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Resumen Introducción: La monoartritis aguda (MA) represen ta una causa relevante de morbilidad que requiere de atención médica oportuna: El estudio del líquido sino vial constituye un elemento clave para su diagnóstico. El objetivo del estudio fue determinar la frecuencia y características clínicas-analíticas de los episodios de MA y bursitis agudas valoradas en un hospital durante un período de 6 años. Métodos: Estudio analítico retrospectivo de corte transversal en un hospital de Córdoba, Argentina. Se identificaron todos los episodios de monoartritis y bur sitis agudas que ocurrieron en pacientes de ≥18 años entre 2012 y 2017. Se excluyeron los cuadros de MA en embarazadas y las monoartritis crónicas. Resultados: Se incluyeron 180 episodios de MA y 12 de bursitis aguda. Entre las MA, 120 (66.7%) ocurrieron en hombres, la edad promedio fue 62.1±16.9 años. La principal causa de MA fue séptica, identificándose 70 (36%) casos, seguida la secundaria a microcristales con 54 episodios (28%) que correspondieron 27 (14%) a MA por gota y 27 (14%) a MA por depósitos de pirofosfato de calcio dihidratado (CPPD). Se identificaron cristales de urato monosódico en 26 (14.3%) pacientes, CPPD en 28 (15.6%) y de colesterol en 1 (0.6%). Discusión: La principal causa de MA fue séptica, seguida de la secundaria a microcristales (gota y secun daria a CPPD). La principal articulación afectada fue la rodilla, seguida del hombro. El análisis del líquido sino vial fue un elemento clave a la hora de poder realizar el diagnóstico diferencial entre las distintas causas de monoartritis aguda y bursitis.
Abstract Introduction: Acute monoarthritis (AM) represents a relevant cause of morbidity that requires prompt medical care. The study of synovial fluid becomes re levant to allow a rapid diagnostic approach. The main objective of the study was to determine the frequency and clinical-analytical characteristics of episodes of AM and acute bursitis evaluated in a hospital during a period of 6 years. Methods: Cross-sectional retrospective analytical study in a hospital at Córdoba, Argentina. All episodes of acute monoarthritis and bursitis that occurred in patients aged 18 years or older between 2012 and 2017 were included. AM in pregnant women and chronic monoarthritis were excluded. Results: One hundred and eighty episodes of AM and 12 of acute bursitis were included. Among the AM, 120 (66.7%) occurred in male patients and the average age was 62.1±16.9 years. The main cause of AM was septic, identifying 70 (36%) cases, followed by microcrystalline AM identify 54 (28%) cases, which corresponded to gout and calcium pyrophosphate dihydrate (CPPD) with 27 (14%) cases each one. Monosodium urate crystals were identified in 26 (14.3%) patients, CPPD in 28 (15.6%) and cholesterol in 1 (0.6%). Discussion: The main cause of AM was septic arthri tis, followed by microcrystalline AM (gout and secondary to CPPD). The main affected joint was the knee, followed by the shoulder. Synovial fluid analysis was a key ele ment when making the differential diagnosis between the different causes of acute monoarthritis and bursitis.
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RESUMEN Se presenta caso de varón con poliartritis crónica por depósito de uratos
ABSTRACT We presents a case of a man with chronic polyarthritis due to urate deposition.
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Resumo Introdução A frouxidão ligamentar associada ao estresse mecânico sobre a articulação trapeziometacarpiana do polegar é considerada o principal fator para predispor a rizartrose. Objetivo Avaliar o efeito do uso de uma órtese confeccionada em impressora 3D associada a um programa de reabilitação terapêutico ocupacional sobre a dor, a força de preensão e pinça de pessoas com rizartrose - estágio I e II. Método Estudo de série de casos que utilizou os instrumentos: Dinamometro Jammar®, Preston Pinch Gauge, Escala Visual Analógica da Dor e o questionário Quebec User Evaluation of Satisfaction with Assistive Technology. Os participantes foram submetidos a 14 sessões de terapia ocupacional, 2 vezes por semana e ao uso contínuo da órtese. Resultados Participaram 4 mulheres e 2 homens, casados (50%), escolaridade superior completo (50%), destros (83%), média de idade de 54,3 (DP12,01). Os resultados mostraram que a dor, medida pelo EVA, melhorou para 5 (83,3%) participantes, visto que antes do tratamento a dor variou de 3 a 10 e, após, de 0 a 6. A pinça polpa a polpa melhorou em 5 casos, a pinça trípode e a preensão palmar apresentou melhora em 4 casos e a pinça lateral melhorou em 2 casos. Todos os usuários afirmaram estar satisfeitos com a órtese e com os serviços oferecidos e destacaram: "facilidade de uso", "serviços de acompanhamento" e "conforto". Conclusão O uso da órtese confeccionada em impressora 3D associada ao tratamento terapêutico ocupacional mostrou-se eficaz no alívio da dor, na melhora da força e na satisfação dos acometidos pela rizartrose.
