Enfrentamiento del paciente con poliartralgias y poliartritis / Patient's facing polyarthralgia and polyarthritis

El dolor articular es un motivo de consulta frecuente en la práctica clínica. La distinción del tipo de dolor, su distribución, los síntomas acompañantes, el examen físico y la evaluación de algunos exámenes de laboratorio ayudan a orientar acerca de las posibles causas y a pesquisar enfermedades graves que pueden causar destrucción articular o compromiso de otros órganos, con el fin de dar tratamiento oportuno y eficaz. En este artículo se dan algunas pautas que se pueden realizar en la consulta de Atención Primaria para distinguir cuadros de poliartralgias y poliartritis agudas y crónicas. Además, se dan nociones de algunas de las enfermedades reumatológicas más frecuentes.

Joint pain is a frequent reason for consultation in clinical practice. The distinction of the type of pain, its distribution, the accompanying symptoms, the physical examination and the evaluation of some laboratory test help to guide about the possible causes and to investigate serious diseases that can cause joint destruction or involvement other organs, in order to provide timely and effective treatment. This article gives some guidelines that can be carried out in the Primary Care consultation to distinguish acute and chronic polyarthralgia and polyarthritis. In addition, notions of some of the most frequent rheumatological diseases are given.

Dolor crónico del tobillo: banda fibrosa (Web Impingement) / Chronic ankle pain. Web impingement

Objetivo: Presentamos una serie de pacientes con dolor crónico de tobillo y estudios por imágenes negativos, en los que hallamos solamente una banda fibrosa intraarticular como causa probable del dolor en la artroscopia diagnóstica. Métodos: Entre el año 2010 y 2016 se realizaron 212 artroscopias anteriores de tobillo. En 19 pacientes (8,96%) se encontró una banda fibrosa intrarticular. En 13 pacientes se encontraban asociadas con otras patologías y solo en 6 pacientes (2,83%) fueron aisladas, sin lesión asociada. El promedio de edad fue de 40,42 años. El seguimiento promedio de 20,42 meses. La mayoría de los pacientes fueron atendidos en centros de aseguradoras de riesgo de trabajo. Resultados: Se utilizó el score AOFAS con un promedio para el preoperatorio de 55,63 y para el postoperatorio de 92.26. No hubo complicaciones en esta serie. Conclusiones: La banda fibrosa es una patología infrecuente, con sintomatología clínica similar a la de otras patologías que producen un síndrome friccional anterior de partes blandas del tobillo. La mayoría tenía antecedentes traumáticos. Los estudios por imágenes utilizados fueron la radiografía y la Resonancia. Ninguno de ellos fue de utilidad en el diagnóstico. La banda fibrosa es una de las diferentes formas de impingement en la cara anterior del tobillo y puede ser una causa de fricción y dolor. Dado que los estudios por imágenes no fueron concluyentes, la artroscopía fue nuestro método de elección para el diagnóstico y tratamiento en los pacientes con dolor crónico de tobillo con imágenes negativas. Tipo de trabajo: Serie de casos. Nivel de evidencia: IV.

Purpose: We present a series of patients with chronic anterior ankle pain and negative imaging studies, in which we found an isolated fibrous intrarticular band as a probable cause of pain in diagnostic arthroscopy. Methods: Between 2010 and 2016 we performed 212 anterior ankle arthroscopies. In 19 patients (8,96%) a fibrous web like band was found. In 13 cases they were associated with other diseases and only 6 of them (2.83 %) were isolated. Average age was 42 years. Follow up was between 4 months and 3 years (average 20.42 months). Most of them were workers compensation patients. Results: We used the AOFAS scores with an average value of 55,63 preoperative and 92.26 points postoperative. No complications were found in this series. Conclusions: Intra articular fibrous band is an infrequent pathology, with clinical presentation similar to other soft tissues anterior impingement. Most of them had previous trauma. Imaging studies performed were radiographs and MRI, but they have not proven to be useful due to their low or none sensitivity to this condition. Intra articular fibrous bands is one of the causes of anterior impingement of the ankle, and may be a cause of friction and pain. Most of them had history of previous trauma. Imaging studies were not conclusive, and arthroscopy was our election method for diagnosis and treatment in patients with chronic ankle pain and negative imaging studies. Type of study: Case series. Level Of Evidence: IV.

