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1.
BMJ Case Rep ; 16(1)2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36599493

RESUMO

A girl in middle childhood was referred to rheumatology with a 1-month history of progressive skull pain, preceded by fleeting musculoskeletal symptoms. Apart from a scaly rash on her scalp, she was well, with moderately elevated inflammatory markers. Skull imaging (radiographs, CT and MRI) revealed osteolytic lesions, soft tissue swelling and pachymeningeal enhancement at frontal and temporal convexities. Langerhans cell histiocytosis, bone infection/inflammation or malignancy was considered. Skin and bone biopsies eventually ruled out mimicking diseases and confirmed the diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). She was treated with intravenous pamidronate (IVPAM) for 9 months, with rapid resolution of pain and gradual resolution of bony abnormalities. She remains in remission at 15-month follow-up. While CRMO can affect any bone, skull involvement is extremely rare, with a broad differential diagnosis. We recommend bone biopsy to confirm skull CRMO. The patient achieved excellent clinical and radiological response to IVPAM.


Assuntos
Osteíte , Osteomielite , Feminino , Criança , Humanos , Diagnóstico Diferencial , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Pamidronato/uso terapêutico , Imageamento por Ressonância Magnética , Dor/diagnóstico , Crânio/diagnóstico por imagem , Crânio/patologia , Doença Crônica
2.
RMD Open ; 8(2)2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36549857

RESUMO

OBJECTIVE: To identify predictors of flare in a 2-year follow-up study of patients with rheumatoid arthritis (RA) in sustained clinical remission tapering towards withdrawal of biological disease-modifying anti-rheumatic drugs (bDMARDs). METHODS: Sustained clinical remission was defined as Disease Activity Score for 28 joints (DAS28)-C reactive protein (CRP) ≤2.6 without radiographic progression for >1 year. bDMARDs were tapered according to a mandatory clinical guideline to two-thirds of standard dose at baseline, half of dose at week 16 and discontinuation at week 32. Prospective assessments for 2 years included clinical evaluation, conventional radiography, ultrasound and MRI for signs of inflammation and bone changes. Flare was defined as DAS28-CRP ≥2.6 with ∆DAS28-CRP ≥1.2 from baseline. Baseline predictors of flare were assessed by logistic regression analyses. RESULTS: Of 142 included patients, 121 (85%) flared during follow-up of which 86% regained remission within 24 weeks after flare. Patients that flared were more often rheumatoid factor positive, had tried more bDMARDs and had higher baseline ultrasound synovitis sum scores than those not flaring. For patients on standard dose, predictors of flare within 16 weeks after reduction to two-thirds of standard dose were baseline MRI-osteitis (OR 1.16; 95% CI 1.03 to 1.33; p=0.014), gender (female) (OR 6.71; 95% CI 1.68 to 46.12; p=0.005) and disease duration (OR 1.06; 95% CI 1.01 to 1.11; p=0.020). Baseline predictors for flare within 2 years were ultrasound grey scale synovitis sum score (OR 1.19; 95% CI 1.02 to 1.44; p=0.020) and number of previous bDMARDs (OR 4.07; 95% CI 1.35 to 24.72; p=0.007). CONCLUSION: The majority of real-world patients with RA tapering bDMARDs flared during tapering, with the majority regaining remission after stepwise dose increase. Demographic and imaging parameters (MR-osteitis/ultrasound greyscale synovitis) were independent predictors of immediate flare and flare overall and may be of importance for clinical decision-making in patients eligible for tapering.


