult and delayed due to its nonspecific signs, symptoms and physical findings. Also, the identification of the causative microorganism is frequently challenging due to a high proportion of negative blood cultures and the risks involved in joint aspiration in this site. Patients and methods: We performed a retrospective review of the health records of all patients aged less than 18 years admitted to a tertiary children's hospital due to PSI between 2008 and 2016. Results: We identified 6 cases of paediatric PSI. The blood cultures were negative, and the identification of the causative agent required joint fluid aspiration in one patient with infection by Aggregatibacter aphrophilus, and specific screening tests for less frequent agents in the other patients: Kingella kingae (n = 2), Brucella melitensis (n = 1) and Bartonella henselae (n = 1). The patients were treated with specific antimicrobial regimens, and all had favourable clinical outcomes and were free from sequelae during the follow-up. Conclusions: Despite the small sample size, our study evinced the low effectiveness of blood cultures for diagnosis of paediatric PSI. It also highlights the need for a high level of suspicion for atypical agents and the early use of adequate diagnostic methods, including imaging and serological testing or polymerase chain-reaction (PCR) analysis of blood samples, as well as prescription of effective antimicrobial therapy


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Antibacterianos/administração & dosagem , Bactérias/isolamento & purificação , Sacroileíte/diagnóstico , Seguimentos , Hospitais Pediátricos , Estudos Retrospectivos , Sacroileíte/tratamento farmacológico , Sacroileíte/microbiologia , Resultado do Tratamento
8.
An Pediatr (Barc) ; 91(1): 42-46, 2019 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-31130517

RESUMO

INTRODUCTION: Pyogenic sacroiliitis (PSI) is a rare condition that amounts to 1% to 2% of all joint infections in the paediatric age group. Its diagnosis is often difficult and delayed due to its nonspecific signs, symptoms and physical findings. Also, the identification of the causative microorganism is frequently challenging due to a high proportion of negative blood cultures and the risks involved in joint aspiration in this site. PATIENTS AND METHODS: We performed a retrospective review of the health records of all patients aged less than 18 years admitted to a tertiary children's hospital due to PSI between 2008 and 2016. RESULTS: We identified 6 cases of paediatric PSI. The blood cultures were negative, and the identification of the causative agent required joint fluid aspiration in one patient with infection by Aggregatibacter aphrophilus, and specific screening tests for less frequent agents in the other patients: Kingella kingae (n=2), Brucella melitensis (n=1) and Bartonella henselae (n=1). The patients were treated with specific antimicrobial regimens, and all had favourable clinical outcomes and were free from sequelae during the follow-up. CONCLUSIONS: Despite the small sample size, our study evinced the low effectiveness of blood cultures for diagnosis of paediatric PSI. It also highlights the need for a high level of suspicion for atypical agents and the early use of adequate diagnostic methods, including imaging and serological testing or polymerase chain-reaction (PCR) analysis of blood samples, as well as prescription of effective antimicrobial therapy.


Assuntos
Antibacterianos/administração & dosagem , Bactérias/isolamento & purificação , Sacroileíte/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Hospitais Pediátricos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Sacroileíte/tratamento farmacológico , Sacroileíte/microbiologia , Resultado do Tratamento
9.
Curr Opin Rheumatol ; 31(4): 335-343, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31045950

RESUMO

PURPOSE OF REVIEW: Axial spondyloarthritis (AxSpA) is a distinct clinical entity with characteristic clinical and radiographic features; however, a multitude of other metabolic, infectious and inflammatory disorders mimic it both clinically and radiographically. RECENT FINDINGS: We present in this review article recent updates about the various disease entities and conditions that may mimic AxSpA and how to differentiate among them. The sensitivity and specificity of MRI in diagnosing AxSpA has limitations and needs to be interpreted in the context of the clinical picture. Interestingly, some recent studies have highlighted that a relatively high prevalence of bone marrow edema on pelvic MRIs in healthy volunteers which could even be categorized as having a 'positive MRI' as defined by Assessment of Spondyloarthritis International Society. Another study revealed that a substantial proportion of patients with suspected sacroiliitis were more commonly diagnosed with diseases other than inflammatory sacroiliitis. On the basis of these reports, it is prudent to request MRIs in the appropriate clinical context and interpreted with caution taking into considerations the wide differential diagnosis of such MRI changes. SUMMARY: Highlighting the clinical pearls that differentiate disorders suspected of having sacroiliitis will lead to earlier and correct diagnosis and management; however, one must always take into considerations the radiographic and MRI findings in addition to the clinical presentations in order to make the appropriate diagnosis.


