ABSTRACT
La ultrasonografía se ha convertido en un examen muy útil para el estudio de artritis inflamatorias indiferenciadas, ya que posee mayor sensibilidad que el examen físico para detectar sinovitis y entesitis. La necesidad de realizar el diagnóstico de forma precoz, ha permitido que esta herramienta se vuelva un pilar fundamental en el enfrentamiento de estas patologías. Se presenta el caso de una paciente de 37 años que consulta por cuadro de seis meses de evolución de poliartralgias de distribución asimétrica en manos, hombros y codos. Al examen físico se detecta sinovitis en articulaciones metacarpofalángicas e interfalángicas proximales. Finalmente se solicita ultrasonografía de manos, la cual revela sinovitis activa en articulaciones interfalángicas distales. En base a esto se rescata antecedente familiar de psoriasis, se realiza HLA-B27 que resulta negativo y un TAC de sacroiliacas sugerente de sacroileítis bilateral. Por los hallazgos y el nuevo antecedente se diagnostica como Artritis Psoriática.
Ultrasonography has become a useful imaging test in the assessment of undifferentiated arthritis, due to its greater sensitivity in detecting synovitis and enthesitis in comparison with physical examination. In the need of making an early diagnosis, this exam has turn into a cornerstone when approaching certain arthritis. We present the case of a 37 years old women, with a six months history of asymmetric polyarthralgias in hands, shoulders and elbows. Synovitis is detected with physical exam in metacarpophalangeal and proximal interphalangeal joints. An ultrasonography is requested, revealing active synovitis in distal interphalangeal joints. Based on these information, the family background of psoriasis is obtained. HLA-B27 results negative and a sacroiliac CT suggests bilateral sacroiliitis. According to these findings the diagnosis of Psoriatic Arthritis is finally made.
Subject(s)
Humans , Adult , Female , Arthritis, Psoriatic , Synovitis , Arthralgia , Early DiagnosisABSTRACT
Se describe hallazgo en hombre de 22 años, asintomático, sano, de Arteria Mediana Persistente (AMP) bilateral de gran calibre asociada a un nervio median bífido (NMB) en una de las muñecas. La arteria mediana puede persistir hasta la adultez, acompañando al nervio por el túnel carpiano. Es una variante frecuente, suele ser bilateral y se asocia usualmente a NMB. La presencia de AMP puede asociarse a STC agudo secundario a trombosis y a STC crónicos por conflicto espacial. Sorprende el carácter asintomático de nuestro paciente a pesar del gran calibre de sus AMP. Sugerimos realizar, previo a cirugía o infiltración por STC, una ultrasonografía para adaptar tratamiento y evitar complicaciones.
We describe two high-caliber persistent median arteries (MPA) in an asymptomatic 22 year old healthy man, one of them between a bifid median nerve (BMN). The median artery may persist into adulthood, accompanying the median nerve through the carpal tunnel. It is a frequent anatomic variant, usually bilateral, regularly associated to BMN. The presence of MPA may be associated with acute carpal tunnel syndrome (CTS) secondary to thrombosis and chronic CTS probably due to spatial conflict. In this case, calls attention the lack of symptomatology despite the great size of MPA. We suggest performing prior to any surgery or infiltration of corticosteroids for CTS, an ultrasonographic study to avoid surgical complications.
Subject(s)
Humans , Male , Adult , Arteries/abnormalities , Arteries , Wrist , Median Nerve , Wrist/innervation , Wrist/blood supply , Median Nerve/abnormalitiesABSTRACT
Objetivo y método: Evaluar la correlación entre la electromiografía (EMG) y la ultrasonografía (US) de 19 pacientes con síndrome del túnel carpiano (STC) clínico. Resultados: Debieron ser descartados dos pacientes por presentar nervios medianos bíjidos. Se hallaron 15 nervios medianos con US alterada y18 nervios medianos con electromiografía alterada. Se encontró correlación positiva entre US y electromiografía en 12/24 túneles carpianos, y se observó una concordancia de lateralidad entre el tamaño del nervio y su alteración electrofisiológica en cinco pacientes. Se detectó sinovitis de muñeca en seis túneles carpianos (dos pacientes con artritis reumatoide, uno con osteoartritis erosiva). Conclusión: La US músculo-esquelética es una herramienta complementaria a la electromiografía en el estudio del STC en el paciente reumático, aportando información adicional con relación a la patología de base.
