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1.
Intern Med ; 58(22): 3267-3271, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31292397

RESUMO

A 69-year-old man developed bilateral polyarthritis, edematous extremities, and skin desquamation on the fingers and ears. He did not meet the criteria for any connective tissue disease, including rheumatoid arthritis. An examination revealed advanced lung cancer. His systemic manifestations were attributed to paraneoplastic Bazex syndrome and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. Treatment with pembrolizumab (an anti-programmed death-1 antibody) for lung cancer relieved his symptoms and shrank the lung tumor. Bazex and RS3PE syndromes are rare paraneoplastic diseases. We herein report this unique case of synchronous development of these two paraneoplastic syndromes in the presence of advanced lung cancer.


Assuntos
Carcinoma Basocelular/complicações , Edema/complicações , Hipotricose/complicações , Neoplasias Pulmonares/complicações , Neoplasias Cutâneas/complicações , Sinovite/complicações , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Edema/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Síndromes Paraneoplásicas , Síndrome , Sinovite/diagnóstico
3.
Rehabilitación (Madr., Ed. impr.) ; 53(2): 136-140, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185471

RESUMO

Varón de 55 años con lesión centromedular postraumática, diagnosticado de sinovitis simétrica seronegativa remitente con edema con fóvea (remitting seronegative symmetrical synovitis with pitting edema o síndrome RS3PE). El cuadro clínico comienza con dolor agudo, hinchazón y rigidez de manos. La exploración física muestra edema foveolar en el dorso de ambas manos, dolor y tumefacción en las articulaciones metacarpofalángicas (MCF). Ante esto, se solicitan diferentes pruebas analíticas y radiografía de manos. Iniciamos tratamiento con 30mg de prednisona, evidenciando mejoría clínica significativa, desapareciendo la artritis y los edemas, y normalización de los valores analíticos. La peculiaridad de presentación del síndrome RS3PE en un paciente con lesión centromedular se debe a la dificultad de su diagnóstico por la superposición de manifestaciones clínicas junto al desconocimiento del mismo, pudiendo ser, en ausencia de esta lesión, una enfermedad de fácil diagnóstico, al no requerir excesivas pruebas complementarias, y con un excelente pronóstico tras el tratamiento precoz adecuado


A 55-year-old man with post-traumatic central cord injury, diagnosed with remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome). The clinical picture begins with an acute pain in hands, swelling and stiffness. The physical examination revealed edema with fovea on the back of both hands, with pain and swelling in the metacarpophalangeal joints. Given this, different analytical tests and radiography of hands were requested. We started treatment with 30mg of prednisone, showing significant clinical improvement, disappearing arthritis and edema, and normalization of the analytical values. The peculiarity of presentation of RS3PE syndrome in a patient with a central cord injury is due to the difficulty of identifying it due to the superposition of clinical manifestations together with the lack of knowledge of it, being in the absence of this lesion, an easily diagnosable pathology, do not require excessive complementary tests, and with an excellent prognosis after the appropriate early treatment


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Sinovite/diagnóstico , Mãos/fisiopatologia , Edema/fisiopatologia , Síndrome Medular Central/complicações , Prednisona/uso terapêutico , Corticosteroides/uso terapêutico
4.
BMC Infect Dis ; 19(1): 455, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117984

RESUMO

BACKGROUND: Leprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy. CASE REPORT: A 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy. CONCLUSION: This report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past.


Assuntos
Edema/diagnóstico , Hanseníase/etiologia , Mycobacterium leprae/isolamento & purificação , Sinovite/diagnóstico , Idoso , Antibacterianos , Artrite/tratamento farmacológico , Artrite/etiologia , Edema/etiologia , Humanos , Hanseníase/tratamento farmacológico , Hanseníase/microbiologia , Masculino , Mycobacterium leprae/patogenicidade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Pele/microbiologia , Pele/patologia , Síndrome , Sinovite/etiologia
6.
Arch Orthop Trauma Surg ; 139(8): 1111-1116, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30820695