Assuntos
Imagem por Ressonância Magnética/métodos , Radiografia/métodos , Articulação Sacroilíaca/diagnóstico por imagem , Espondilartrite/diagnóstico , Diagnóstico Diferencial , Humanos , Sacroileíte/diagnóstico
10.
Arthritis Care Res (Hoboken) ; 71(6): 717-734, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31021516

RESUMO

OBJECTIVE: To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. METHODS: The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. RESULTS: Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. CONCLUSION: This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/terapia , Entesopatia/terapia , Terapia Ocupacional , Modalidades de Fisioterapia , Reumatologia/normas , Sacroileíte/terapia , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/efeitos adversos , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Produtos Biológicos/uso terapêutico , Consenso , Entesopatia/diagnóstico , Entesopatia/epidemiologia , Glucocorticoides/uso terapêutico , Humanos , Fatores de Risco , Sacroileíte/diagnóstico , Sacroileíte/epidemiologia , Resultado do Tratamento
11.
Am J Emerg Med ; 37(7): 1395.e1-1395.e2, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31005399

RESUMO

Although sacroiliitis is not uncommon in patients with inflammatory bowel diseases (IBD), bacterial infection of the sacroiliac joint is rare. The diagnosis is often delayed because of low clinical suspicion, a vague clinical picture and poorly defined localization of symptoms. We report a case of pyogenic sacroiliitis in a patient with Crohn's disease caused by Clostridia spp. and discuss key clinical components and protocol for the successful evaluation, diagnosis, and treatment of this uncommon illness.


Assuntos
Artrite Infecciosa/diagnóstico , Infecções por Clostridium/diagnóstico , Doença de Crohn/complicações , Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Infecções por Clostridium/tratamento farmacológico , Clostridium perfringens/isolamento & purificação , Feminino , Humanos , Sacroileíte/microbiologia , Tomografia Computadorizada por Raios X
12.
Medicine (Baltimore) ; 98(16): e15324, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008988

RESUMO

RATIONALE: An accessory sacroiliac (SI) joint usually has little clinical significance. However, severe arthritic changes can cause chronic buttock or low back pain and can be misdiagnosed as another disease presenting with sacroiliitis such as ankylosing spondylitis (AS). PATIENT CONCERNS: A 33-year-old woman was diagnosed with AS due to chronic buttock pain and progressive sacroiliitis on plain X-ray and magnetic resonance imaging (MRI). Her buttock and low back pain gradually worsened despite proper treatment for AS. DIAGNOSIS: Computed tomography revealed an accessory SI joint with arthritic changes. INTERVENTIONS: Nonsteroidal anti-inflammatory drugs (NSAIDs) and restricted movement were prescribed. OUTCOMES: The symptoms were controlled with NSAIDs, rest, and restriction of excessive movement. The medication could be stopped after the pain subsided. LESSONS: An accessory SI joint can be a cause of chronic back pain and can be misdiagnosed as AS with sacroiliitis when progressive arthritic changes are observed. Therefore, additional imaging studies other than conventional X-ray or MRI may be required for accurate diagnosis.


Assuntos
Articulação Sacroilíaca/anormalidades , Sacroileíte/diagnóstico , Espondilite Anquilosante/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Radiografia , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
BMC Musculoskelet Disord ; 20(1): 144, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947732

RESUMO

BACKGROUND: This study compared clinical, laboratory and radiographic features of axial spondyloarthritis (axSpA) between ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nrAxSpA) of young male patients. Additionally, we sought factors which can predict the baseline inflammatory status of sacroiliac joint (SIJ) in axSpA. METHODS: We retrospectively reviewed the medical records of 322 patients who visited our hospital due to inflammatory back pain, and 159 male patients with axSpA were enrolled. Enrolled patients were divided into two groups, AS group and nrAxSpA group, and medical records, laboratory data, radiologic findings were collected and analyzed. RESULTS: Alternating buttock pain and CRP elevation were significantly frequent in AS patients than nrAxSpA patients (68.8% vs 41.3%, P = 0.001, 63.5% vs 37.1%, P = 0.002), and SPondyloArthritis Research Consortium of Canada (SPARCC) score of SIJ was higher in AS patients than nrAxSpA patients (14.0 vs 5.0, P < 0.0001). Baseline sacroiliitis severity, psoriasis, and CRP elevation had positive association in univariate and multivariate regression analysis for SIJ inflammatory SPARCC score. CONCLUSION: AS patients were more frequently in acute inflammatory state than nrAxSpA patients according to laboratory and MRI finding. Baseline sacroiliitis grade was significantly associated with baseline inflammatory SPARCC score of SIJ. AS patients might need more intense initial treatment to resolve active inflammatory lesion of SIJ and prevent further radiologic progression.