Assuntos
Antirreumáticos , Artrite Reumatoide , Osteíte , Sinovite , Humanos , Feminino , Seguimentos , Osteíte/tratamento farmacológico , Estudos Prospectivos , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Proteína C-Reativa , Sinovite/diagnóstico por imagem , Sinovite/tratamento farmacológico
3.
AJNR Am J Neuroradiol ; 43(9): 1318-1324, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36538385

RESUMO

BACKGROUND AND PURPOSE: Sinus CT is critically important for the diagnosis of chronic rhinosinusitis. While CT is sensitive for detecting mucosal disease, automated methods for objective quantification of sinus opacification are lacking. We describe new measurements and further clinical validation of automated CT analysis using a convolutional neural network in a chronic rhinosinusitis population. This technology produces volumetric segmentations that permit calculation of percentage sinus opacification, mean Hounsfield units of opacities, and percentage of osteitis. MATERIALS AND METHODS: Demographic and clinical data were collected retrospectively from adult patients with chronic rhinosinusitis, including serum eosinophil count, Lund-Kennedy endoscopic scores, and the SinoNasal Outcomes Test-22. CT scans were scored using the Lund-Mackay score and the Global Osteitis Scoring Scale. CT images were automatically segmented and analyzed for percentage opacification, mean Hounsfield unit of opacities, and percentage osteitis. These readouts were correlated with visual scoring systems and with disease parameters using the Spearman ρ. RESULTS: Eighty-eight subjects were included. The algorithm successfully segmented 100% of scans and calculated features in a diverse population with CT images obtained on different scanners. A strong correlation existed between percentage opacification and the Lund-Mackay score (ρ = 0.85, P < .001). Both percentage opacification and the Lund-Mackay score exhibited moderate correlations with the Lund-Kennedy score (ρ = 0.58, P < .001, and ρ = 0.58, P < .001, respectively). The percentage osteitis correlated moderately with the Global Osteitis Scoring Scale (ρ = 0.48, P < .001). CONCLUSIONS: Our quantitative processing of sinus CT images provides objective measures that correspond well to established visual scoring methods. While automation is a clear benefit here, validation may be needed in a prospective, multi-institutional setting.


Assuntos
Aprendizado Profundo , Osteíte , Rinite , Sinusite , Adulto , Humanos , Estudos Retrospectivos , Estudos Prospectivos , Rinite/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Doença Crônica , Tomografia Computadorizada por Raios X/métodos , Algoritmos
5.
Pediatr Rheumatol Online J ; 20(1): 88, 2022 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-36224598

RESUMO

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic inflammatory disease with osteoarticular and cutaneous involvements as its main manifestations. Acne conglobata as a severe acne form may affect adolescent patients. Tumor necrosis factor inhibitors are usually used as a second-line therapy for refractory SAPHO syndrome and has been reported to treat acne conglobata successfully. We herein report three cases of adolescent patients with SAPHO syndrome associated with acne conglobata who were successfully treated with TNFi therapy.


Assuntos
Acne Conglobata , Acne Vulgar , Síndrome de Hiperostose Adquirida , Osteíte , Acne Conglobata/complicações , Acne Vulgar/complicações , Acne Vulgar/tratamento farmacológico , Acne Vulgar/patologia , Síndrome de Hiperostose Adquirida/complicações , Síndrome de Hiperostose Adquirida/tratamento farmacológico , Adolescente , Criança , Humanos , Inibidores do Fator de Necrose Tumoral
6.
Arthritis Res Ther ; 24(1): 240, 2022 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-36303202

RESUMO

OBJECTIVES: We compared the treatment effectiveness between guselkumab and adalimumab in patients with pustulotic arthro-osteitis (PAO). In addition, we performed peripheral blood immunophenotyping to elucidate the immunological background and analyzed the impact of therapeutic drugs to verify the validity of immunological phenotypes as therapeutic targets. METHODS: Patients were treated with guselkumab 100 mg (guselkumab group; n = 12) and adalimumab 40 mg (adalimumab group; n = 13). Arthritis disease activity, skin lesion activity, and patient-reported outcomes (PROs) were evaluated and compared between the two groups. The retention rate and adverse events were evaluated. Comprehensive phenotyping of peripheral immune cells was performed in both groups, and phenotypes were compared before and after treatment. RESULTS: At 6 months, both groups showed significant improvement in arthritis disease activity and PROs. In the guselkumab group, skin symptoms significantly improved. The 6-month continuation rates were 91.7% (11/12) and 69.2% (9/13) in the guselkumab and adalimumab groups, respectively. Adverse events occurred in 2/12 and 5/13 patients in the guselkumab (16.7%) and adalimumab (38.5%) groups, respectively. Peripheral blood immunophenotyping showed that the proportion of activated T helper (Th) 1 cells was significantly lower in patients with PAO than in healthy controls and that the proportion of activated Th17 cells was significantly higher in patients with PAO, which significantly decreased after treatment with guselkumab. CONCLUSION: Although guselkumab and adalimumab have comparable efficacy for PAO, their impact on immunophenotypes varies.