RESUMO

INTRODUCTION: Shoulder pathologies are often accompanied by rotator interval synovitis. This phenomenon is poorly described in the literature so far. The aim of the study was to analyze the occurrence of macroscopically visible synovial reaction in the rotator interval in patients with chronic shoulder pathologies and to perform a histopathological evaluation. MATERIALS AND METHODS: In this prospective cohort study, 167 consecutive patients undergoing arthroscopic shoulder surgery for chronic shoulder pathology were included (♀ = 45, ♂ = 122; [Formula: see text]54.5 years ± 12.8). Included patients were divided into subgroups according to the encountered chronic shoulder pathology: (1) impingement syndrome with or without bursal sided partial rotator cuff tear (RCT); (2) articular sided partial RCT; (3) full-thickness RCT; (4) RCT that involves at least two tendons; (5) shoulder instability; and (6) cartilage damage. Standardized soft tissue biopsies from the rotator interval were taken. The synovitis score of Krenn/Morawietz was used for histopathological examination. RESULTS: Extraarticular pathology (group 1) showed significantly decreased synovitis scores compared to all the other groups. Increased size of rotator cuff tears (group 4), as well as cartilage damage (group 6) showed significantly higher synovitis scores than group 3 (p < 0.05). Moreover, the synovitis score was significantly increased in patients with concomitant pathologies of the long head of the biceps (p = 0.001). CONCLUSIONS: This study suggests that chronic intra- and extraarticular shoulder diseases are very often accompanied by a histopathologically verifiable low-grade synovitis. Intraarticular pathologies seem to induce increased levels of synovitis. Furthermore, the increased size of rotator cuff tears is accompanied by a higher degree of synovitis. STUDY DESIGN: Cohort study, level of evidence, 2b.


Assuntos
Cartilagem Articular/lesões , Instabilidade Articular/complicações , Lesões do Manguito Rotador/complicações , Síndrome de Colisão do Ombro/complicações , Sinovite/diagnóstico , Artroscopia , Cartilagem Articular/cirurgia , Estudos de Coortes , Feminino , Humanos , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Lesões do Manguito Rotador/cirurgia , Índice de Gravidade de Doença , Síndrome de Colisão do Ombro/cirurgia , Articulação do Ombro/cirurgia , Sinovite/complicações
7.
Scand J Rheumatol ; 48(4): 279-283, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30843453

RESUMO

Objective: Intra-articular glucocorticoid (IAGC) injection treatment is an easy and effective way to treat the signs and symptoms of arthritis, but there is limited knowledge on the adequate dosing for different joints. The aim of this study was to compare the outcome between two common doses of intra-articular triamcinolone hexacetonide (THA) for knee synovitis using the relapse rate during 6 months. Methods: A total of 159 adult patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA) and active knee synovitis were randomized to IAGC injection with 20 mg or 40 mg THA. Participants were blinded to the treatment dose. The primary endpoint was relapse of arthritis. When symptoms from the treated joint recurred and signs of arthritis could be confirmed on a subsequent clinical examination, a relapse was recorded and the duration of response survival was calculated. At the end of the observation period, patients without relapse were telephoned to verify the persistence of the good treatment response. Results: The proportion of relapse after 6 months was equal in the 20 mg and 40 mg THA treatment arms (30% vs 32%, respectively, p = 0.822), and no significant differences were found in the subgroups with RA and PsA patients. Conclusion: As no difference in outcome was found between the compared doses, the lower 20 mg THA dose should be preferred in IAGC treatment for knee synovitis in chronic polyarthritis. This may also reduce pharmaceutical costs and metabolic side effects. EudraCT number: 2014-000993-20, Clinical Trials.gov identifier: NCT02437461.