Assuntos
Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico , Espondilartrite/diagnóstico , Adulto , Estudos Transversais , Progressão da Doença , Humanos , Imagem por Ressonância Magnética , Masculino , Prognóstico , Estudos Retrospectivos , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/patologia , Sacroileíte/terapia , Índice de Gravidade de Doença , Espondilartrite/patologia , Espondilartrite/prevenção & controle , Adulto Jovem
14.
Clin Rheumatol ; 38(6): 1579-1585, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30628016

RESUMO

OBJECTIVES: To evaluate the association between inflammatory back pain (IBP) features, acute and structural MRI findings suggestive of sacroiliitis, and diagnosis of spondyloarthritis (SpA). METHODS: Data from 224 patients who underwent MRI for suspected sacroiliitis (2005-2015) was retrospectively reviewed by an expert rheumatologist for the presence of IBP features and for clinical standard of reference diagnosis. A telephone questionnaire was performed in cases of missing data. Acute and structural MRI parameters were scored by an experienced radiologist for the presence of sacroiliitis using the Assessment of Spondyloarthritis International Society (ASAS) criteria, Berlin score, and observer's global impression (GI) scores. Association between IBP features and MRI scores, and odds ratio for SpA diagnosis, were calculated. RESULTS: One hundred ninety-three subjects were included (119 F:74 M, mean age 39.7 ± 15.6, mean follow-up 49 ± 18 months). Fifty-two (26.9%) subjects were diagnosed with SpA. IBP scores were significantly higher in SpA patients (p < 0.001). IBP, ASAS, and GI MRI scores were significantly associated with the SpA diagnosis (p < 0.001 for all). The presence of night pain and morning stiffness was significantly associated with sacroiliac-joints' bone marrow edema (BME, p < 0.05). Sensitivity for diagnosis of SpA was high for IBP (96%) and low for the MRI parameters (26.9-57.4%), and specificity was low for IBP (32%) and high for the MRI parameters (88.3-94.3%). CONCLUSIONS: The presence of IBP features is highly associated with diagnosis of SpA and correlates with MRI BME, all probably reflect inflammation. The combination of IBP and MRI should be the cornerstone in the clinician's final diagnosis of SpA.


Assuntos
Dor nas Costas/complicações , Imagem por Ressonância Magnética , Sacroileíte/diagnóstico , Espondilartrite/diagnóstico , Adulto , Dor nas Costas/diagnóstico , Dor nas Costas/fisiopatologia , Feminino , Humanos , Inflamação/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/complicações , Sacroileíte/fisiopatologia , Sensibilidade e Especificidade , Espondilartrite/complicações , Espondilartrite/fisiopatologia , Adulto Jovem
15.
Z Rheumatol ; 78(1): 31-42, 2019 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-30377767

RESUMO

The classification of axial spondyloarthritis (axSpA) comprises the classical ankylosing spondylitis (AS), which is characterized by already existing structural changes in the sacroiliac joints, and the so-called non-radiographic axSpA (nr-axSpA), in which by definition such changes are not present. This distinction is based on the ASAS classification criteria for axSpA, which are however not suitable for a diagnosis. According to the current classification, spondyloarthritis (SpA) includes axSpA, which can be associated with psoriasis and/or chronic inflammatory bowel diseases (CED), such as Crohn's disease and ulcerative colitis, and peripheral SpA, which is further divided into SpA associated with psoriasis, partially synonymous with psoriatic arthritis (PsA), reactive SpA, partially synonymous with reactive arthritis (ReA) and SpA associated with CED, partially synonymous with arthritis associated with CED (e.g. Crohn's disease, ulcerative colitis) and peripheral undifferentiated SpA, which by definition is not associated with any of the above. In this article only the most important differential diagnoses are discussed, i. e. diffuse idiopathic skeletal hyperostosis (DISH), fractures and infections in the axial skeleton. In addition, the frequency of certain musculoskeletal findings in the normal population examined by magnetic resonance imaging (MRI) are also discussed.