Assuntos
Artrite , Osteíte , Psoríase , Humanos , Adalimumab/efeitos adversos , Psoríase/induzido quimicamente , Imunofenotipagem , Artrite/tratamento farmacológico
7.
Artigo em Inglês | MEDLINE | ID: mdl-36232123

RESUMO

BACKGROUND: The objectives of this study were: (1) to determine whether athletes with stage 1 osteitis pubis (OP) present differences in hip range of motion (ROM) and muscle strength, between both sides and compared with healthy athletes; (2) to investigate the relationship between the internal rotation (IR) ROM and pain intensity and physical function. METHODS: a cross-sectional and correlational study was designed, in which 30 athletes (15 athletes with stage 1 OP and 15 healthy athletes) were included. Pain intensity, physical function, hip ROM and hip muscle strength were assessed. RESULTS: The ROM assessment reported significant differences between both groups in the IR, external rotation (ER) and adduction (ADD) ROM of the painful side (PS) (p < 0.05). The OP group showed differences between both sides in IR ER and ADD ROM (p < 0.05). No statistically significant differences were found between or within groups in the maximum isometric strength of the hip (p > 0.05). A strong negative correlation between pain intensity and IR ROM (r = -0.640) and a strong positive correlation between physical function and IR ROM (r = 0.563) were found in the OP group. CONCLUSIONS: Male athletes with stage 1 OP present a hip IR, ER and ADD ROM limitation in the PS compared to non-PS and to healthy athletes. IR ROM is correlated to pain intensity and physical function in athletes with stage 1 OP.


Assuntos
Artrite , Osteíte , Atletas , Estudos Transversais , Humanos , Masculino , Força Muscular/fisiologia , Dor , Osso Púbico , Amplitude de Movimento Articular/fisiologia
8.
Pediatr Rheumatol Online J ; 20(1): 85, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36183086

RESUMO

OBJECTIVES: The objectives were to assess changes in radiological disease activity in children with chronic non-bacterial osteomyelitis (CNO) receiving pamidronate therapy and to test a modified radiological index for non-bacterial osteitis (mRINBO) in CNO. mRINBO was used for standardized reporting and quantification of whole-body MRI (WBMRI) findings resulting in an individual summary patient score. METHODS: WBMRI was retrospectively assessed in 18 children with CNO at baseline and after receiving pamidronate therapy for one year. Parameters of interest were: number and anatomic site of radiologically active bone lesions (RAL), size of RAL, extramedullary affection, spinal involvement and changes in mRINBO, which includes both the number and maximal size of RAL (RALmax) in addition to extramedullary and chronic changes. RESULTS: At the time of diagnosis, the mean age of the children was 9.8 (sd, 8.7-10.9) years and 11/18 were females. The number of RALs per patient decreased from median [interquartile range] 4.5 [3-8] to 3 [2-5] RALs per patient (p = 0.02) and extramedullary inflammatory changes regressed. Sixty-one percent of all RALs occurring at baseline resolved and three children became without active inflammatory lesions by WBMRI. The median size of RALs did not change when taking new lesions occurring in 7/18 children into account, but RALmax decreased significantly from 39 [29-45] mm at baseline to 28 [20-40] mm (p < 0.01) at year-one with a concomitant decrease of mRINBO from a median of 5 [4-7] to 4 [3-5] (p = 0.05). CONCLUSIONS: Pamidronate therapy resulted in a decrease of mRINBO from baseline to year one. mRINBO may be a potential scoring method to quantify changes in radiological disease activity in children with CNO. However, further studies are needed to test feasibility and validity of mRINBO.