Prevalência de sintomas e lesões osteoarticulares em ecocardiografistas / Prevalence of symptoms and osteoarticular lesions on Brazilian echocardiographers

Síntomas y lesiones articulares y neuromusculares (SLANM) pueden ocurrir por esfuerzo repetitivo, con elevada prevalencia en técnicos en ecocardiografía. La prevalencia de los SLANM diagnosticados aun es desconocida en ecocardiografistas brasileños. Objetivo:Evaluar la prevalencia de SLANM en cardiólogos brasileños relacionada al trabajo como ecocardiografistas. Métodos: Médicos asociados al Departamento de Imagen Cardiovascular fueron invitados a responder preguntas relacionadas al perfil antropométrico, de trabajo como ecocardiografista, y SLANM. La comparación entre los participantes con (grupo 1) y sin SLANM (grupo 2) fue hecha con el test t no pareado para variables continuas y con Chi-cuadrado para categóricas. Fueron considerados significativos valores de p <0,05. Resultados: De junio de 2014 a junio de 2015, 474 respondieron el cuestionario; de esos, 311 fueron válidos; 248 (80%) fueron del grupo1 (45 ± 9,2 años; 48% mujeres) y 63 (20%), del grupo 2 (43 ± 9,8 años; 29% mujeres). En el grupo 1, el tiempo medio de aparición de los SLANM fue de 6,8 ± 5,3 años a partir del entrenamiento como ecocardiografista; 144(58%) procuraron atención; 126 (88%) requirieron tratamiento; 51 (35%) necesitaron apartamiento temporal; y 5(4%), de cirugía. Los SLANM fueron más frecuentes en los hombros y en los profesionales con más de 10 años de trabajo como ecocardiografista (65%); en el grupo 2 había menos mujeres (p = 0,009). No hubo diferencia entre los grupos en relación a las medidas antropométricas, miembro superior utilizado para el examen (p = 0,25), número de exámenes por semana(p = 0,49), o práctica de actividades físicas(p = 0,91).Conclusión:La prevalencia de SLANM en ecocardiografistas brasileños parece ser elevada. Las mujeres y los profesionales con más de 10 años de ecocardiografía parecen más susceptible.

Introduction: Joint and neuromuscular injuries and symptoms (JNIS) may occur due to repetitive strain, with high prevalence in echocardiography technicians. The prevalence of diagnosed JNIS remains unknown in Brazilian echocardiographers. Objective: Evaluate the prevalence of JNIS in Brazilian cardiologists related to their work as echocardiographers. Methods: Physicians from the Department of Cardiovascular Imaging were asked to answer a questionnaire about their anthropometric profile, their work as echocardiographers, and JNIS. Participants with JNIS (group 1) and without JNIS (group 2) were analyzed as follows: a comparison of continuous variables was made by the unpaired t-test, and a comparison of categorical variables was made by a chi-square test. P values were considered significant if <0.05. Results: From June 2014 to June 2015, 474 answered the questionnaire; of these, 311 were valid; 248 (80%) were in group 1 (45 ± 9.2 years; 48%women) and 63 (20%) in group 2 (43 ± 9.8 years; 29% women). In group 1, the mean time to the onset of JNIS was 6.8 ± 5.3 years as from the start of echocardiography training; 144 (58%) sought care; 126 (88%) required treatment; 51 (35%) required temporary leave; and 5 (4%) underwentsurgery. JNIS were more common on shoulders and in professionals with more than 10 years working as echocardiographers (65%); group 2 had fewer women (p = 0.009). There was no difference between groups in relation to anthropometric measurements; test criteria: upper limb used for the exam(p = 0.25), number of exams per week (p = 0.49), or physical activity (p = 0.91). Conclusion: The prevalence of JNIS in Brazilian echocardiographers seems to be high. Women and professionals with over 10-years’ experience in echocardiography seem more susceptible.