Assuntos
Sacroileíte , Espondilartrite , Espondilite Anquilosante , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico , Espondilartrite/diagnóstico , Espondilite Anquilosante/diagnóstico
16.
PM R ; 11(2): 210-213, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29860020

RESUMO

A 53-year-old woman with no significant medical history presented with 10/10 right buttock pain that radiated to the right groin. With no reported recent injury, the absence of fever, and no identifiable risk factors, an infectious etiology, including septic sacroiliitis (SSI), is at the end spectrum of the differential. SSI is a rare condition with nonspecific findings that can lead to major complications, including death. To our knowledge, there are only 4 recent major literature reviews on SSI, with most cases reported to have at least 1 risk factor or clinical sign indicating the possibility of an infectious etiology. The patient reported in this case had no identifiable risk factors; therefore, high clinical suspicion is needed to prevent debilitating consequences from prolonged infection. LEVEL OF EVIDENCE: V.


Assuntos
Artrite Infecciosa/diagnóstico , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico , Infecções Estafilocócicas/diagnóstico , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Diagnóstico Diferencial , Feminino , Humanos , Biópsia Guiada por Imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Articulação Sacroilíaca/microbiologia , Sacroileíte/tratamento farmacológico , Sacroileíte/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Tomografia Computadorizada por Raios X
17.
J Clin Rheumatol ; 25(2): 69-73, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29596210

RESUMO

BACKGROUND/OBJECTIVE: Familial Mediterranean fever (FMF) is an autosomal recessive disease, characterized by recurrent, self-limited attacks of fever with serositis. Various diseases were reported to be associated with FMF. The aim of this study was to investigate the frequency and characteristics of sacroiliitis in children with FMF. METHODS: Files of FMF patients who had been seen in 2 reference hospitals in Ankara were retrospectively evaluated. Patients with FMF and concomitant sacroiliitis were included to the study. All patients had magnetic resonance imaging evidence of sacroiliitis. RESULTS: Among 650 FMF patients, 17 (11 females, 6 males; mean age, 13.32 ± 4.24 years) (2.6%) of them were found to have sacroiliitis. Familial Mediterranean fever diagnosis was done prior to sacroiliitis diagnosis in 11 patients (65%) and concurrently or afterward in 6 patients (35%). Ten patients had isolated sacroiliitis, and 7 had associated diseases (5 enthesitis-related arthritis, 1 psoriatic arthritis, and 1 ulcerative colitis). Arthritis (59%), arthralgia (77%), leg pain (71%), heel pain (41%), and enthesitis (29%) were common complaints. Sacroiliac tenderness was detected in 77%, and M694V mutation in almost 90% of the patients. All patients received colchicine therapy. Additionally, 14 of them were treated with nonsteroidal anti-inflammatory drugs, 10 were on sulfasalazine treatment, and 7 of them were on biological agents. CONCLUSIONS: Sacroiliitis can be seen in patients with FMF during childhood, and M694V mutation seems to be a susceptibility factor for its development. Inflammatory low-back pain and leg and heel pain could suggest sacroiliitis.


Assuntos
Febre Familiar do Mediterrâneo/complicações , Sacroileíte/epidemiologia , Adolescente , Criança , Febre Familiar do Mediterrâneo/diagnóstico por imagem , Febre Familiar do Mediterrâneo/genética , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Mutação/genética , Pirina/genética , Estudos Retrospectivos , Sacroileíte/diagnóstico , Sacroileíte/genética , Turquia , Adulto Jovem
19.
Scand J Clin Lab Invest ; 78(6): 483-489, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30176763

