ABSTRACT
Abstract Toll-like receptor 9 (TLR9) is an important component of the innate immune system and have been associated with several autoimmune diseases, such as Systemic Lupus Erythematosus (SLE). The aim of this study was to investigate polymorphisms in TLR9 gene in a Brazilian SLE patients group and their association with clinical manifestation, particularly Jaccoud's arthropathy (JA). We analyzed DNA samples from 204 SLE patients, having a subgroup of them presenting JA (n=24). A control group (n=133) from the same city was also included. TLR9 single nucleotide polymorphisms (SNPs) (−1237 C>T and +2848 G>A) were identified by sequencing analysis. The TLR9 gene genotype frequency was similar both in SLE patients and the control group. In the whole SLE population, an association between the homozygosis of allele C at position −1237 with psychosis and anemia (p < 0.01) was found. Likewise, the homozygosis of allele G at position +2848 was associated with a discoid rash (p < 0.05). There was no association between JA and TLR9 polymorphisms. These data show that TLR9 polymorphisms do not seem to be a predisposing factor for SLE in the Brazilian population, and that SNPs are not associated with JA.
Resumo O receptor Toll-like 9 (TLR9) é um componente importante do sistema imunológico inato e tem sido associado a várias doenças autoimunes, como o Lúpus Eritematoso Sistêmico (LES). O objetivo deste estudo foi investigar polimorfismos no gene TLR9 em um grupo de pacientes brasileiros com LES e sua associação com a manifestação clínica, particularmente a artropatia de Jaccoud (JA). Foram analisadas amostras de DNA de 204 pacientes com LES, e um subgrupo com JA (n=24). Um grupo de controle (n=133) da mesma cidade também foi incluído. Os polimorfismos de nucleotídeos únicos TLR9 (SNPs) (−1237 C>T e +2848 G>A) foram identificados pela análise de sequenciamento. A frequência do genótipo genético TLR9 foi semelhante tanto em pacientes com LES quanto no grupo controle. Em toda a população de LES, foi encontrada associação entre a homozigose do alelo C na posição −1237 com psicose e anemia (p < 0,01). Da mesma forma, a homozigose do alelo G na posição +2848 foi associada a uma erupção cutânea discoide (p < 0,05). Não houve associação entre polimorfismos JA e TLR9. Esses dados mostram que os polimorfismos TLR9 não parecem ser um fator predisponível para o LES na população brasileira, e que os SNPs não estão associados ao JA.
Subject(s)
Humans , Toll-Like Receptor 9/genetics , Lupus Erythematosus, Systemic/genetics , Brazil , Pilot Projects , Genetic Predisposition to Disease/genetics , Gene Frequency/geneticsABSTRACT
ABSTRACT Objective: To describe the efficacy of using viscosupplementation in patients with hemophilic arthropathy (HA), on pain, limb functionality, and quality of life. Methods: A systematic review of the literature was performed following the PRISMA guidelines without limitations of language or year of publication. The search was performed on the following medical databases: PubMed, Cochrane Library, EMBASE, BVS/BIREME, Scopus, Web of Science, EBSCOhost, and PROQUEST in April 2020. The search used the following word: (hemophilia AND joint diseases) OR (haemophilic arthropathy OR hemophilic arthropathy) AND viscosupplementation. Results: The systematic review identified 127 articles, 10 of which were selected for data extraction and qualitative analysis. The 10 selected articles included 297 joints with HA in 177 hemophilic subjects. Our review showed positive results in alleviating pain and improving functional capacity, and quality of life. No major adverse effects were observed. Conclusion: There is a lack of scientific evidence regarding viscosupplementation with hyaluronic acid, but the results presented in this research suggest that it is an effective and safe therapeutic option to alleviate pain and improve functional capacity in patients with HA. Level of Evidence II, Systematic Review.
RESUMO Objetivo: Descrever o uso da viscossuplementação com ácido hialurônico em pacientes com artropatia hemofílica (HA), sua eficácia na dor, a funcionalidade do membro e a qualidade de vida após sua aplicação. Métodos: Revisão sistemática da literatura (RSL) que seguiu as diretrizes PRISMA, sem limitação de idioma ou ano de publicação. A pesquisa foi realizada em abril de 2020 nas seguintes bases de dados médicas: PubMed, Cochrane Library, EMBASE, BVS/BIREME, Scopus, Web of Science, EBSCOhost e ProQuest. A estratégia de pesquisa foi: (hemofilia AND joint disease) OR (artropatia hemofílica OU artropatia hemofílica) E viscossuplementação. Resultados: A RSL identificou 127 artigos, dos quais 10 foram selecionados para extração de dados e análise qualitativa. Os 10 artigos selecionados incluíram 297 articulações com AH em 177 indivíduos hemofílicos. Nossa revisão mostrou resultados positivos na melhora da dor, na capacidade funcional e na qualidade de vida. Não foram observados efeitos adversos importantes. Conclusão: A evidência científica atual a respeito da viscossuplementação com ácido hialurônico é escassa, mas os resultados apresentados nesta pesquisa sugerem que é uma opção terapêutica eficaz e segura para diminuir a dor e melhorar a capacidade funcional em pacientes com AH. Nível de Evidência II, Revisão Sistemática.