Assuntos
Artrite Psoriásica/complicações , Artrite Reumatoide/complicações , Glucocorticoides , Articulação do Joelho , Sinovite/tratamento farmacológico , Triancinolona Acetonida/análogos & derivados , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Relação Dose-Resposta a Droga , Cálculos da Dosagem de Medicamento , Monitoramento de Medicamentos/métodos , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Injeções Intra-Articulares/métodos , Articulação do Joelho/efeitos dos fármacos , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Prevenção Secundária/métodos , Sinovite/diagnóstico , Sinovite/etiologia , Resultado do Tratamento , Triancinolona Acetonida/administração & dosagem , Triancinolona Acetonida/efeitos adversos
8.
Int J Rheum Dis ; 22(5): 842-851, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30883001

RESUMO

AIM: We conducted this retrospective study to identify objective and comprehensive diagnostic criteria for early-stage rheumatoid arthritis (RA) that are based on ultrasound (US) and serologic findings. METHOD: From August 2014 to May 2016, we recruited 216 consecutive patients at Hospital 1 and 223 consecutive patients at Hospital 2 who were suspected to have RA and underwent US of bilateral hands. In the US of bilateral hands from 22 sites, the findings obtained by grayscale and power Doppler (PD) assessments were each graded on a semi-quantitative scale from 0 to 3. We also examined the assessment of the novel outcome measures in rheumatology (OMERACT)-European League Against Rheumatism (EULAR) combined power Doppler ultrasound score (ie the cPD score) and the Global OMERACT-EULAR Synovitis Score. We used the US findings and the combination of US and serologic findings to evaluate the diagnostic performance of these modalities. RESULTS: Seventy patients (32.4%) at Hospital 1 and 59 patients (26.5%) at Hospital 2 were diagnosed as having RA. The best-balanced diagnostic performance at each hospital was achieved using a combination, such as (1) the presence of PD grade ≥2 articular synovitis or (2) the presence of PD grade ≥1 articular synovitis and serologic positivity, as well as by using (1) the presence of cPD grade = 3 or (2) a cPD grade ≥2 and serologic positivity. CONCLUSION: The combination of a PD assessment or the cPD score with the measurement of autoantibodies of rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies can accurately identify patients with early-stage RA.


Assuntos
Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide/diagnóstico , Fator Reumatoide/sangue , Testes Sorológicos , Membrana Sinovial/diagnóstico por imagem , Sinovite/diagnóstico , Ultrassonografia Doppler , Adulto , Idoso , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico por imagem , Biomarcadores/sangue , Diagnóstico Precoce , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Sinovite/sangue , Sinovite/diagnóstico por imagem
9.
BMJ Case Rep ; 12(1)2019 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-30610030

RESUMO

Selective immunoglobulin M deficiency (sIgMD) is an immunodeficiency with undefined pathogenesis and commonly presenting with recurrent infections. 1 The European Society for Immunodeficiencies Registry defines sIgMD as a serum IgM level repeatedly below 2 SD of normal with normal levels of serum IgA, IgG and IgG subclasses, normal vaccination responses, absence of T-cell defects and absence of causative external factors. Rarely it can also be associated with autoimmune diseases. 2-7 Here we describe a patient with primary sIgMD; who presented with multiple autoimmune diseases without a history of recurrent infections and we provide a short literature review on sIgMD and autoimmune diseases.


Assuntos
Doenças Autoimunes/diagnóstico , Imunoglobulina M/deficiência , Síndromes de Imunodeficiência/diagnóstico , Doença Mista do Tecido Conjuntivo/tratamento farmacológico , Doença Mista do Tecido Conjuntivo/imunologia , Adulto , Assistência ao Convalescente , Antirreumáticos/administração & dosagem , Antirreumáticos/uso terapêutico , Doenças Autoimunes/complicações , Doenças Autoimunes/imunologia , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/uso terapêutico , Iloprosta/administração & dosagem , Iloprosta/uso terapêutico , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Síndromes de Imunodeficiência/complicações , Síndromes de Imunodeficiência/imunologia , Infusões Intravenosas , Masculino , Doença Mista do Tecido Conjuntivo/sangue , Doença Mista do Tecido Conjuntivo/diagnóstico , Mialgia/diagnóstico , Mialgia/etiologia , Nifedipino/administração & dosagem , Nifedipino/uso terapêutico , Sinovite/diagnóstico , Sinovite/etiologia , Resultado do Tratamento , Vasodilatadores/administração & dosagem , Vasodilatadores/uso terapêutico
10.
Clin Exp Rheumatol ; 37(1): 49-54, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29998844