RESUMO

The chronic joint inflammation in axial spondyloarthritis (axSpA) is characterized by infiltration of activated macrophages. The haptoglobin-hemoglobin receptor CD163 and the mannose receptor CD206 are strongly expressed on M2c and M2a macrophages, respectively. We measured the soluble forms of the receptors (sCD163 and sCD206) in plasma (PL) in two axSpA cohorts. All patients fulfil the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axSpA and/or the 1984 modified New York criteria for ankylosing spondylitis. The first cohort included anti-TNF-α treated patients with active axSpA (n = 30); the second cohort included patients in early disease stages (n = 38). Plasma sCD163 and sCD206 were both within the reference interval of healthy controls (HC), but sCD163 decreased slightly during anti-TNF-α treatment [baseline: 1.49 mg/L (IQR: 1.22-1.77 mg/L, 12 weeks: 1.29 (IQR: 1.09-1.57) mg/L, 20 weeks: 1.25 (IQR: 0.99-1.75) mg/L, 52 weeks: 1.39 (IQR: 1.15-1.78) mg/L], while sCD206 increased [baseline: 0.17 (IQR: 0.13-0.21) mg/L, 12 weeks: 0.19 (0.16-0.23) mg/L, 20 weeks: 0.20 (0.14-0.24) mg/L, 52: 0.19 (IQR: 0.14-0.23) mg/L], pointing toward a shift in polarization of involved macrophages. Plasma levels of sCD206 proved significantly higher in patients with early disease stages and definite radiological sacroiliitis (n = 10). This was not the case for sCD163. A significant increase in response to anti-TNF-α treatment, could suggest sCD206 as a marker of response to anti-TNF-α treatment, however, the potential for the two macrophage markers as diagnostic and prognostic indicators of disease in axSpA is weak.


Assuntos
Antígenos CD/sangue , Antígenos de Diferenciação Mielomonocítica/sangue , Lectinas Tipo C/sangue , Macrófagos/imunologia , Lectinas de Ligação a Manose/sangue , Receptores de Superfície Celular/sangue , Sacroileíte/diagnóstico , Espondilartrite/diagnóstico , Adalimumab/uso terapêutico , Adulto , Anti-Inflamatórios/uso terapêutico , Antígenos CD/genética , Antígenos CD/imunologia , Antígenos de Diferenciação Mielomonocítica/genética , Antígenos de Diferenciação Mielomonocítica/imunologia , Biomarcadores/sangue , Movimento Celular , Estudos de Coortes , Diagnóstico Precoce , Feminino , Expressão Gênica , Humanos , Lectinas Tipo C/genética , Lectinas Tipo C/imunologia , Ativação de Macrófagos , Macrófagos/efeitos dos fármacos , Macrófagos/patologia , Masculino , Lectinas de Ligação a Manose/genética , Lectinas de Ligação a Manose/imunologia , Pessoa de Meia-Idade , Radiografia , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/imunologia , Sacroileíte/imunologia , Sacroileíte/patologia , Sacroileíte/terapia , Solubilidade , Espondilartrite/imunologia , Espondilartrite/patologia , Espondilartrite/terapia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/imunologia
20.
J Med Case Rep ; 12(1): 237, 2018 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-30119703

RESUMO

BACKGROUND: Tuberculosis is the leading infectious cause of death worldwide. Among native Swiss people, tuberculosis is more common in older people than in younger people. Approximately 25-30% of reported cases of tuberculosis are purely extrapulmonary; skeletal tuberculosis is reported in 3-5% of cases. The purpose of this case report is to draw attention to the diagnostic challenge of tuberculous sacroiliitis with secondary psoas abscess, as this clinical picture is very rare. CASE PRESENTATION: A magnetic resonance imaging scan of an 85-year-old (Swiss-German) Caucasian woman with chronic left-sided hip pain and limitation of hip joint movement showed a progressive destruction of her sacroiliac joint and a large collection in her left iliopsoas muscle. Drainage of the abscess revealed pus; a polymerase chain reaction assay was positive for Mycobacterium tuberculosis complex. Tuberculous sacroiliitis with secondary iliopsoas abscess was diagnosed 9 months after the start of the symptoms. Combination treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. CONCLUSIONS: Sacroiliitis with secondary psoas abscess is an unusual cause of hip pain and is likely to be overlooked since joint pain of the lower extremity and lumbar pain are some of the most common complaints in older individuals. A high level of suspicion and invasive diagnostic procedures are needed for timely diagnosis of tuberculous sacroiliitis not only in immunocompromised patients living in or originating from endemic areas.


Assuntos
Abscesso do Psoas/diagnóstico , Articulação Sacroilíaca , Sacroileíte/diagnóstico , Tuberculose Osteoarticular/diagnóstico , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Feminino , Humanos , Abscesso do Psoas/terapia , Sacroileíte/terapia , Tuberculose Osteoarticular/terapia
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