ABSTRACT
Toll-like receptor 9 (TLR9) is an important component of the innate immune system and have been associated with several autoimmune diseases, such as Systemic Lupus Erythematosus (SLE). The aim of this study was to investigate polymorphisms in TLR9 gene in a Brazilian SLE patients group and their association with clinical manifestation, particularly Jaccouds arthropathy (JA). We analyzed DNA samples from 204 SLE patients, having a subgroup of them presenting JA (n=24). A control group (n=133) from the same city was also included. TLR9 single nucleotide polymorphisms (SNPs) (−1237 C>T and +2848 G>A) were identified by sequencing analysis. The TLR9 gene genotype frequency was similar both in SLE patients and the control group. In the whole SLE population, an association between the homozygosis of allele C at position −1237 with psychosis and anemia (p < 0.01) was found. Likewise, the homozygosis of allele G at position +2848 was associated with a discoid rash (p < 0.05). There was no association between JA and TLR9 polymorphisms. These data show that TLR9 polymorphisms do not seem to be a predisposing factor for SLE in the Brazilian population, and that SNPs are not associated with JA.
O receptor Toll-like 9 (TLR9) é um componente importante do sistema imunológico inato e tem sido associado a várias doenças autoimunes, como o Lúpus Eritematoso Sistêmico (LES). O objetivo deste estudo foi investigar polimorfismos no gene TLR9 em um grupo de pacientes brasileiros com LES e sua associação com a manifestação clínica, particularmente a artropatia de Jaccoud (JA). Foram analisadas amostras de DNA de 204 pacientes com LES, e um subgrupo com JA (n=24). Um grupo de controle (n=133) da mesma cidade também foi incluído. Os polimorfismos de nucleotídeos únicos TLR9 (SNPs) (−1237 C>T e +2848 G>A) foram identificados pela análise de sequenciamento. A frequência do genótipo genético TLR9 foi semelhante tanto em pacientes com LES quanto no grupo controle. Em toda a população de LES, foi encontrada associação entre a homozigose do alelo C na posição −1237 com psicose e anemia (p < 0,01). Da mesma forma, a homozigose do alelo G na posição +2848 foi associada a uma erupção cutânea discoide (p < 0,05). Não houve associação entre polimorfismos JA e TLR9. Esses dados mostram que os polimorfismos TLR9 não parecem ser um fator predisponível para o LES na população brasileira, e que os SNPs não estão associados ao JA.
Subject(s)
Humans , Joint Diseases/genetics , Lupus Erythematosus, Systemic/genetics , Toll-Like Receptor 9/analysisABSTRACT
Abstract Toll-like receptor 9 (TLR9) is an important component of the innate immune system and have been associated with several autoimmune diseases, such as Systemic Lupus Erythematosus (SLE). The aim of this study was to investigate polymorphisms in TLR9 gene in a Brazilian SLE patients group and their association with clinical manifestation, particularly Jaccouds arthropathy (JA). We analyzed DNA samples from 204 SLE patients, having a subgroup of them presenting JA (n=24). A control group (n=133) from the same city was also included. TLR9 single nucleotide polymorphisms (SNPs) (1237 C>T and +2848 G>A) were identified by sequencing analysis. The TLR9 gene genotype frequency was similar both in SLE patients and the control group. In the whole SLE population, an association between the homozygosis of allele C at position 1237 with psychosis and anemia (p 0.01) was found. Likewise, the homozygosis of allele G at position +2848 was associated with a discoid rash (p 0.05). There was no association between JA and TLR9 polymorphisms. These data show that TLR9 polymorphisms do not seem to be a predisposing factor for SLE in the Brazilian population, and that SNPs are not associated with JA.
Resumo O receptor Toll-like 9 (TLR9) é um componente importante do sistema imunológico inato e tem sido associado a várias doenças autoimunes, como o Lúpus Eritematoso Sistêmico (LES). O objetivo deste estudo foi investigar polimorfismos no gene TLR9 em um grupo de pacientes brasileiros com LES e sua associação com a manifestação clínica, particularmente a artropatia de Jaccoud (JA). Foram analisadas amostras de DNA de 204 pacientes com LES, e um subgrupo com JA (n=24). Um grupo de controle (n=133) da mesma cidade também foi incluído. Os polimorfismos de nucleotídeos únicos TLR9 (SNPs) (1237 C>T e +2848 G>A) foram identificados pela análise de sequenciamento. A frequência do genótipo genético TLR9 foi semelhante tanto em pacientes com LES quanto no grupo controle. Em toda a população de LES, foi encontrada associação entre a homozigose do alelo C na posição 1237 com psicose e anemia (p 0,01). Da mesma forma, a homozigose do alelo G na posição +2848 foi associada a uma erupção cutânea discoide (p 0,05). Não houve associação entre polimorfismos JA e TLR9. Esses dados mostram que os polimorfismos TLR9 não parecem ser um fator predisponível para o LES na população brasileira, e que os SNPs não estão associados ao JA.
ABSTRACT
Congenital insensitivity to pain with anhidrosis (CIPA) is associated with Charcot arthropathy and is a rare clinical syndrome, with limited treatment options. Through a decade-long follow-up of a single case, we aim to provide new insights for clinicians regarding the choice of surgical strategies and postoperative complications. The diagnosed patient exhibited congenital insensitivity to pain and anhidrosis, accompanied by severe Charcot arthropathy affecting the spine. Multiple postoperative complications, including implant displacement, adjacent segment pathology, and pedicle screw loosening, occurred after surgical intervention, leading to five subsequent revision surgeries. Considering the limited experience in managing CIPA-related Charcot spinal arthropathy in the literature, surgical correction remains the preferred treatment. Among the 16 cases reviewed, common postoperative complications included implant displacement, adjacent segment pathology, and pedicle screw loosening. Based on current experience, we do not recommend extensive resection and reconstruction after removing the affected vertebral body, as this may increase the risk of implant displacement. Instead, a 360° long-segment fusion may help reduce the risk of adjacent segment degeneration. Additionally, we discuss potential reasons for revision surgery after Charcot spinal arthropathy surgery and perioperative management strategies for such cases. Meticulous care, appropriate rehabilitation exercises, and metabolic therapy for bone mineralization are crucial components of the treatment for this condition.