Assuntos
Osteíte , Osteomielite , Criança , Doença Crônica , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Osteíte/diagnóstico , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Pamidronato/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
9.
Clin Imaging ; 92: 19-24, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36152432

RESUMO

INTRODUCTION: To investigate the acute inflammatory and structural changes of sacroiliitis as auxiliary findings on magnetic resonance enterography (MRE) and their presence on closely timed conventional magnetic resonance imaging of the sacroiliac joint (SI joint MRI). MATERIALS AND METHODS: We screened axial spondyloarthritis patients for the simultaneous presence of MREs and SI joint MRIs. Two blinded radiologists evaluated SI joint MRIs and MREs on two separate occasions. We used the Assessment of SpondyloArthritis International Society (ASAS)/Outcome Measures in Rheumatology Network (OMERACT) definitions for SI joint MRI. We implemented previously published standard definitions for osteitis, erosion, sclerosis, and fatty infiltration of SI joint in MREs that contain T1w and T1w post-gadolinium sequences. RESULTS: SI joint MRI and MRE images were present in 43 patients. The median time between the two modalities was 14 (0-89) days. Twelve patients had ASAS-defined positive SI joint MRI. Radiologist-1 and radiologist-2 detected osteitis on MRE in nine and eight out of these 12 patients, respectively. The two radiologists detected ankylosis and fatty metaplasia with a complete agreement and sclerosis with an almost perfect agreement. Both radiologists agreed on erosions on SI joint MRI in the same 10 cases. Radiologists did not identify acute inflammatory or structural changes on MRE in patients with a negative SI joint MRI for these lesions. CONCLUSION: Along with intestinal findings, additional reporting of acute inflammatory and structural changes of the SI joint on a MRE is valuable and may alert physicians to the presence of previously not diagnosed axial spondyloarthritis.


Assuntos
Espondiloartrite Axial , Osteíte , Sacroileíte , Humanos , Sacroileíte/diagnóstico por imagem , Sacroileíte/patologia , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/patologia , Osteíte/diagnóstico por imagem , Osteíte/patologia , Esclerose/patologia , Imageamento por Ressonância Magnética/métodos
10.
Front Immunol ; 13: 976800, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36081521

RESUMO

Objective: To determine the distribution and diagnostic value of peripheral enthesitis detected by whole-body MRI (WBMRI) in axial spondyloarthritis (axSpA) diagnosis, and to determine the value of the peripheral enthesitis score in axSpA assessment. Methods: Sixty axSpA patients [mean age of 33.2 (24.8-40.6) years] and 50 controls with chronic low back pain (LBP) [mean age of 34.7 (28.3-41.1) years] were enrolled. The gold standard was physician's comprehensive diagnosis based on current classification criteria and physical examination. All subjects underwent WBMRI, and 47 peripheral entheses were assessed for each patient with scores of 0-188. Results: WBMRI identified 155 enthesitis sites in 78.3% (n = 47) patients with axSpA. Meanwhile, 23 enthesitis sites were identified in 32% (n = 16) controls. The pelvis had the maximum number of enthesitis sites (52, 33.5%) in axSpA patients. Pelvic and anterior chest wall enthesitis had the highest sensitivity (51.67%) and specificity (100%) in axSpA diagnosis, respectively. There were different manifestations of enthesitis subtypes between axSpA patients and the control group. Osteitis was more present than soft-tissue inflammation in axSpA patients. The AUC for the number of enthesitis sites was 0.819 (95% CI 0.739-0.899), and that for the enthesitis score was 0.833 (95% CI 0.755-0.910), indicating statistically significant differences (P = 0.025). Based on the Youden index and clinical need, three enthesitis sites (sensitivity of 53.33, specificity of 98, and Youden index of 0.51) and enthesitis score (sensitivity of 58.33, specificity of 98, and Youden index of 0.56) may have the greatest value for axSpA diagnosis. Conclusion: The distribution of peripheral enthesitis can be adequately assessed by whole-body MRI, which could help diagnose axial spondyloarthritis. The enthesitis score may provide a more accurate assessment and diagnostic tool in axSpA compared with enthesitis site counting.