RESUMO

OBJECTIVES: Body mass index (BMI) might affect rheumatoid arthritis (RA) outcomes. Clinical assessment of swollen joint count (SJC) might also be affected by obesity in terms of obesity-related excess adipose tissue. In this study, we compared ultrasonography (US) and clinical examination in assessing the effect of BMI on RA disease activity assessment. METHODS: This was a single-centre study including RA (ACR/EULAR criteria) patients. US assessment was performed by one trained rheumatologist blinded to clinical data. US synovitis was defined as grey-scale score ≥2 and/or power Doppler score ≥1. The primary outcome measure was difference in SJC (ΔSJC) between clinical and US assessment (US-clinical examination). The secondary outcome was to evaluate the difference between clinical and US assessment of the Disease Activity Score in 28 joints (ΔDAS28) in the 3 BMI subgroups according to the WHO classification. RESULTS: We included 76 RA patients (mean age 53.8 ± 11.8 years; 67% female). Overall, 28 (36.8%), 33 (43.4%) and 15 (19.7%) were normal weight, overweight and obese, respectively. Baseline characteristics did not differ between the 3 BMI subgroups. US-determined SJC was significantly higher than clinical-determined SJC for overweight and obese RA patients: p=0.001 and p=0.049, respectively. The DAS28 was higher with US than clinical examination within the overweight group only (p=0.002). One-way analysis of variance (ANOVA) revealed a significant difference between ΔDAS28 among the 3 BMI subgroups (p=0.046). CONCLUSIONS: In high BMI RA patients both SJC and DAS28 seem to be undervalued by clinical assessment when compared to US.


Assuntos
Artrite Reumatoide , Obesidade/complicações , Sinovite , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/diagnóstico por imagem , Feminino , Humanos , Articulações/diagnóstico por imagem , Articulações/patologia , Masculino , Pessoa de Meia-Idade , Sobrepeso/complicações , Índice de Gravidade de Doença , Sinovite/diagnóstico , Sinovite/diagnóstico por imagem , Ultrassonografia , Ultrassonografia Doppler
12.
Haemophilia ; 25(1): 144-153, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30444298

RESUMO

AIM: The use of musculoskeletal ultrasound (MSK-US) following protocols for haemophilic arthropathy and the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score can help standardize monitoring in haemophilia. This study evaluated the joint status (elbows, knees and ankles) of patients with haemophilia B (HB) in Spain using MSK-US and the HEAD-US score. METHODS: Haemophilia B patients ≥14 years old were included in this observational, multicentre, cross-sectional study, regardless of their clinical condition, HB severity and treatment received. Two blinded observers were involved in image acquisition and scoring in each centre. RESULTS: Eighty-two patients from 12 centres were enrolled: 27% mild HB, 23% moderate, 50% severe HB. Mean age was 38.9 ± 16.4 years, 60% were treated on demand (OD) and 40% were on prophylaxis. HEAD-US was zero in all joints in 28.6% OD patients and 36.4% on prophylaxis. Mean scores significantly worsened with HB severity, except for the left knee. Patients on primary and secondary prophylaxis had significantly better joint health vs OD patients in all joints, except the right ankle. Among OD patients, those with severe disease presented significantly worse scores in all HEAD-US items related to permanent damage. CONCLUSION: Joint status of HB patients in Spain is influenced by severity and treatment modality, related to the development of arthropathy, which appears prevalent in OD patients with severe HB. Routine assessment with an imaging tool such as ultrasound and HEAD-US system may help to improve joint health by personalizing and adjusting treatment in this population.