ABSTRACT
Abstract Objective The present study aimed to evaluate the clinical outcomes of reverse shoulder arthroplasty to treat several conditions. Methods Retrospective, longitudinal study analyzing the Constant and University of California at Los Angeles (UCLA) scores and range of motion of patients undergoing reverse shoulder arthroplasty. Results In total, 28 patients were analyzed, with a mean age of 75.6 years old. The mean duration of follow-up was 45 months. Overall, there was a significant variation (p< 0.0001) between the preoperative (10.2 points) and the postoperative UCLA scores (29.6 points), corresponding to a relative increase of approximately 200%. In addition, the mean Constant score was 67.8, and the complication rate was 17.8%. As for functional outcomes per etiology, fracture sequelae cases presented the best mean elevation (165°), Constant score (79 points), postoperative UCLA score (32.5 points), and absolute delta UCLA score increase (22 points), but with no statistical significance. However, cases operated for fracture sequelae showed significantly higher elevation (p= 0.027) and Constant score (p= 0.047) compared to rotator cuff arthropathy cases. In addition, the lowest mean postoperative Constant and UCLA scores were observed for the following etiologies: primary arthrosis, acute fracture, and arthroplasty revision. Conclusion Reverse shoulder arthroplasty showed satisfactory functional outcomes and may be a treatment option not only for rotator cuff arthropathy but for several other conditions.
Resumo Objetivo Avaliar os resultados clínicos da artroplastia reversa do ombro no tratamento de suas diversas indicações. Métodos Estudo longitudinal retrospectivo que analisou os resultados dos escores Constant, UCLA e amplitudes de movimentos dos pacientes submetidos à artroplastia reversa do ombro. Resultados Foram analisados 28 pacientes, a média de idade foi de 75.6 anos, com seguimento médio de 45 meses. No geral, obtivemos uma variação significativa (p< 0,0001) entre o escore UCLA pré-operatório (10,2 pontos) e o escore UCLA pós-operatório (29,6 pontos), o que corresponde a um aumento relativo de aproximadamente 200%. Além disso, obtivemos pontuação média do escore Constant de 67,8 e uma taxa de complicações de 17,8%. Quanto aos resultados funcionais segundo as indicações, os casos de sequela de fratura apresentaram as melhores médias de elevação (165°), escore Constant (79 pontos), escore UCLA pós-operatório (32,5 pontos) e aumento absoluto na variação do escore UCLA (22 pontos), sem significância estatística. Porém, identificou-se que os casos operados por sequela de fratura apresentaram elevação (p= 0,027) e pontuação no escore Constant (p= 0,047) significativamente maiores em relação aos casos de artropatia do manguito rotador. Além disso, observamos que as menores médias dos escores Constant e UCLA pós-operatórios foram obtidos nas seguintes etiologias: artrose primária, fratura aguda e revisão de artroplastia. Conclusão A artroplastia reversa de ombro apresentou resultados funcionais satisfatórios, podendo ser uma opção de tratamento não somente nos casos de artropatia do manguito rotador, mas também em várias outras patologias.
Subject(s)
Humans , Male , Female , Shoulder/physiopathology , Rotator Cuff Injuries , Arthroplasty, Replacement, ShoulderABSTRACT
RESUMEN Introducción: la artropatía enteropática representa una manifestación derivada de complicaciones inflamatorias intestinales. Presentación del caso: paciente de 53 años de edad, de piel blanca, femenina, que sufrió caída de sus pies, con trauma en rodilla izquierda que le ocasionó fractura de meseta tibial izquierda. Discusión: los estudios radiológicos fueron positivos y confirman el diagnóstico de la artropatía enteropática y fractura de platillos tibiales, se aplicaron pautas de tratamientos integradores funcionales. Conclusiones: con los tratamientos el paciente reportó efectos beneficiosos, se lograron los objetivos propuestos en la rehabilitación, así como la incorporación de la paciente a la sociedad con un mínimo de discapacidad e independencia.
ABSTRACT Introduction: enteropathic arthropathy represents a manifestation derived from intestinal inflammatory complications. Case presentation: 53-year-old white-skinned female patient who suffered a fall from her feet, with trauma to the left knee that caused a fracture of the left tibial plateau. Discussion: the radiological studies were positive and confirm the diagnosis of enteropathic arthropathy and tibial plateau fractures, functional integrative treatment guidelines were applied. Conclusions: with the treatments the patient reported beneficial effects, the objectives proposed in the rehabilitation were achieved, as well as the incorporation of the patient into society with a minimum of disability and independence.
RESUMO Introdução: a artropatia enteropática representa uma manifestação derivada de complicações inflamatórias intestinais. Apresentação do caso: Paciente do sexo feminino, 53 anos, branca, que sofreu queda dos pés, com trauma no joelho esquerdo que ocasionou fratura do platô tibial esquerdo. Discussão: os estudos radiológicos foram positivos e confirmam o diagnóstico de artropatia enteropática e fraturas do planalto tibial, foram aplicadas diretrizes de tratamento integrativo funcional. Conclusões: com os tratamentos o paciente relatou efeitos benéficos, os objetivos propostos na reabilitação foram alcançados, bem como a incorporação do paciente à sociedade com um mínimo de incapacidade e independência.