Abstract Introduction Ligament laxity associated with mechanical stress on the trapeziometacarpal joint of the thumb is considered the main factor to predispose to rhizarthrosis. Objective To evaluate the effect of using an orthosis made in a 3D printer associated with an occupational therapy rehabilitation program on pain, grip strength, and forceps of people with rhizarthrosis - stage I and II. Method Case series study that used the instruments: Jammar® dynamometer, Preston Pinch Gauge, Visual Analog Pain Scale, and the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire. Participants underwent 14 Occupational Therapy sessions, twice a week and continued use of the orthosis. Results 4 women and 2 men participated. They married (50%), complete higher education (50%), right-handed (83%) with a mean age of 54.3 (SD12.01). The results showed that the pain, measured by the VAS, improved for 5 (83.3%) participants since before the treatment the pain ranged from 3 to 10 and after from 0 to 6. The pulp forceps improved in 5 cases, the tripod clamp and handgrip improved in 4 cases and the lateral clamp improved in 2 cases. All users stated that they were satisfied with the orthosis and with the services offered and highlighted: "ease of use", "monitoring services" and "comfort". Conclusion The use of orthosis made in a 3D printer associated with occupational therapy treatment proved to be effective in relieving pain, improving strength, and satisfying those affected by rhizarthrosis.
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BACKGROUND: Glenoid baseplate location is important to good clinical outcomes of reverse total shoulder arthroplasty (RTSA). The glenoid vault is the determining factor for glenoid baseplate location, but, to date, there are no reports on the effect of central cage location within the glenoid vault on RTSA outcomes when using the Exactech® Equinoxe® Reverse System. The purpose of this study was to determine the appropriate cage location in relation to the glenoid vault and monitor for vault and/or cortex penetration by the cage. METHODS: Data were retrospectively collected from the Samsung Medical Center (SMC) and Seoul National University Bundang Hospital (SNUBH). Patients who underwent RTSA between November 2016 and February 2018 were enrolled. Glenoid vault depth, central cage location within the vault were examined. Inferior glenoid rim-center distance, inferior glenoid rim-cage distance, and center-cage center distances were collected. RESULTS: Twenty-two patients were enrolled. Three SNUBH patients had inappropriate central cage fixation (33.3%) versus 4 SMC patients (30.8%). All cage exposures were superior and posterior to the glenoid vault. Mean center-cage distance was 5.0 mm in the SNUBH group and 5.21 mm in the SMC group. Center-prosthesis distance was significantly longer in the inappropriate fixation group than in the appropriate fixation group (p<0.024). CONCLUSIONS: To ensure appropriate glenoid baseplate fixation within the glenoid vault, especially in a small glenoid, the surgeon should place the cage lower than usually targeted, and it should overhang the inferior glenoid rim.
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Humans , Arthroplasty , Retrospective Studies , Seoul , ShoulderABSTRACT
ABSTRACT Objective: To demonstrate whether or not there is a correlation between the risk factors for gonarthrosis and the radiographic classification of Ahlbäck. Methods: We studied patients with primary gonarthrosis attended at the knee outpatient clinic of the General Hospital of Vila Penteado during their routine visit. We collected data on patient age (years), weight (kg), height (meters), body mass index (BMI = patient weight/height2), personal history of hypertension or diabetes mellitus (positive or negative), sedentarism (physical activity less than three times per week, 30 minutes per session), functional demand (how many blocks walked weekly), time of onset of symptoms (in years) and laterality or bilaterality. The data were correlated with the Ahlbäck classification applied to the radiographs performed at the time of the consultation. Results: A sample of 108 patients was studied. We did not find an association between the Ahlbäck classification and the patient's age, smoking, sedentary lifestyle, laterality, number of blocks walked per week, diabetes mellitus, and sex; however, a positive association was observed in hypertensive patients as well as a weak correlation with height and weight of the patient and moderate correlation with BMI. Conclusion: The Ahlbäck classification is unrelated to most of the risk factors for primary gonarthrosis. Level of evidence III, Case-control study.