Objective: Compare high-resolution ultrasonography (US) and electromyography (EMG) of 19 patients with carpal tunnel syndrome (CTS) Results: Two patients were ruled out because of bifid median nerves. We found 15 median nerves with abnormal US appearance and 18 median nerve with abnormal EMG. We found a positive correlation between US and EMG in 12/24 carpal tunnels, and lateral agreement between nerve size and EMG alteration in 5 patients. Wrist synovitis was detected in six carpal tunnels (two patients with rheumatoid arthritis and one with osteoarthritis). Conclusion: Musculoskeletal ultrasound is a complementary tool to electromyography in the CTS study of rheumatologic patients, thus providing additional information in relation to the basal pathology.
Subject(s)
Humans , Female , Adult , Middle Aged , Electromyography , Carpal Tunnel Syndrome/diagnosis , Ultrasonography , Hand/innervation , Median Nerve/physiopathology , Median Nerve , Carpal Tunnel Syndrome/physiopathologyABSTRACT
The use of musculoskeletal ultrasound with power Doppler in the evaluation of arthritis has already demonstrated its importance. Its use to check steroid injections can help us improve the management of arthritis. We describe the case of a woman with rheumatoid arthritis, which was controlled using methotrexate and prednisone until 6 months ago, when she presented a persistent inflammation in the left wrist, with pain and morning stiffness. A bilateral study of the wrist with ultrasound was performed. The exploration showed erosions, joint effusion and synovial thickening in both wrists, where as Doppler signal existed only in the left wrist. Patient received a steroid injection in the left wrist and was controlled a week later, the pain disappeared without signs of activity. Despite clinical improvement, ultrasound continued showing Doppler signal in this joint. This case illustrates the clinical and ultrasound correlation before the injection. The persistence of the Doppler signal, in spite of the steroid injection and clinical improvement could be explained by either a, perhaps, too precocious control or a subclinical activity of the disease. This phenomenon could explain why asymptomatic patients present a radiological aggravation. In these cases, ultrasound with power Doppler would be an important option to optimize treatment.
Subject(s)
Humans , Female , Arthritis, Rheumatoid , Musculoskeletal System , Ultrasonography, DopplerABSTRACT
We present the case of a 60-year-old woman, without morbidity or trauma, with right elbow swelling after protein and alcohol overfeeding. Joint radiography was normal. Swelling remained refractory to anti- inflammatory therapy. A right elbow ultrasonography was made, finding a hyperechoic, irregular band over the superficial margin of the humeral cartilage, and synovitis in olecranon fossa. The study of articular liquid confirmed the presence of urate crystals. This shows that a double contour sign in cartilage using ultrasonography can be useful in the diagnosis of gout.
Subject(s)
Humans , Female , Middle Aged , Gout , Elbow , Rheumatic DiseasesABSTRACT
Behçet syndrome is a vasculitis of a unclear pathogenesis, having diverse clinical diagnosis and manifestations which compromise different organs. In this article we review some of the pathogenic and clinical elements, diagnostic criteria, activity levels and severity of the syndrome. Emphasis is placed on the angio-behçet and neuro-behçet manifestations and treatment.