ABSTRACT
Resumen: Introducción: El estadio final de la artropatía de manguito (AM) genera dolor e invalidez, el tratamiento mediante artroplastía invertida (AI) muestra buenos índices de reducción de dolor y mejoras en movilidad. El objetivo de nuestro trabajo fue evaluar de manera retrospectiva los resultados a mediano plazo de la artroplastía invertida de hombro en nuestro centro. Material y método: Retrospectivamente analizamos 21 pacientes (23 prótesis) sometidos a AI con el diagnóstico de AM. La edad media fue de 75.21 años. El seguimiento mínimo fue de 60 meses. Analizamos las escalas ASES, DASH y CONSTANT preoperatorias y en la última visita de seguimiento. Se analizó la escala VAS preoperatoria y postoperatoria y rango de movilidad preoperatoria y postoperatoria. Resultados: Mejoraron todas las escalas funcionales y dolor (p < 0.001). ASES en 38.91 puntos (IC 95% 30.97-46.84); CONSTANT en 40.89 puntos (IC 95% 34.57-47.21); DASH en 52.65 puntos (IC 95% 46.31-59.0) p < 0.001; y 5.41 puntos (IC 95% 4.31-6.50) en VAS. Mejoraron con significación estadística la flexión (66.52o a 113.91o); y la abducción (63.69o a 105.85o). No obtuvimos significación estadística en rotación externa ni en rotación interna. Aparecieron complicaciones en 14 pacientes; 11 notching glenoideo, una infección crónica, una infección tardía y una fractura intraoperatoria de glenoides. Conclusiones: La AI de hombro representa una alternativa eficaz para el tratamiento de la AM. Puede esperarse alivio del dolor y una mejoría en la flexión y abducción del hombro; la ganancia en rotaciones es poco predecible.
Abstract: Introduction: The final stage of rotator cuff tear arthropathy generates pain and disability, treatment with reverse shoulder arthroplasty shows in different published studies good rates of pain reduction and improvements in mobility. the objective of our study was to retrospectively evaluate the medium-term results of inverted shoulder replacement at our center. Material and methods: Retrospectively, we analyzed 21 patients (23 prosthetics) undergoing reverse shoulder arthroplasty with the diagnosis of rotator cuff tear arthropathy. The average age of patients was 75.21 years The minimum follow-up was 60 months. We analyzed in all preoperative ASES, DASH and CONSTANT patients, and a new functional assessment was made using these same scales at the last follow-up visit. We analyzed pre and postoperative VAS as well as pre and postoperative mobility range. Results: We achieved a statistically significant improvement in all functional scale and pain values (p < 0.001). The ASES scale showed an improvement of 38.91 points (95% CI 30.97-46.84); the 40.89-point CONSTANT scale (95% 34.57-47.21) and the 52.65-point DASH scale (95% 46.31-59.0) p < 0.001. We found an improvement of 5.41 points (95% CI 4.31-6.50) on the VAS scale. We also achieved a statistically significant improvement in flexion values 66.52o to 113.91o degrees; abduction 63.69o to 105.85o degrees at the end of the follow-up. We did not get statistical significance in terms of external rotation but with a tendency to improve in the obtained values; instead in internal rotation we obtained results that showed a tendency to worsen. Complications occurred during follow-up in 14 patients; 11 in relation to notching glenoid, one patient with a chronic infection, one patient with a late infection and one intraoperative fracture of glenoid. Conclusions: Reverse shoulder arthroplasty is an effective treatment of rotator cuff arthropathy. Pain relief and improvement in shoulder flexion and abduction can be expected especially; the gain in rotations is unpredictable.
ABSTRACT
Resumen Antecedentes: La exploración articular por ultrasonido mediante el método HEAD-US en la detección de la artropatía temprana ha sido poco estudiada en nuestro país. Objetivo: Comparar la evaluación clínica y por ultrasonido de las articulaciones en niños con hemofilia. Métodos: Estudio longitudinal, prospectivo y descriptivo con pacientes pediátricos con hemofilia A y B valorados con la escala HJHS 2.1 y ultrasonido con transductor lineal de 8 a 12 MHz. Se evaluaron las articulaciones de codos, rodillas y tobillos de forma bilateral, con el método HEAD-US. Resultados: Se incluyeron 69 pacientes; de ellos, 48 con hemofilia A grave (peso: 40.1 kg). En la escala HJHS se observó mayor afectación en la rodilla izquierda (0.49) y menor en el tobillo derecho (0.05). Con la escala HEAD-US, la más afectada fue la rodilla derecha (0.78). Existe una relación significativa en la afectación de la rodilla derecha evaluada con la escala HEAD-US en presencia de inhibidor. Conclusiones: El peso superior al percentil 50 es un factor de riesgo independiente de complicaciones por sangrado articular, mientras que la edad y el tipo de hemofilia no parecen relacionados. El método HEAD-US es una herramienta útil y accesible para la detección temprana de artropatía y hemartrosis.