RESUMO Objetivo: Demonstrar se existe ou não correlação entre os fatores de risco de gonartrose e a classificação radiográfica de Ahlbäck. Métodos: Estudamos pacientes com gonartrose primária, assistidos no ambulatório de joelho do Hospital Geral de Vila Penteado em sua consulta de rotina. Foram coletados dados referentes a idade do paciente (anos), peso do paciente (kg), altura (metros), índice de massa corporal (IMC= peso do paciente/altura2), antecedente pessoal de hipertensão ou diabetes mellitus (positivo ou negativo), sedentarismo (se pratica atividade física menos de três vezes por semana, 30 minutos por sessão), demanda funcional (quantas quadras caminha semanalmente), tempo do início dos sintomas (em anos) e lateralidade ou bilateralidade. Os dados foram correlacionados com a classificação de Ahlbäck aplicada às radiografias realizadas no momento da consulta. Resultados: Uma amostra de 108 pacientes foi estudada. Não encontramos associação entre a classificação de Ahlbäck e a idade do paciente, tabagismo, sedentarismo, lateralidade, quantidade de quadras percorridas por semana, diabetes mellitus e sexo do paciente, porém verificou-se associação positiva em pacientes hipertensos e correlação fraca com altura e peso do paciente e correlação moderada com IMC. Conclusão: A classificação de Ahlbäck não apresenta relação com a maioria dos fatores de risco de gonartrose primária. Nível de evidência III, Estudo caso-controle.
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BACKGROUND: Comprehensive clinical and radiologic follow-up is needed to preserve joint functions and quality of life in hemophilia using clinimetric tools such as Hemophilia joint health score (HJHS) or Pettersson score (PS). We investigated the joint health status evaluated using the tools in Korean hemophilia patients. METHODS: We reviewed retrospectively medical records to collect clinical parameters, HJHS and PS, who were followed up in Severance Hospital, Seoul, Korea. The correlation between HJHS and PS, and the effect of the prophylaxis for hemophilia on the outcomes measured with the scores were evaluated. The prophylaxis proportion (PP) was calculated as the proportion of prophylaxis duration to each patient's life time. RESULTS: Total of 28 patients with severe hemophilia were enrolled. Twelve patients (42.8%) were less than 20 years old. Total of 23 patients had experienced prophylaxis during their lives, and median PP was 39.7%. There was significant correlation between HJHS and PS (P 20 years old. CONCLUSION: HJHS and PS were positively correlated. Each score increased as the patient's age increased. The prophylaxis had protective effect on joint health. The prospective evaluation of HJHS and PS will be needed to prove the effect of proper management on the joint health status.
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Humans , Follow-Up Studies , Health Status , Hemophilia A , Joints , Korea , Medical Records , Patient Outcome Assessment , Prospective Studies , Quality of Life , Retrospective Studies , SeoulABSTRACT
Objetivo: Desarrollar criterios para determinar las indicaciones apropiadas de la prótesis invertida de hombro en artropatías por lesión del manguito rotador y las variables determinantes de este proceso. Método: Se utilizó un panel de expertos mediante metodología RAND/UCLA con 9 expertos en Traumatología, 2 en Rehabilitación y 1 en Reumatología, que evaluaron 192 casos hipotéticos. Cada experto puntuó mediante una escala del 1 (extremadamente inadecuado) al 9 (extremadamente apropiado). Resultados: 22 casos hipotéticos fueron considerados adecuados. El dolor, limitación funcional, necesidad funcional, defecto glenoideo, edad, artrosis y posibilidad de reparación del manguito rotador son variables determinantes para indicar la implantación de una prótesis invertida de hombro. Conclusiones: El método RAND/UCLA es útil para el estudio de las indicaciones de procedimientos como la prótesis invertida de hombro, y proporciona una lista de las indicaciones adecuadas. Las variables requieren ser validadas mediante estudios prospectivos o revisión de historias clínicas(AU)