Test de Zohlen y su relación con el ángulo Q en población sin dolor patelofemoral / Zohlen's test and its relation to the Q angle in a population without patellofemoral pain

Determinar qué porcentaje de una población sin dolor anterior de rodilla tiene un test de Zohlen positivo, además determinar el ángulo Q de esta población y buscar si existe alguna relación entre la positividad del test de Zohlen y alteraciones en el ángulo Q. Material y método: Estudio descriptivo-prospectivo observacional. Aplicación del test de Zohlen y medición del ángulo Q. La población se dividió en 2 grupos: test de Zohlen positivo y test de Zohlen negativo. Cuantificación y comparación de medias del ángulo Q en los dos grupos. Resultados: 90 sujetos evaluados, promedio de edad 20,18 años (18-40). Veinte sujetos (22,2 por ciento) con test de Zohlen positivo. Ángulo Q promedio en los sujetos con test de Zohlen negativo: 14,95°; ángulo Q promedio en los sujetos con test de Zohlen positivo: 16,9° (p < 0,05). Ángulo Q promedio en hombres con test de Zohlen negativo 13,4°; ángulo Q promedio en hombres con test de Zohlen positivo: 16° (p < 0,05). Ángulo Q promedio en mujeres con test de Zohlen negativo: 16,5°; ángulo Q promedio en mujeres con test de Zohlen positivo: 18°, sin diferencias estadísticamente significativas entre ambos grupos. Conclusiones: El test de Zohlen tiene una correlación positiva con el ángulo Q en sujetos de sexo masculino. Dada la correlación entre un ángulo Q alterado y la presencia de dolor anterior de rodilla, en los pacientes que presentan un test de Zohlen positivo sin haber consultado por dolor anterior de rodilla, la prevención primaria de dolor anterior de rodilla puede ser de utilidad...

To determine the percentage of a population without anterior knee pain with a positive Zohlen test, and also to determine the Q angle of this population and to determine if there is any relationship between the Zohlen test and Q angle anomalies. Methods:A prospective observational study was conducted in which Zohlen¿s test was applied and the Q angle was measured. The population was divided into 2 groups: Zohlen¿s positive and Zohlen¿s negative. Q angle was compared in the 2 groups. Results: The study included 90 subjects, with a mean age 20.18 years (18-40), of whom 20 subjects (22.2 percent) had positive Zohlen¿s test. The mean Q angle in subjects with negative Zohlen¿s test was 14.95°, and the mean Q angle in subjects with positive Zohlen¿s test was 16,9° (p<.05). The mean Q angle in men with negative Zohlen¿s test was 13.4°, and the mean Q angle in men with positive Zohlen¿s test was 16° (p < .05). The mean Q angle in women with negative Zohlen¿s test was 16.5°, with a mean Q angle of 18° in women with positive Zohlen¿s test, with no statistically significant differences found between groups. Conclusions: Zohlen¿s test has a positive correlation with the Q angle in male subjects. Given the correlation between the Q angle and the presence of anterior knee pain in patients who have a positive test without symptoms, primary prevention of anterior knee pain can be achieved...

Identificação de sintomas musculoesqueléticos e articulares em estudantes de graduação em enfermagem / Identification of musculoskeletal and joint symptoms in undergraduate nursing students

Os objetivos deste estudo são: identificar sintomas musculoesqueléticos e articulares nos estudantes de graduação em Enfermagem e relacionar o surgimento ou a exacerbação dos sintomas às atividades desenvolvidas na prática assistencial hospitalar. Abordagem quantitativa, analítico, observacional do tipo caso controle com metodologia tipo Survey. Amostra composta por 127 estudantes de graduação em Enfermagem de uma Universidade pública federal na cidade do Rio de Janeiro, sendo 56 estudantes do quinto e sexto período (grupo caso) e 71 do primeiro e segundo período (grupo controle). Os resultados demonstraram um grupo homogêneo com semelhança das características sociodemográficas. Dos 127 estudantes pesquisados, 115 apontaram ter um ou mais dos sintomas musculoesqueléticos e articulares. A coluna lombar, ombros e pernas foram as regiões mais afetadas pelo grupo caso e no grupo controle foram a coluna cervical, ombros e joelhos. A dor foi o sintoma predominante em ambos os grupos. As situações agravantes dos sintomas no grupo caso foram problemas posturais, sobrecarga, estágio e estresse e no grupo controle foram a postura, sobrecarga e estresse. Dos 54 estudantes do grupo caso, 48 têm os seus sintomas agravados durante ou depois do estágio curricular, entre eles destaca-se a lombalgia. Dentre as atividades que mais colaboram para o agravamento dos sintomas estão: realizar banho no leito, mobilizar o paciente, ficar muito tempo em pé, esforço físico, ficar na mesma posição e fazer curativos. Concluiu-se que atividades de cuidado hospitalar cotidianas exacerbam os sintomas musculoesqueléticos e articulares, sendo a dor o sintoma mais frequente em estudantes de Enfermagem.