Abstract Background: Joint ultrasound examination using the HEAD-US method in the detection of early arthropathy is poorly studied in our country. Objective: To compare the clinical and ultrasound evaluation of the joints in haemophilia. Methods: Longitudinal, prospective and descriptive study with paediatric patients with haemophilia A and B evaluated with the HJHS 2.1 scale and ultrasound with a linear transducer of 8 to 12 MHz. Elbows, knees and ankles joints were evaluated bilaterally, with HEAD-US protocol. Results: 69 paediatric patients were included of which 48 with severe haemophilia A (weight: 40.1 kg). On the HJHS scale, a greater involvement was observed in the left knee (0.49), and less in the right ankle (0.05). With the HEAD-US scale, the most affected was the right knee (0.78). There is a significant relationship in the involvement of the right knee evaluated with the HEAD-US scale in the presence of inhibitor. Conclusions: Weight above the 50th percentile is an independent risk factor for joint bleeding complications, while age and type of haemophilia do not appear to be related. The HEAD-US method is a useful and accessible tool for early detection of arthropathy and hemarthrosis.
ABSTRACT
Abstract Background: Joint pain in the absence or with little synovitis is observed in a large percentage of HTLV-1 infected subjects. As the virus infect CD4 +and CD8 +positive, macrophages and B cells an exaggerated production of pro-inflammatory cytokines is detected in these patients. However, the possible association of HTLV-1 infection with autoimmune diseases has not been documented definitively and the clinical characteristics of HTLV-1 associated arthropathy has not been defined. The objective this study is to describe clinic and radiographic features in HTLV-1-infected individuals with complaints of joint pain. Methods: Cross-sectional study enrolling HTLV-1-infected individuals with chronic joint pain, aged up to 75 years, both genders and seronegative controls with osteoarthritis. All participants underwent conventional radiography of the hips, knees and ankles. Results: Eighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis participated in the study. Polyarticular and symmetrical arthritis prevailed in the HTLV-1 positive group (54%), while oligoarticular and asymmetrical (44%) were more common in controls ( p < 0.05). The frequency of enthesophytes (90%) in HTLV-1-infected patients was greater than in the control group (73%) ( p < 0.05). Radiographic features were similar in HTLV-1 carriers and in patients with probable or definite HTLV-1 associated myelopathy. The presence of enthesophytes in the absence of joint space reduction or osteophytes was only observed in HTLV-1-infected individuals ( p < 0.001). Magnetic resonance imaging of the ankles of five HTLV-1-infected patients and five controls demonstrated a higher frequency of enthesitis, bursitis and osteitis in the HTLV-1 infected group. Conclusion: HTLV-1-associated arthropathy is clinically characterized by symmetrical polyarthralgia and the main radiological finding is the presence of enthesophytes in the absence of osteophytes and joint space narrowing.
ABSTRACT
Objective:To explore the application of microvascular flow imaging (MVFI) combined with high-frequency ultrasonography in children with haemophilic arthropathy A (HAA).Methods:Retrospective study.A total of 82 children diagnosed with HAA in the First Affiliated Hospital of Zhengzhou University from October 2018 to October 2020 were recruited.The elbow, knee and ankle joints of each child were examined by high-frequency ultrasonography.The numbers of thickened synovial joints were recorded.Blood flow signals of the thickening of synovial joints was checked by the MVFI and power Doppler ultrasound (PDUS), respectively.Color flow signals were graded by the semi-quantitative scoring systems.The chi- square test and independent multi-group ordinal multi-category rank-sum test were used to compare the differences of MVFI and PDUS in the display of thickened synovial blood flow. Results:A total of 254 joints were involved in 82 children with HAA, including synovial hypertrophy in 188 joints, hydrops articuli in 146 joints, fibrotic septa in 66 joints, cartilage damage in 63 joints, haemosider indeposition in 45 joints, bone erosion in 25 joints, osteophytes in 15 joints and bone remodeling in 8 joints.Grade Ⅱ synovial thickened joints were the most common.The proportion of blood flow signals detected by PDUS in thickened synovial membranes was significantly higher than that detected MVFI (52.66% vs.70.21%, χ2=12.225, P<0.05). Numbers of grade 0 and Ⅰ joints with thickened synovial membranes detected by MVFI were less than those of PDUS, while the opposite result was obtained in detecting grade Ⅱ and Ⅲ joints ( H=21.158, P<0.05). Compared with PDUS, MVFI more sensitively visualized the blood flow of the thickened synovial membrane. Conclusions:MVFI can more prominently detect the thickened synovial blood flow in children with HAA.A combined application of MVFI and high-frequency ultrasonography contributes to the evaluation of children with HAA.
ABSTRACT
Hemophilic arthropathy is the most common complication of hemophilia and is also the main factor of disability in hemophilia patients. Using high-resolution musculoskeletal ultrasound examination technology, the joints of hemophilia patients can be rapidly evaluated and injury grade can be established, which can provide the basis and guidance for clinical evaluation, treatment and prognosis. Standardized ultrasound operation and scoring are very important for objective evaluation of joint condition. This paper introduces the ultrasonic examination and scoring method of hemophilic arthropathy which is suitable for the clinical needs of China in detail in order to improve the consistency of ultrasonic evaluation of hemophilia centers.