Assuntos
Espondiloartrite Axial , Osteíte , Espondilartrite , Espondilite Anquilosante , Adulto , Humanos , Imageamento por Ressonância Magnética , Espondilartrite/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico
11.
Int J Rheum Dis ; 25(11): 1328-1332, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35938529

RESUMO

Pachydermoperiostosis (PDP) is a rare disorder characterized by skin thickening, acropachia, and periostosis. Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is also an orphan disease featured by different dermatological and osteoarthritic manifestations. Herein, we report the first case of an adolescent male diagnosed with both PDP and SAPHO syndrome, presenting with digital clubbing, polyarthralgia, ostealgia, pachydermia and acne on his face, chest and back. Furthermore, we distinguish the characteristics of both diseases and explore the potential pathological mechanism for this coexistence in one patient. Further investigations are needed to establish the detailed pathophysiological association of these 2 diseases.


Assuntos
Acne Vulgar , Síndrome de Hiperostose Adquirida , Hiperostose , Osteíte , Osteoartropatia Hipertrófica Primária , Sinovite , Adolescente , Masculino , Humanos , Hiperostose/complicações , Hiperostose/patologia , Síndrome de Hiperostose Adquirida/complicações , Sinovite/diagnóstico , Acne Vulgar/complicações , Acne Vulgar/diagnóstico , Acne Vulgar/patologia , Doenças Raras/complicações
14.
Vaccine ; 40(33): 4922-4928, 2022 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-35690499

RESUMO

BACKGROUND: Japan amended the recommended age for the Bacille Calmette-Guérin (BCG) vaccination to less than 6 months after 2005, but subsequently amended the recommended age to 5-8 months (latest amendment, <1 year) in April 2013 due to the increasing incidence of BCG-associated osteitis/osteomyelitis since 2005. METHODS: We collected data on BCG-associated vaccine adverse events (VAEs) in the population aged <1 year between April 2013 and March 2017. The incidence of BCG-associated VAE was analyzed using census and vaccine coverage data from the government website. We compared the incidence of VAEs in patients vaccinated at less than 6 months with those vaccinated at 6 months or older. RESULTS: Among the 581 BCG-associated VAEs recorded during the study period, 354 (61%) were male, and the average age at vaccination was 5.7 months. The incidence of VAEs per million population aged <1 year at vaccination was highest for suppurative lymphadenitis (63.7), followed by skin lesions (38.4), and BCG-associated osteitis/osteomyelitis (3.1). Disseminated BCG and anaphylaxis were rare (1.1 and 1.6%, respectively). The incidence of VAEs in the population vaccinated at <6 months of age was higher for BCG-associated osteitis/osteomyelitis (3.8) and disseminated BCG (1.3) than in the population vaccinated at ≥6 months. CONCLUSIONS: The population vaccinated at <6 months of age was more likely to develop BCG-associated osteitis/osteomyelitis than the population vaccinated at ≥6 months of age, indicating that the change in the recommended vaccination age in 2013 might have contributed to the subsequent decrease in the incidence of BCG-associated osteitis/osteomyelitis.


Assuntos
Vacina BCG , Osteíte , Osteomielite , Vacina BCG/efeitos adversos , Feminino , Humanos , Incidência , Lactente , Japão/epidemiologia , Masculino , Osteíte/etiologia , Osteomielite/induzido quimicamente , Osteomielite/complicações , Vacinação/efeitos adversos
15.
Curr Opin Rheumatol ; 34(4): 209-217, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35699334