Objective: Develop criteria to determine the appropriate indications of inverted shoulder prosthesis in arthropathies due to rotator cuff injury and the variables that determine this process. Method: A panel of experts assessed 192 hypothetical cases using RAND/UCLA methodology. Nine Traumatology experts, two Rehabilitation experts and one Rheumatology expert comprised this panel. Each expert scored on a scale from 1 (extremely unsuitable) to 9 (extremely appropriate). Results: 22 hypothetical cases were considered adequate. Pain, functional limitation, functional need, glenoid defect, age, osteoarthritis and possibility of rotator cuff repair are determining as variables to indicate the implantation of an inverted shoulder prosthesis. Conclusions: The RAND/UCLA method is useful for the study of procedure indications such as the inverted shoulder prosthesis, and it provides a list of suitable indications. Prospective studies or medical record reviews should validate these variables(AU)
Objectif: Proposer les critères définissant l'indication appropriée de prothèse d'épaule inversée dans les arthropathies pour lésion de la coiffe des rotateurs, et les variables déterminant ce processus. Méthodes: Un panel d'experts, compris par 9 traumatologues, 2 kinésithérapeutes et 1 rhumatologue, a été utilisé pour évaluer 192 cas hypothétiques par la méthode RAND/UCLA. Chaque expert a fait son évaluation sur une échelle de 1 (extrêmement inapproprié) à 9 (extrêmement approprié). Résultats: Vingt-deux cas hypothétiques ont été considérés comme appropriés. Des variables telles que la douleur, la limitation fonctionnelle, la nécessité fonctionnelle, le défaut glénoïdien, l'âge, l'arthrose et la possibilité de correction de la coiffe des rotateurs, ont déterminé l'indication de prothèse d'épaule inversée. Conclusions: La méthode RAND-UCLA est utile pour l'étude des indications de procédés, tels que la prothèse d'épaule inversée, et procure une liste des indications appropriées. Il faut valider les variables avec des études prospectives ou une révision des dossiers médicaux(AU)
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Humans , Risk Factors , Rotator Cuff Injuries/etiology , Shoulder Prosthesis , Joint Diseases/surgeryABSTRACT
The green seaweed Caulerpa cupressoides var. lycopodium contains three SPs fractions (Cc-SP1, Cc-SP2 and Cc-SP3). Cc-SP1 and Cc-SP2 had anticoagulant (in vitro), pro- and antithrombotic, antinociceptive and/or anti-inflammatory (in vivo ) effects. This study analyzed structural features and the antinociceptive and anti-inflammatory effects of Cc-SP1 on zymosan-induced acute arthritis of the rat temporomandibular joint (TMJ). Cc -SP1 was investigated by infrared technique. Male Wistar rats (200-240 g) received subcutaneously (s.c.) Cc-SP1 1h prior to intra-articular (i.art.) injection of zymosan (2 mg joint -1) or saline (0.9%) into the left TMJ. Mechanical hypernociception was measured by the electronic Von Frey method in the basal and 4h after zymosan injection. Animals were euthanized 6h after zymosan injection and the TMJ cavity was removed for total leukocyte counts from the synovial fluid and myeloperoxidase (MPO) activity assessment. Cc-SP1 (1, 3 or 9 mg kg-1) containing sulfate ester, galactose-6-sulfate, uronic acid and glycosidic linkages reduced zymosan-induced hypernociception (78.12, 81.13 and 87.43%, respectively, p < 0.01), and inhibited the total leukocyte influx (85, 88.14 and 89.95%, respectively, p < 0.01), being confirmed by MPO activity (p < 0.05). Therefore, Cc-SP1 reveals a pharmacological tool for treating inflammatory arthropathies.
A alga marinha verde Caulerpa cupressoides var. lycopodium contém três frações de PSs (Cc-PS1; Cc-PS2 e Cc-PS3). Cc-PS1 e Cc-PS2 apresentaram efeitos anticoagulante (in vitro), pró- e antitrombótico, antinociceptivo e/ou anti-inflammatório (in vivo). Analisaram-se as características estruturais e os efeitos antinociceptivo e anti-inflamatório de Cc-PS1 sobre artrite aguda induzida por zimosam na articulação temporomandibular (ATM) de ratos. Foi investigada a Cc-PS1 por técnica de infravermelho. Ratos machos Wistar (200-240 g) receberam subcutaneamente (s.c.) Cc-PS1 1h antes de injeção intra-articular (i.art.) de zimosam (2 mg articulação-1) ou salina (0,9%) na ATM esquerda. A hipernocicepção mecânica foi mensurada por método Von Frey elétrico em zero e 4h após injeção de zimosam. Os animais foram entanasiados após 6h de injeção de zimosam e a cavidade da ATM foi removida para contagem de leucócitos totais do fluído sinovial e ensaio da atividade de mieloperoxidase (MPO). A Cc-PS1 (1; 3 ou 9 mg kg-1) contendo éster sulfato, galactose-6-sulfato, ácido urônico e ligações glicosídicas reduziu a hipernocicepção induzida por zimosam (78,12; 81,13 e 87,4%, respectivamente; p < 0,01), além de inibir o influxo de leucócitos totais (85; 88,14 e 89,95%, respectivamente; p < 0,01), sendo, ainda, confirmado pela atividade de MPO (p < 0,05). Portanto, a Cc-PS1 revela como uma ferramenta farmacológica para tratar de artropatias inflamatórias.