ABSTRACT
RESUMEN La artropatía gotosa es una enfermedad inflamatoria que afecta fundamentalmente a pacientes masculinos por encima de los 50 años de edad. Su principal expresión clínica desde el punto de vista articular es la presencia de un cuadro inflamatorio monoarticular de elevada sensibilidad. Cuando el diagnóstico es tardío, el tratamiento inadecuado o no existe adherencia terapéutica por parte de los pacientes, los cristales de urato monosódico se acumulan en forma de tofos gotosos que no solo afectan la función articulares, sino que generan gran discapacidad y afectación de la percepción de la calidad de vida relacionada con la salud. Se presenta la imagen poco frecuente de gran acumulación de tofos gotosos en el dorso de ambas manos que limita considerablemente la movilidad articular, la capacidad funcional y la percepción de la calidad de vida secundaria a una no adherencia farmacológica del paciente.
ABSTRACT Gouty arthropathy is an inflammatory disease that mainly affects male patients over 50 years of age. Its main clinical expression from the joint point of view is the presence of a highly sensitive monoarticular inflammatory picture. When the diagnosis is late, the treatment is inadequate or there is no therapeutic adherence by the patients, the monosodium urate crystals accumulate in the form of gouty tophi that not only affect joint function, but also cause great disability and impairment of perception quality of life related to health. The rare image of a large accumulation of gouty tophi on the back of both hands is presented, which considerably limits joint mobility, functional capacity, and the perception of quality of life secondary to the patient's pharmacological non-adherence.
ABSTRACT
RESUMEN Introducción: La artropatía hemofílica (AH) cursa con diferentes manifestaciones clínicas importantes, como son las hemorragias articulares, el dolor, la disminución de la amplitud del movimiento y las alteraciones funcionales que pueden causar secuelas en la funciona lidad y movilidad. El ejercicio físico adaptado a los pacientes con hemofilia puede ser una adecuada estrategia terapéutica, que repercuta positivamente sobre la calidad de vida de dichos sujetos. Objetivos: Evaluar la eficacia de la rehabilitación física en el tratamiento de la artropatía hemofílica. Materiales y métodos: Se ha realizado una revisión sistemática y metaánálisis de ensayos clí nicos (seleccionados según criterios de elegibilidad). Para ello, se han utilizado las siguientes bases de datos: PEDro, Pubmed, Scopus y Web of Science. Se empleó la escala «PEDro¼ para evaluar la calidad metodológica de los estudios. Resultados: Tras aplicar los criterios de inclusión y exclusión, en la revisión final fueron incluidos siete artículos, los cuales aportaron resultados favorables sobre la fuerza y el diá metro muscular, el rango de movilidad, el estado articular y la calidad de vida. De ellos, dos estudios aportaron datos para metaanálisis, con resultados favorables sobre la variable dolor [Diferencia de medias estandarizada (DME) = -2,64; IC 95%: (-4,26; 1,03)]. Conclusiones: Se encontró evidencia sobre la eficacia de la rehabilitación física en el trata miento de la artropatía hemofílica. El ejercicio terapéutico (ET) es el principal tratamiento realizado; con este se obtuvieron mejoras significativas en distintas variables físicas.
ABSTRACT Introduction: Haemophilic arthropathy presents with different important clinical disorders, such as joint disease, pain, decreased range of motion, and functional alterations that can produce limitations in functionality and mobility. The physical exercise adapted to patients with haemophilia can be an adequate therapeutic strategy, having a positive impact on the quality of life of these subjects. Objectives: To identify the published clinical trials that evaluate the efficacy of physical rehabilitation in the treatment of haemophilic arthropathy. Materials and methods: A systematic review and meta-analysis of clinical trials was con ducted (using pre-defined eligibility criteria). The literature search was performed in the databases: PEDro, Pubmed, Scopus, and Web of Science. The quality of the methods used in the studies was evaluated using the PEDro scale. Results: After applying the inclusion and exclusion criteria, 7 studies were included in this review, providing favourable results on muscle strength and circumference, range of motion, joint disease, and quality of life. Moreover, 2 articles contributed information to the meta-analysis, showing favourable results on pain [Standardised mean difference (SMD) = -2.64; 95% CI: (-4.26; 1.03)]. Conclusions: This systematic review found evidence on the efficacy of physical rehabilitation in the treatment for haemophilic arthropathy. Therapeutic exercise is the main treatment carried out, obtaining significant improvements in the different physical outcomes.
Subject(s)
Humans , Child , Middle Aged , Rehabilitation , Therapeutics , Blood Coagulation Disorders , Patient Care , Hemic and Lymphatic Diseases , Hemophilia AABSTRACT
Resumen La prevalencia global de diabetes mellitus (DM) aumenta cada año y, con ella, sus complicaciones. La afección del pie relacionada con DM se ha convertido en una de las principales causas de morbilidad y discapacidad. Los hallazgos más frecuentes son las alteraciones cutáneas y musculares, la arterioesclerosis y el edema óseo. Las complicaciones son la osteomielitis y la neuroartropatía, siendo causas importantes de amputación. El estudio imagenológico se inicia con radiografía (Rx), que permite descartar anomalías óseas y articulares, presencia de cuerpos extraños o alteraciones del tejido blando. Después de la Rx, la resonancia magnética (RM) es la modalidad de elección para la evaluación de la osteomielitis e infección de tejidos blandos del pie. Aunque esas afecciones comparten algunas características clínicas y de imagen con otros trastornos, el conocimiento de sus hallazgos distintivos permite al radiólogo contribuir al diagnóstico oportuno y correcto, con el fin de proporcionar al clínico información adecuada.