Assuntos
Hemofilia B/patologia , Artropatias/diagnóstico , Articulações/diagnóstico por imagem , Sinovite/diagnóstico , Adolescente , Adulto , Estudos Transversais , Humanos , Artropatias/patologia , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Índice de Gravidade de Doença , Espanha , Sinovite/patologia , Ultrassonografia , Adulto Jovem
13.
Eur Radiol ; 29(5): 2573-2580, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30488107

RESUMO

OBJECTIVES: To investigate the agreement between double-inversion recovery (DIR) with synthetic magnetic resonance imaging (MRI) and T1-weighted contrast-enhanced (CE)-MRI for the assessment of knee synovitis. METHODS: T1-weighted CE-MRI and synthetic MRI of 30 patients were compared. Synthetic DIR image reconstruction was performed with two inversion times (280-330 ms and 2800-2900 ms). Subjective image quality, visibility of synovium, detection of synovitis, and total synovitis score in the knee joint were evaluated on both MR images. The relative signal intensity (SI) and relative contrast of synovium, joint effusion, and bone marrow for two imaging were assessed. Differences in data between two imaging were assessed by using Wilcoxon's signed-rank test and chi-square test/Fisher's exact test. Interobserver agreement was expressed as weighted kappa value. Accuracy of synthetic DIR image was calculated by using CE-MRI as reference standard. RESULTS: T1-weighted CE-MRI yielded better image quality than synthetic DIR imaging (p < 0.001). Interobserver agreements for detecting synovitis diagnosis/sum of the synovitis score were moderate to almost perfect (κ = 0.58/0.44, synthetic DIR; κ = 0.83/0.65, T1-weighted CE-MRI). There were no statistical differences in visibility of synovium (p = 0.058-0.190), detection of synovitis (p < 0.001), and relative SI of structures between two imaging (p = 0.086-0.360). Synovium-to-effusion contrast was higher in synthetic DIR (p = 0.003) and synovium-to-bone marrow contrast was higher in CE-MRI (p < 0.001). CONCLUSION: Synthetic DIR imaging showed a moderate degree of interobserver agreement and good accuracy for detecting synovitis. Though it has limitations, it may play a role in imaging of degenerative joint disease or larger cohort scientific studies where gadolinium application is not feasible. KEY POINTS: • Synthetic double-inversion recovery (DIR) imaging avoids the use of contrast agent. • There was no significant difference between T1-weighted CE-MRI and synthetic DIR imaging in evaluating presence of synovitis in knee joint. • Synthetic DIR imaging showed moderate degree of interobserver agreement and good accuracy for detecting synovitis compared to CE-MRI, and it may facilitate evaluation of some regions of peripatellar synovitis.


Assuntos
Processamento de Imagem Assistida por Computador , Articulação do Joelho/patologia , Imagem por Ressonância Magnética/métodos , Membrana Sinovial/patologia , Sinovite/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Curva ROC , Adulto Jovem
14.
Rev Med Interne ; 40(5): 330-333, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-30391043

RESUMO

INTRODUCTION: Polymyalgia rheumatica (PMR) can be associated with distal swelling indicating an associated RS3PE syndrome. We report a case of PMR associated with oedema of the lower limbs, which resolved rapidly under glucocorticoid therapy. CASE REPORT: A 85-year-old woman presented with a 4 month history of PMR responding to the 2012 EULAR/ACR classification criteria. Examination of the lower limbs revealed pitting oedema bilaterally up to the knees, with mild erythema and warmth. Hypoalbuminemia (30g/L) was present. There was no cardiac, renal or hepatic cause to explain leg swelling. FDG-PET/CT demonstrated increased metabolism in the periarticular area of shoulders and hips. There was no sign of aortitis or neoplasia. Under treatment with prednisone 10mg/day leg swelling disappeared concomitantly to a weight loss of 8kg within 8days. CONCLUSION: This case, the first to report leg swelling of inflammatory origin in the context of PMR, could indicate an increased vascular permeability caused by inflammation in the elderly.