The objectives of this study are: to identify musculoskeletal and joint symptoms in undergraduate nursing students and to relate the onset or exacerbation of symptoms to activities developed in hospital care practice. Quantitative, analytical, observational case- control approach with Survey methodology. A sample of 127 undergraduate nursing students from a federal public university in the city of Rio de Janeiro, 56 students from the fifth and sixth period (case group) and 71 from the first and second period (control group). The results showed a homogeneous group with similarity of sociodemographic characteristics. Of the 127 students surveyed, 115 reported having one or more musculoskeletal and joint symptoms. The lumbar spine, shoulders and legs were the regions most affected by the case group and in the control group were the cervical spine, shoulders and knees. Pain was the predominant symptom in both groups. The aggravating situations of symptoms in the case group were postural problems, overload, stage and stress and in the control group were posture, overload and stress. Of the 54 students in the case group, 48 have their symptoms aggravated during or after the curricular internship, including low back pain. Among the activities that most contribute to the aggravation of symptoms are: bathing in the bed, mobilizing the patient, standing for a long time, physical exertion, staying in the same position and dressing. It was concluded that daily hospital care activities exacerbate musculoskeletal and joint symptoms, with pain being the most frequent symptom in nursing students.

Eficácia do piroxicam e laser de baixa potência no tratamento da artralgia da articulação temporomandibular: estudo clínico randomizado duplo-cego / Effectiveness of piroxicam and low level laser in the treatment of temporomandibular joint arthralgia: a double-blind clinical randomized trial

O presente estudo avaliou a eficácia do piroxicam associado ao laser de baixa potência (LBP) no tratamento da artralgia da articulação temporomandibular (ATM). Trinta e dois pacientes (média de idade de 32,44 anos ± 13,02) com artralgia da ATM foram selecionados e divididos em 3 grupos: LBP+piroxicam (LPi), LBP+placebo de piroxicam (L) e piroxicam+placebo de LBP (Pi). Os pacientes receberam a terapêutica por 10 dias. As avaliações foram feitas no 1º, 3º, 8º, 10º dias de tratamento e 30 dias após o término. A presença e intensidade de dor espontânea, dor à palpação e máxima abertura bucal foram mensurados. Os dados foram analisados usando os testes de Friedman e de Wilcoxon, ou ANOVA e o teste t, adotando-se p<0,05 como nível de significância. Melhoras foram encontradas para os fatores dor espontânea e dor à palpação na análise intragrupo, embora diferenças significantes não foram encontradas entre os grupos. Entretanto, na avaliação de 30 dias, o grupo Pi apresentou menor dor à palpação (p=0,01) e menor dor para o músculo temporal (p=0,02) com diferenças significantes entre os grupos. Os resultados obtidos sugerem que a associação entre LBP e piroxicam não foi mais eficaz que as terapêuticas isoladas no tratamento de artralgia da ATM, e todas as terapêuticas foram eficazes na diminuição da dor. O uso do piroxicam isolado mostrou-se mais eficaz no acompanhamento de 30 dias para dor à palpação comparado ao uso de LBP isolado.