Abstract The global prevalence of Diabetes Mellitus (DM) tends to increase over the years, along with its complications. Diabetes related foot disease has become one of the leading causes of morbidity and disability. The most frequent findings are skin and muscle disorders, arteriosclerosis and bone marrow edema. Complications are osteomyelitis and neuroarthropathy, being important causes of amputation. The imaging study begins with radiography, which allows to rule out bone and joint abnormalities, presence of foreign bodies or soft tissue alterations. After radiography, magnetic resonance imaging (MRI) is the chosen modality to study osteomyelitis and soft tissue infection of the foot. Although these conditions share some clinical and imaging characteristics with other disorders, to know the distinctive findings allows the radiologist to contribute to get a timely and correct diagnosis, providing as well an appropriate information to the clinician.
ABSTRACT
RESUMEN La enfermedad de Dieterich o necrosis avascular de la cabeza de los metacarpianos es una enfermedad muy poco frecuente, con poco más de 50 casos reportados en la literatura. De etiología desconocida, clínicamente se puede manifestar de forma variable, desde asintomática hasta con evidente inflamación y limitación funcional dolorosa de la articulación metacarpofalángica afectada. Presentamos el caso de un paciente de 82 anos que presentaba dolor a nivel de la articulación metacarpofalángica del tercer dedo de la mano derecha, de un año de evolución, sin causa aparente. La exploración física no evidenciaba limitación funcional, ni dolor; tampoco se objetivó eritema, tumefacción o efecto masa. Se realizó un estudio radiológico con diagnóstico de enfermedad de Dieterich avanzada, estableciendo tratamiento conservador con antiinflamatorios no esteroideos con mejoría clínica significativa.
ABSTRACT Dieterich's disease, or avascular necrosis of the metacarpal head, is a very rare disease, with just over 50 cases reported in the literature. Of unknown aetiology, it can manifest clinically in a variable way, from asymptomatic to obvious inflammation and painful functional limitation of the affected metacarpophalangeal joint. The case is presented of an 82-yearold patient who presented with pain at the level of the metacarpophalangeal joint of the third finger of the right hand of 1 year of duration without apparent cause. The physical examination showed no functional limitation or pain. Furthermore, no erythema, swelling, or mass effect was observed. A radiological study was carried out, leading to a diagnosis of advanced Dieterich's disease. Conservative treatment was started with nonsteroidal anti-inflammatory drugs, with a significant clinical improvement.
Subject(s)
Humans , Male , Aged, 80 and over , Osteonecrosis , Disease , Rare Diseases , Diagnosis , Conservative Treatment , Head , Metacarpophalangeal JointABSTRACT
ABSTRACT Introduction: The radiosynovectomy (RS) is one treatment option for recurrent hemarthrosis in patients with hemophilia (PWH). A prospective cohort study was designed to evaluate the effects of the RS on the synovial membrane volume in the ankles and knees of PWH and patient characteristics related to the RS outcome. Methods: In a one-year follow-up, 25 joints of 22 PWH who presented 3 bleeds or more in the same joint over the last 6 months (target joints) were subjected to the RS. Two groups were compared: those who retained target joints following the RS and those who did not (less than 3 bleeds/6 months after the RS). The groups were analyzed according to age, hemophilia type/severity, joint, body mass index (BMI), inhibitor and Hemophilia Joint Health Score 2.1 (HJHS). The magnetic resonance images (MRI) of six ankles and six knees were acquired prior to, and 6 months after, the RS. The synovial membrane volume and arthropathy MRI scale were accessed and volumes were compared and correlated with the Yttrium-90 dose injected. Results: Patients with a mean age of 12 years and a mean HJHS of 6.7 (p < 0.05) retained target joints after the RS. The inhibitor, joint, type/severity of disease and BMI showed no significant differences between groups. The synovial membrane volume had a significant reduction after the RS (p = 0.03), but no correlation with the Yttrium-90 dose. In proportion to the synovial membrane volume, doses injected to the ankles were larger than those injected to the knees. Conclusion: The synovial membrane volume is reduced after the RS, regardless of the effective 90Y dose.
Subject(s)
Humans , Child , Adolescent , Adult , Synovitis , Magnetic Resonance Imaging , Synovectomy , Hemarthrosis , Hemophilia A , Joint DiseasesABSTRACT
El ataque de pie diabético es uno de los desenlaces más fatídicos para el paciente con diabetes, lo que demuestra la importancia del control en una enfermedad que avanza hasta presentar cambios macroscópicos importantes en el miembro inferior. Durante la progresión de la Diabetes, la enfermedad puede derivar en un aumento de la morbilidad e intervenciones invasivas y limitantes para el paciente, de ahí la importancia de la detección e intervención temprana y oportuna de la patología por parte del equipo médico. Estas recomendaciones van dirigida a médicos generales y especialistas en diversas ramas médicas, con el objetivo de enfatizar el cómo se debe realizar el abordaje integral del paciente con pie diabético. Abarcando la prevención, diagnóstico inicial, evaluación de la progresión de la patología, estratificación con las clasificaciones propuestas, y por último el tratamiento según el estadio en el que se encuentre el paciente. Esto con el fin de minimizar desenlaces, intervenciones y complicaciones derivadas de la progresión del pie diabetico. Hablamos de recomendaciones y no de guías debido a la ausencia en un gran número de oportunidades de evidencia científica debidamente estructurada (I y II). Tal vez lo más importante por recalcar en todas estas recomendaciones es recordarle al lector que en los casos de afectación de un pie diabético, siempre se debe tener en cuenta que el pie contralateral también ha estado sometido a la misma enfermedad durante el mismo tiempo y por lo tanto aunque no tenga síntomas se debe considerar igualmente enfermo y se debe examinar también.