Subject(s)
Humans , Behcet Syndrome/classification , Behcet Syndrome/diagnosis , Diagnosis, DifferentialABSTRACT
Background: Systemic vasculitis are a group of heterogeneous diseases characterized by inflammation and necrosis of blood vessel walls. The etiology is not known, but geographic and environmental factors are implicated. Aim: To describe the clinical features of microscopic polyangiitis (MPA) and Wegener's granulomatosis (WG) in a Chilean cohort of patients. Patients and methods: Retrospective review of the medical records of 123 patients with the diagnosis of systemic vasculitis (65 MPA and 58 WG), seen from 1990 to 2001. The diagnosis were made based on the American College of Rheumatology and Chapel Hill criteria. Results: The mean follow-up for MPA was 15 months (1-120) and for WG, 20 months (1-120). The median age (years) at diagnosis for MPA was 61 (19-82) and WG 50 (20-82). Gender distribution was similar in both groups (male: 68percent and 57percent respectively).The main clinical features in the MPA group were renal involvement (68percent), peripheral nervous system involvement (57percent), pulmonary hemorrhage (28percent), and skin disease (32percent). In the WG group were alveolar hemorrhage (62percent), renal involvement (78percent), paranasal sinus involvement (57percent), and ocular disease (26percent). In both, creatinine levels above 2.0 mg/dl were associated with a higher mortality (p< 0.01). ANCA by immunofluorescence was performed in 56 MPA patients (75percent had pANCA, 4percent had cANCA and 21percent were ANCA negative) and in 55 WG patients (17percent had pANCA, 79percent had cANCA and 4percent were ANCA negative). Global mortality was 18percent and 17percent respectively, and the most common causes of death were infections. Conclusions: The clinical features of our patients are similar to other published data. In our WG and MPA patients the main predictor for death was a serum creatinine above 2 mg/dl.
Subject(s)
Adult , Male , Humans , Female , Middle Aged , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/immunology , Granulomatosis with Polyangiitis/pathology , Polyarteritis Nodosa/complications , Polyarteritis Nodosa/immunology , Polyarteritis Nodosa/pathology , Chile , Follow-Up StudiesABSTRACT
Toxic epidermal necrolysis is a potentially fatal disease due to allergic reactions to drugs. We report on a 58 years old female, that presented Raynaud sphenomenon during 20 years. During the last year, she developed polyarthritis of hands, shoulders, knees and ankles. Rheumatoid factor (RF), antinuclear antibodies (ANA) and U_ ribonucleoprotein (U1 RNP) were present, and Mixed connective tissue disease was suspected. Because of a poor response to methotrexate the patient received leflunomide. Two weeks later, she began with fever, pruritus and generalized edema. Within days this affected her neck, thorax, eyes and oral mucous. She had bullaes and areas of epidermic detachment. A toxic epidermal necrolysis was diagnosed and treated with IV immunoglobulins. The lesions disappeared successfully. In addition to the dermatological problem, the patient later presented ocular complications that required the transplant of both corneal, with the sub-sequent loss of one of her eyes.
Subject(s)
Humans , Female , Middle Aged , Isoxazoles/toxicity , Stevens-Johnson Syndrome , Antidotes , Antirheumatic Agents/toxicity , Anaphylaxis/chemically induced , Immunoglobulins, Intravenous/therapeutic use , Isoxazoles/adverse effects , Isoxazoles/pharmacokinetics , Isoxazoles/therapeutic use , Stevens-Johnson SyndromeABSTRACT
En este trabajo se revisan y resumen los conocimientos actuales acerca de las artritis reactivas(síndrome de Reiter), artritis enteropáticas (colitis ulcerosas, enfermedad de Crohn y de Wipple) y psoriática. Todas ellas junto a la espondiloartritis anquilosante revisada anteriormente (primera parte), contituyen la familia de las pelviespondiloartritis, cuadros frecuentes, con características propias, de inicio habitual en personas jóvenes, y cuyo conocimiento y diagnóstico precoz permite prevenir secuelas no recuperables en etapas tardías
Subject(s)
Humans , Arthritis, Reactive , Arthritis, Psoriatic/diagnosis , Spondylitis, Ankylosing , Colitis, Ulcerative , Crohn Disease , Inflammatory Bowel DiseasesABSTRACT
Las artropatías inflamatorias constituyen un conjunto importante de afecciones reumatológicas, que afectan preferentemente los adultos jóvenes y entre las cuales las hay seropositivas y seronegativas. Existen entre ellas importantes similitudes tanto clínicas como patogénicas pero también considerables diferemcias. En este trabajo se presenta una revisión de los conocimientos actuales acerca de la espondiloartritis anquilosante