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to present the up-to-date evidence on the epidemiology, pathogenesis, musculoskeletal manifestations, and imaging of the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and to discuss its relationship with spondyloarthritis (SpA). RECENT FINDINGS: SAPHO is a rare inflammatory disorder of bone, joints, and skin, with a worldwide distribution that predominantly affects the middle-age adults. The hallmark of the syndrome is a constellation of sterile inflammatory osteitis, hyperostosis, and synovitis involving the anterior chest wall, associated with acneiform and neutrophilic dermatoses, such as palmoplantar pustulosis and severe acne. The axial skeleton, sacroiliac, and peripheral joints can be involved in a similar fashion to SpA. The pathogenesis of the syndrome is multifactorial. The diagnosis is mainly based on the clinical and typical radiological features. The treatment approach is based on the off-label use of antibiotics, bisphosphonates, disease-modifying antirheumatic drugs, and anticytokine biologics. SUMMARY: The SAPHO syndrome shares common features with SpA-related diseases, yet also shows some unique pathogenetic and clinical features. The nosology of SAPHO remains a subject of controversy, awaiting further research into the pathogenetic and clinical aspects of this syndrome. A better understanding of these aspects will improve the diagnostics and clinical care of patients with SAPHO.


Assuntos
Acne Vulgar , Síndrome de Hiperostose Adquirida , Hiperostose , Osteíte , Espondilartrite , Sinovite , Acne Vulgar/tratamento farmacológico , Acne Vulgar/etiologia , Síndrome de Hiperostose Adquirida/diagnóstico , Síndrome de Hiperostose Adquirida/tratamento farmacológico , Síndrome de Hiperostose Adquirida/patologia , Adulto , Humanos , Hiperostose/patologia , Pessoa de Meia-Idade , Osteíte/diagnóstico , Osteíte/tratamento farmacológico , Osteíte/etiologia , Espondilartrite/complicações , Espondilartrite/diagnóstico , Espondilartrite/tratamento farmacológico , Sinovite/patologia
17.
RMD Open ; 8(1)2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35580924

RESUMO

INTRODUCTION: Differentiating ankylosing spondylitis (AS) from osteitis condensans ilii (OCI) remains challenging for clinicians. The aim of this study was to determine whether Subchondral Bone Attenuation Coefficient of the SacroIliac margins (SBAC-SI) is different in AS, OCI and diffuse idiopathic skeletal hyperostosis (DISH). METHODS: A monocentric retrospective observational study was performed at the University Hospital of Besançon. Patients included were followed for AS, DISH or OCI and underwent CT scan including sacroiliac joint. Patients with tumour lesion of bone or a history of pelvic radiotherapy were excluded. AS and OCI patients were matched with a control of the same age and sex. SBAC-SI was evaluated by the sum of 24 identical circular regions of interest, 8 per slice (anterior, middle and posterior). RESULTS: Thirty AS and AS controls, 31 DISH, 29 OCI and OCI controls were included. SBAC-SI score was 9727 (±2430) in the OCI group (p<0.001), 3563 (±1860) in the AS group, 3899 (±1937) in the DISH group, 4224 (±1693) in the AS control group and 5445 (±1205) in the OCI control group. A threshold of 7500 HU had the best discriminative value between OCI and AS (youden index: 0.89). In AS, disease duration is negatively associated with SBAC-SI (r: -0.623; p<0.01) and HLA B27 is associated with lower SBAC-SI (6523 (5198; 7137) vs 2809 (1568; 3371); p<0.001). CONCLUSION: SBAC-SI is significatively different between AS and OCI and could help to distinguish these two diseases.


Assuntos
Osteíte , Espondilartrite , Espondilite Anquilosante , Antígeno HLA-B27 , Humanos , Osteíte/diagnóstico por imagem , Articulação Sacroilíaca/diagnóstico por imagem , Espondilartrite/diagnóstico , Espondilite Anquilosante/diagnóstico por imagem
18.
Unfallchirurgie (Heidelb) ; 125(6): 452-459, 2022 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-35546643