Diabetic foot is one of the most fatal outcomes for patients with diabetes; the importance of control in a disease that progresses until presenting important macroscopic changes in the lower limb is absolutely relevant. Along diabetes progression, the disease can lead to increased morbidity and invasive and limiting interventions for the patient, hence the importance of early and timely detection and intervention of the pathology by the medical team. These recommendations are addressed to general practitioners and specialized faculty in various medical branches, emphasizing how a comprehensive approach to the patient with diabetic foot should be carried out. Covering prevention, initial diagnosis, evaluation of the progression of the pathology, stratification with the proposed classifications, and finally the treatment according to the stage in which the patients are, is actually well described herein in order to minimize unsatisfactory outcomes, interventions and complications derived from the progression of diabetic foot. We are talking about recommendations and not guidelines due to the absence in a large number of opportunities of properly structured scientific evidence (I and II). Perhaps, the most important thing to emphasize in all these recommendations is to remind the reader that in cases of treating a diabetic foot, it should always be kept in mind that the contralateral foot is not healthy because it has also been subjected to the same disease, for the same period of time and stressed equally as well. Therefore, even if the contralateral foot does not have symptoms, it should be considered equally ill and should be examined and treated likewise.
Subject(s)
Humans , Diabetic Foot , Diabetes Mellitus , Arthropathy, Neurogenic , Therapeutics , Ulcer , Diabetic Neuropathies , DiagnosisABSTRACT
Diabetic foot is one of the most fatal outcomes for patients with diabetes; the importance of control in a disease that progresses until presenting important macroscopic changes in the lower limb is absolutely relevant. Along diabetes progression, the disease can lead to increased morbidity and invasive and limiting interventions for the patient, hence the importance of early and timely detection and intervention of the pathology by the medical team. These recommendations are addressed to general practitioners and specialized faculty in various medical branches, emphasizing how a comprehensive approach to the patient with diabetic foot should be carried out. Covering prevention, initial diagnosis, evaluation of the progression of the pathology, stratification with the proposed classifications, and finally the treatment according to the stage in which the patients are, is actually well described herein in order to minimize unsatisfactory outcomes, interventions and complications derived from the progression of diabetic foot. We are talking about recommendations and not guidelines due to the absence in a large number of opportunities of properly structured scientific evidence (I and II). Perhaps, the most important thing to emphasize in all these recommendations is to remind the reader that in cases of treating a diabetic foot, it should always be kept in mind that the contralateral foot is not healthy because it has also been subjected to the same disease, for the same period of time and stressed equally as well. Therefore, even if the contralateral foot does not have symptoms, it should be considered equally ill and should be examined and treated likewise.
El ataque de pie diabético es uno de los desenlaces más fatídicos para el paciente con diabetes, lo que demuestra la importancia del control en una enfermedad que avanza hasta presentar cambios macroscópicos importantes en el miembro inferior. Durante la progresión de la Diabetes, la enfermedad puede derivar en un aumento de la morbilidad e intervenciones invasivas y limitantes para el paciente, de ahí la importancia de la detección e intervención temprana y oportuna de la patología por parte del equipo médico. Estas recomendaciones van dirigida a médicos generales y especialistas en diversas ramas médicas, con el objetivo de enfatizar el cómo se debe realizar el abordaje integral del paciente con pie diabético. Abarcando la prevención, diagnóstico inicial, evaluación de la progresión de la patología, estratificación con las clasificaciones propuestas, y por último el tratamiento según el estadio en el que se encuentre el paciente. Esto con el fin de minimizar desenlaces, intervenciones y complicaciones derivadas de la progresión del pie diabetico. Hablamos de recomendaciones y no de guías debido a la ausencia en un gran número de oportunidades de evidencia científica debidamente estructurada (I y II). Tal vez lo más importante por recalcar en todas estas recomendaciones es recordarle al lector que en los casos de afectación de un pie diabético, siempre se debe tener en cuenta que el pie contralateral también ha estado sometido a la misma enfermedad durante el mismo tiempo y por lo tanto aunque no tenga síntomas se debe considerar igualmente enfermo y se debe examinar también.
Subject(s)
Humans , Diabetic Foot , Therapeutics , Ulcer , Diabetic Neuropathies , Diagnosis , Joint DiseasesABSTRACT
Introduction: Epidemiological studies on hemophilia in the Brazilian population are historically scarce. Despite the continuous effort made by the National Program of Inherited Bleeding Disorders to map this condition, little information is available, especially on the period prior to program conception. Therefore, the present study aims to assess the epidemiological, serological, and clinical characteristics of patients with hemophilia in the state of Rio Grande do Sul, Brazil. Methods: A total of 455 patients had their medical records reviewed from January 1, 2003 to December 31, 2007. Results: We observed a remarkable prevalence of hepatitis C virus (HCV) infection in patients with both hemophilia A and B, and this prevalence significantly increased along with age (p < 0.001). No positive anti-HCV results were observed among children younger than 5 years old. There was a significant correlation between the severity of hemophilia and the number of arthropathies in all age categories. Considering the presence of inhibitors, a significant difference was observed between age groups, as older patients had higher inhibitor titers. There was a significant correlation between mean coagulation factor consumption and the number of arthropathies in patients over 5 years old. Conclusions: This profile analysis of patients with hemophilia reflects a gradual improvement in treatment safety and efficiency, as well as the need for continued investment in this population. (AU)