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Rats , Arthritis , Chlorophyta , Inflammation , Joint Diseases , PolymersABSTRACT
Seronegative arthropathies or spondyloarthropathy belong to a group of diseases that share clinical and genetic characteristics associated strongly with major histocompatibility complex class I HLA-B27. We report a case of a female patient of 39 years old with nightly back pain, morning stiffness and diffuse lumbar pain in the right buttock. In the immunological study observed negative rheumatoid factor and radiographic study observed right sacroiliitis. The final diagnosis is an enteric spondyloarthropathy...
Las artropatías seronegativas o espondiloartropatías corresponden a un grupo de enfermedades que comparten características clínicas y genéticas, asociadas fuertemente con el complejo mayor de histocompatibilidad clase I HLA-B27. Se presenta el caso de una paciente de 39 años con dolor lumbar nocturno, rigidez matutina lumbar y dolor difuso en la región glútea derecha.En el estudio inmunológico se observa factor reumatoídeo negativo, y al estudio radiológico se constata sacroileítis derecha. El diagnóstico final es una espondiloartropatía entérica...
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Humans , Adult , Female , Spondylarthropathies/complications , Spondylarthropathies/diagnosis , Arthritis, Reactive , Enteritis , Spondylarthropathies/therapy , Spondylitis, AnkylosingABSTRACT
La presencia de dolor y/o tumefacción a nivel de la rodilla es un motivo de consulta frecuente, ya sea en pacientes con enfermedad reumatológica definida o en la población general. Si bien la rodilla es una región accesible para el examen clínico, la ultrasonografía se ha convertido en una herramienta de gran ayuda para el reumatólogo al momento de definir el origen del dolor y/o la tumefacción, ya que permite detectar inclusive mínimas alteraciones morfoestructurales a nivel de las distintas estructuras anatómicas de la rodilla. En la práctica clínica es importante destacar la importancia de la ultrasonografía para la detección de sinovitis y entesopatía subclínicas en las artropatías inflamatorias, así como para demostrar cambios mínimos sugestivos de artropatía degenerativa y microcristalina. Por otra parte, esta técnica es de suma utilidad en la determinación del origen de los distintos síndromes regionales dolorosos y es una herramienta eficaz como guía para el intervencionismo diagnóstico y/o terapéutico. La ultrasonografía cuenta con muchas ventajas, tales como la inocuidad, el bajo costo operativo y la posibilidad de estudiar múltiples regiones en tiempo real y dinámico; sin embargo, en la actualidad, la larga curva de aprendizaje quizás sea una de sus mayores limitaciones.
The presence of knee pain and/or swelling is an important reason of attendance in rheumatologic daily practice. Although knee is an accessible region to be evaluated by the physical examination ultrasonography has been converted in an excellent and helping tool for the rheumatologists in order to establish the origin of the knee pain and/or swelling. Ultrasonography has the ability to detect subclinical synovitis and enthesopathy in patients with inflammatory arthritis and to demonstrate minimal changes indicative of degenerative or mycrocristaline arthropathies. Moreover, ultrasonography can be useful to determinate the cause of the different pain regional syndromes and is a very good option to be used as guide for the interventional arthrocentesis. Ultrasonography has several advantages as safety, low cost and the capability to study many joints in a realtime. However, at the present the large learning curve might be one of the main limitations.
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Humans , Pain/etiology , Pain , Knee/pathology , Knee , Arthritis, Rheumatoid , Joint Diseases , Spondylarthropathies , Rheumatology , UltrasonographyABSTRACT
Radiosynovectomy is a novel method of treatment for several acute and chronic inflammatory joint disorders. A small amount of a beta-emitting radionuclide is injected into the affected joint delivering a radiation dose of 70 to 100 Gy to the synovia. The proliferative tissue is destroyed, secretion of fluid and accumulation of inflammation causing cellular compounds stops and the joint surfaces become fibrosed, providing long term symptom relief. The radionuclides are injected in colloidal form so that they remain in the synovium and are not transported by lymphatic vessels causing radiation exposure to other organs. Complete reduction of knee joint swelling has been seen in above 40% and pain relief in 88% of patients. Wrist, elbow, shoulder, ankle and hip joints showed significant improvement in 50-60% and restoration of normal function and long term pain relief has been achieved in about 70% of small finger joints. In hemophilic arthropathies complete cessation of bleeding in about 60% and improved mobility in 75% of patients has been reported.