RESUMO

BACKGROUND: The surgical treatment of osteitis or fracture-related infections (FRI) is often associated with large bone defects. The treatment of these defects remains a major challenge in trauma surgery. Within the concept of tissue engineering, the development of various hybrid bone graft substitutes, such as calcium hydroxyapatite with added antibiotics, is continuously progressing. OBJECTIVE: Chances and limitations in the treatment of osteitis with calcium hydroxyapatite containing antibiotics. MATERIAL AND METHODS: Overview of the results of a 2-stage (infection) pseudarthrosis model on rat femurs treated with Cerament® G (Bonesupport, Lund, Schweden). Evaluation of the clinical experiences based on three case examples of osteitis treated with calcium hydroxyapatite containing antibiotics (Cerament® G or Cerament® V). RESULTS: After establishment of a 2­stage pseudarthrosis model on the rat femur, the osteoconductive and osteoinductive potential of calcium hydroxyapatite containing antibiotics could be confirmed. In the clinical application, the use of Cerament® G seems to lead to a more favorable outcome in small cavitary defects. The recurrence rates are higher than previously described, especially for larger segmental defects. CONCLUSION: Taking the clinical and experimental results into consideration, a stricter evaluation of the indications for the use of Cerament® G is necessary to achieve the best possible outcome for patients.


Assuntos
Substitutos Ósseos , Osteíte , Pseudoartrose , Sepse , Animais , Antibacterianos/uso terapêutico , Substitutos Ósseos/farmacologia , Durapatita/uso terapêutico , Osteíte/tratamento farmacológico , Pseudoartrose/tratamento farmacológico , Ratos , Sepse/tratamento farmacológico
19.
J Dermatol ; 49(8): 762-768, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35510638

RESUMO

Pustulotic arthro-osteitis (PAO) has been studied primarily in Japan. However, there is a lack of research regarding its clinical features among large populations in other countries and it is often believed to be similar to psoriatic arthritis (PsA). Although the association between psoriasis (PsO) and palmoplantar pustulosis (PPP) is debatable, differences in the clinical characteristics between PsA and PAO might support the notion that PsO and PPP are distinct entities. This study aimed to investigate the clinical characteristics of PAO in Korean patients and to compare them with those of PsA. We retrospectively reviewed the medical records of patients diagnosed with PPP, PAO, and PsA. Among 266 patients with PPP, 13.2% had PAO. Unlike Japanese patients with PAO, Korean patients had a relatively lower involvement of the chest wall. PAO patients demonstrated lower age of onset, higher proportion of females, and higher severity of cutaneous eruptions compared to PPP patients without PAO, but the differences were not statistically significant. Female predominance was prominent in PAO compared to PsA. Cutaneous eruptions occurred earlier than joint symptoms in 83.5% of the patients with PsA and in 42.9% of the patients with PAO. PAO involved axial joints more frequently compared to PsA, especially the chest wall and spine. PsA mainly involved the peripheral joints, especially the metacarpophalangeal joints and distal interphalangeal joints of the hands and feet. In conclusion, PAO and PsA exhibited different demographics and locations of joint involvement, supporting the notion that PPP and PsO are separate disorders. Many PAO patients presented with joint symptoms before the appearance of skin eruptions, underlining the important role of dermatologists in recognizing PAO among PPP patients. Physicians should be aware of the characteristics of PAO while treating patients with PPP.


Assuntos
Artrite Psoriásica , Exantema , Osteíte , Psoríase , Dermatopatias Vesiculobolhosas , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/epidemiologia , Feminino , Humanos , Masculino , Osteíte/diagnóstico , Psoríase/tratamento farmacológico , Estudos Retrospectivos
20.
Clin Nucl Med ; 47(9): 822-823, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35452006

RESUMO

ABSTRACT: A 37-year-old male personal trainer presented with debilitating groin pains, fever, and night sweats. Enlarged inguinal lymph nodes were noticed during physical examination, and blood tests showed elevated erythrocyte sedimentation rate and C-reactive protein. 18 F-FDG PET/CT excluded lymphoma and other malignancy but showed intense FDG uptake at the pubic symphysis and cortical erosions of the pubic bones on CT. The patient was diagnosed with osteitis pubis, an inflammatory condition of the pubic symphysis commonly seen in athletes. Treatment with anti-inflammatory drugs was initiated. Within several weeks, pain decreased, and inflammatory markers normalized.


Assuntos
Artrite , Osteíte , Esportes , Adulto , Fluordesoxiglucose F18 , Humanos , Masculino , Osteíte/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Osso Púbico/diagnóstico por imagem
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