Assuntos
Edema/diagnóstico , Edema/tratamento farmacológico , Perna (Membro)/patologia , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/tratamento farmacológico , Idoso de 80 Anos ou mais , Edema/etiologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Inflamação/complicações , Inflamação/diagnóstico , Inflamação/tratamento farmacológico , Polimialgia Reumática/complicações , Síndrome , Sinovite/complicações , Sinovite/diagnóstico , Sinovite/tratamento farmacológico
15.
Clin Rheumatol ; 38(3): 835-840, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30406853

RESUMO

OBJECTIVES: Systemic juvenile idiopathic arthritis (sJIA) has recently become regarded as one of the autoinflammatory syndromes (AIS). However, other AIS, such as familial Mediterranean fever (FMF) and Blau syndrome, have been initially misdiagnosed as sJIA because of the clinical similarities. Making the correct diagnosis in the early stage of these AIS is desirable. Therefore, we evaluated serum S100A12 and vascular endothelial growth factor (VEGF) levels to determine if they could be biomarkers for differentiating these AIS. METHOD: Serum S100A12 and VEGF levels were examined in patients with Blau syndrome (n = 4), FMF (n = 4), and sJIA (n = 11) in the active and inactive phases. RESULTS: In the active phase, S100A12 levels were significantly higher in patients with sJIA and FMF compared with those with Blau syndrome (p < 0.001). VEGF levels of patients with sJIA were significantly higher than those of patients with others (p = 0.001). In the inactive phase, there was no significant difference in VEGF levels. However, colchicine-resistant patients or patients without treatment with FMF showed high levels of S100A12 compared with others. CONCLUSIONS: Measuring both serum S100A12 and VEGF levels may be useful for differentiating patients with Blau syndrome and FMF from those with sJIA at the early stage.


Assuntos
Artrite Juvenil/sangue , Artrite/sangue , Febre Familiar do Mediterrâneo/sangue , Proteína S100A12/sangue , Sinovite/sangue , Uveíte/sangue , Fator A de Crescimento do Endotélio Vascular/sangue , Adolescente , Artrite/diagnóstico , Artrite Juvenil/diagnóstico , Criança , Pré-Escolar , Diagnóstico Diferencial , Febre Familiar do Mediterrâneo/diagnóstico , Feminino , Humanos , Lactente , Masculino , Sinovite/diagnóstico , Uveíte/diagnóstico
16.
J Int Med Res ; 47(2): 635-640, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30392431

RESUMO

OBJECTIVE: Osteoarthritis (OA) is a common cause of disability affecting millions of people of all ages worldwide. The pathogenesis involves an inflammatory component, but the cause of the inflammation remains incompletely understood. The intracellular bacteria Chlamydia trachomatis and C. pneumoniae have been demonstrated in patients with reactive arthritis. Both of these microorganisms can cause chronic and persistent infections, with C. trachomatis being the most common cause of reactive arthritis. This study was performed to investigate the presence of C. pneumoniae in a large number of patients with primary OA. METHODS: The study included 75 patients who underwent total knee arthroplasty. During surgery, a synovial biopsy was performed and synovial fluid drawn. Real-time polymerase chain reaction (PCR) of C. pneumoniae was run on all patients, and real-time PCR of bacterial 16S rDNA was conducted on 30 of the 75 patients to screen for the presence of other bacteria. RESULTS: Real-time PCR showed no evidence of the presence of C. pneumoniae in the patients' specimens, nor were other bacteria detected. CONCLUSIONS: Although an inflammatory component is part of the pathogenesis of OA, we found no evidence indicating that C. pneumoniae is a stimulator of that inflammation.


Assuntos
Infecções por Chlamydophila/complicações , Chlamydophila pneumoniae/isolamento & purificação , Osteoartrite/microbiologia , Líquido Sinovial/microbiologia , Membrana Sinovial/microbiologia , Sinovite/diagnóstico , Idoso , Artroplastia , Infecções por Chlamydophila/microbiologia , DNA Bacteriano/genética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/genética , Osteoartrite/cirurgia , Reação em Cadeia da Polimerase , Prognóstico , RNA Ribossômico 16S/genética , Sinovite/genética , Sinovite/microbiologia
17.
Indian J Ophthalmol ; 67(1): 165-167, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30574935

RESUMO

Blau syndrome (BS) is a rare autoinflammatory disorder characterized by the clinical triad of arthritis, uveitis, and dermatitis due to heterozygous gain-of-function mutations in the NOD2 gene. BS can mimic juvenile idiopathic arthritis (JIA)-associated uveitis, rheumatoid arthritis, and ocular tuberculosis. We report a family comprising a mother and her two children, all presenting with uveitis and arthritis. A NOD2 mutation was confirmed in all the three patients - the first such molecularly proven case report of familial BS from India.