This aim of this study was to evaluate the efficacy of piroxicam associated with low-level laser therapy (LLLT) in the treatment of arthralgia of the temporomandibular joint (TMJ). Thirty-two patients (mean age 32,44 years old ± 13,02) with TMJ arthralgia were enrolled in the study and divided into 3 groups: LLLT+ piroxicam (LPi), LLLT+placebo piroxicam (L) e piroxicam+placebo LLLT (Pi). Patients were managed for ten days. Follow-up evaluations were done at the 1st, 3rd, 8th and 10th days of treatment and 30 days after the end. The presence and intensity of spontaneous pain, pain on palpation and mandibular maximum vertical opening were measured. Data were analyzed using Friedman and Wilcoxon tests or ANOVA and t test, considering a significance level of 5%. Improvements were found for factors spontaneous pain and pain on palpation in the intragroup analysis, although no significant differences were detected among groups. However, evaluation of 30 days after the treatment showed significant differences among groups, that the group Pi had the lowest pain on palpation (p=0,01) and the lowest pain for temporal muscle (p=0,02). The obtained results suggest that the association of LLLT and piroxicam were not more effective than single therapies in the treatment of TMJ arthralgia, and all treatments were effective in decreasing pain. The use of piroxicam alone was more effective in the following 30 days for pain on palpation over the use of LBP alone.

Association between magnetic resonance imaging, temporo-mandibular joint scanographic findings and clinical manifestations of joint pain and sounds in temporo-mandibular disorders

Exploring the association between magnetic resonance imaging [MRI], temporomandibular joint [TMJ] scanography and clinical manifestations of joint pain and sounds in patients with temporomandibular [TM] disorder. This study included 62 TM joints with internal derangement. Sagittal scanography and MRI of these TMJs were obtained and reported blindly by the consensus of two radiologists. No significant association was observed between clinical and scanographic findings with MRI. The abnormal range of motion had significant relationship with pain [P=0.017] and sound [P=0.046]. There was a strong association between sound and condylar flattening [P=0.007]. It was demonstrated that joint pain and sounds were predictors of the abnormal range of motion in TMJ scanography. Sound could be heard more often in patients with condylar flattening, and TMJ scanographic findings as well as joint pain and sounds had limited value in the diagnosis of disk position or effusion

Luxação de patela em cães: estudo retrospectivo / Patellar luxation in dogs: a retrospective study

A five-year retrospective study of dogs with patellar luxation was performed. A total of 75 dogs (n=122limbs) were studied: 82.7% (n=62) had medial luxation, 14.6% (n=11) had lateral luxation, and 2.7%(n=2) had both luxations in same stifle joint. Considering the dogs with medial patellar luxation, 6.7%(n=5) were mixed-breed and 76% (n=57) were purebred, with high prevalence in Poodles (n=27; 35.6%),Pinschers (n=13; 17.3%), and Yorkshires (n=4; 5.3%). Of the dogs with lateral patellar luxation, one(1.3%) was mixed-breed and 13.3% were purebred, with high prevalence in Poodles (n=6; 8%) andPinschers (n=2; 2.7%). Regarding the 62 dogs with medial patellar luxation, 20 were unilateral and 42bilateral. Of the 11 dogs with lateral patellar luxation, five were unilateral and six bilateral. Statistically,females were more affected than males by both medial and lateral patellar luxations. The grade II (25;33.3%) of patellar luxation was the most often in medial luxation followed by grades III (20; 26.7%), IV(11; 14.7%), and I (16; 7.9%). The grade II (5; 6.7%) was the most often in lateral luxation followed bygrade I (4; 5.3%), and simultaneously grades III (1.3%) and IV (1.3%). The surgical treatment wasperformed in 64 dogs and the others were submitted a conservative management. It was possible toconclude that among the dogs with patellar luxation evaluated in this study, the most affected were toyand miniature breeds and female dogs with medial patellar luxation.

Osteoartrite / Osteoarthritis

A osteoartrite (OA) é uma desordem articular que leva ao envolvimento global da articulação (osso subcondral, ligamentos, cápsula articular, membrana sinovial e músculos periarticulares). Os desfechos clínicos e patológicos de uma variedade de eventos biológicos e mecânicos levam à falência estrutural e funcional das articulações sinoviais. É a doença articular mais prevalente e é a principal causa de dor e desabilidade em indivíduos idosos. As alterações radiográficas são praticamente universais após os 60 anos de idade, mas as queixas clínicas ocorrem em torno de 20% dos pacientes. O diagnóstico é dado pelas queixas clínicas, os achados no exame físico e as alterações radiográficas. O tratamento atual é dividido em medidas não farmacológicas e farmacológicas.