Assuntos
Artrite/diagnóstico , DNA/genética , Técnicas de Diagnóstico Molecular/métodos , Mutação , Proteína Adaptadora de Sinalização NOD2/genética , Sinovite/diagnóstico , Uveíte/diagnóstico , Adulto , Artrite/genética , Artrite/metabolismo , Análise Mutacional de DNA , Feminino , Humanos , Índia , Proteína Adaptadora de Sinalização NOD2/metabolismo , Microscopia com Lâmpada de Fenda , Sinovite/genética , Sinovite/metabolismo , Uveíte/genética , Uveíte/metabolismo
19.
Indian J Ophthalmol ; 66(10): 1483-1485, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30249847

RESUMO

The classic entity of autosomal dominant Blau syndrome (BS) consists of arthritis, dermatitis, and uveitis, occurring as a result of mutations in the NOD2 gene pattern recognition receptor. Sporadic cases are those in which no known gene mutation is identifiable. Uveitis in BS can be refractory to conventional therapy. We report a case of sporadic Blau uveitis managed with adalimumab monotherapy after failing to respond to topical steroids, systemic steroids, methotrexate, and infliximab therapy sequentially. Uveitis resolved completely with adalimumab and the patient has had a disease-free period over a 2-year follow-up with bi-monthly injections for arthritis control.


Assuntos
Adalimumab/administração & dosagem , Artrite/complicações , Sinovite/complicações , Uveíte/etiologia , Anti-Inflamatórios/administração & dosagem , Artrite/diagnóstico , Artrite/tratamento farmacológico , Pré-Escolar , Relação Dose-Resposta a Droga , Humanos , Injeções Subcutâneas , Masculino , Sinovite/diagnóstico , Sinovite/tratamento farmacológico , Tomografia de Coerência Óptica , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/tratamento farmacológico
20.
Orthopade ; 47(11): 941-948, 2018 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-30255358

RESUMO

Even though the diagnostics of rheumatic joint diseases are mostly based on clinical, immunoserological and imaging criteria, histopathology can also make a significant contribution. This is particularly true for clinically unclear monoarticular and periarticular diseases. The contribution of histopathology to the diagnosis of rheumatic diseases is manifold since the histopathological differential diagnosis includes the complete spectrum of synovial diseases. This heterogeneous pathogenetic spectrum is described in the joint pathology algorithm, which includes inflammatory and non-inflammatory diseases. To the latter group belong certain benign tumors such as the diffuse variant of the tenosynovial giant cell tumor, lipoma, hemangioma, vascular malformations and synovial chondromatosis. Additionally, the rare group of storage diseases should be kept in mind. Inflammatory diseases can be discriminated into crystal-induced arthropathies mainly such as gout and pseudogout, into granulomatous diseases such as tuberculosis and foreign-body inoculations, and finally into the large group of non-granulomatous, non-infectious synovitis. This large group is by far the most common, and it often causes difficulties in assigning the histopathological findings to a concrete rheumatologic diagnosis. In this context the synovitis score should be applied as a diagnostic device in these cases, leading to the diagnosis of a low-grade synovitis (which is associated with degenerative arthropathies) or of a high-grade synovitis (associated with rheumatic diseases). Identification of crystals and crystal-like deposits should be carried out with the application of the joint particle algorithm which addresses the identification of endogenous and non-endogenous particle deposits in the synovial tissues. Additionally, the synovitis-score may be used for evaluation of arthritis-progresssion and for the evaluation of inflammation-regression as a consequence of therapy with biologicals.


Assuntos
Artropatias , Doenças Reumáticas , Sinovite , Algoritmos , Diagnóstico Diferencial , Humanos , Artropatias/diagnóstico , Artropatias/etiologia , Artropatias/patologia , Doenças Reumáticas/complicações , Membrana Sinovial , Sinovite/diagnóstico , Sinovite/etiologia
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