Systemic onset juvenile idiopathic arthritis--its unusual presentation.

We report a case of systemic onset juvenile idiopathic arthritis (SOJIA), the manifestations of which started with fever and skin rash followed by arthritis within neonatal age. Such presentation is extremely rare in the newborn. After exclusion of closely mimicking conditions like congenital infections, neonatal onset multisystem inflammatory disease (NOMID), neonatal; lupus erythematosus (NLE) diagnosis of SOJIA may be entertained even in a neonate where arthritis, fever and rash are the presenting features.

diagnóstico de fiebre reumática en una clínica privada de Izabal, departamento de Guatemala / diagnostic reumatic fever in clinic private of Izabal, guatemala

Objetivos. En Izabal, departamento de Guatemala se observa una alarmante cantidad de casos de Fiebre Reumática (FR), a pesar de tener una adecuada infraestructura sanitaria. Métodos. Se revisó todas las historias clínicas de pacientes atendidos en una clínica privada del lugar, se evaluó un total de 3,422 boletas de pacientes con diversas patologías...

The Effect of 2 Hz and 100 Hz Electrical Stimulation of Acupoint on Ankle Sprain in Rats

The electrical stimulation of acupoint (ESA) releases several endogenous neuropeptides, which play important roles in management of pain and inflammation. ESA with low and high frequencies has been shown to release different neuropepides, suggesting its various therapeutic effects. Pain and edema are major problems for ankle sprain. However, there have been few reports on the effects of ESA for ankle sprain. We aimed to investigate that ESA can reduce pain and edema resulting from ankle sprain, and whether there is a difference in therapeutic effects between low and high frequency ESA. To induce ankle sprain in Sprague-Dawley rats, the ankle of right hindpaw was overextended in direction of simultaneous inversion and plantar flexion. Stepping force and edema in the paw of the sprained ankle were measured by electronic balance and plethysmometer, respectively. In both 2 and 100 Hz ESA groups, stepping force was increased significantly in similar degrees (p<0.05). Only 2 Hz ESA produced the significant rapid decrease in ankle edema. This study demonstrates that ESA of 2 Hz and 100 Hz shows comparable analgesic effects, but only 2 Hz ESA can facilitate the reduction of edema caused by ankle sprain.

Manifestações articulares da febre reumática / Articular involvement in rheumatic fever

A artrite é a manifestação clínica mais freqüente, mas menos específica, da febre reumática. Alguns pacientes podem apresentar quadros articulares atípicos, diferentes da poliartrite migratória clássica descrita por Jones, o que dificulta a identificação dessa doença, principalmente quando o paciente apresenta artrite como único sinal maior.

Enfrentamiento del paciente con dolor musculoesquelético / Confrontation of patient with musculoskeletal pain

Primary musculoskeletal pain consultation is high, and physicians are faced with a number of challenges. One of these is to differentiate between diseases that present similar symptoms, some potentially serious that leave sequelae and limitations, and other that are less severe but more frequent and affect patient's everyday life. Another challenge is early diagnosis in order to avoid greater damage. In order to deal with these problems, doctors must have adequate training and skills that allow them to differentiate the origin of the pain, i,e, if the pain is articular or not, or if is origin does not stem from the muscular and skeletal system. Diagnosis must also include if manifestations are localized or generalized, axial or peripheral, inflammatory or non inflammatory, acute or chronic; if the manifestation is a mono, oligo or polyarthropathy. Together with this, physicians must be aware of the extraskeletal manifestations of rheumatic diseases, such as general manifestations or involvement of diverse systems that are fundamental when diagnosing inflammatory rheumatisms. Moreover, clinical doctors must know how to used and correctly interpret the studies of articular fluid, general and correctly interpret the studies of articular fluid, general and immunological laboratory, and images, always oriented to the patient's clinical manifestation. Once these parameters have been defined, they must be syndromatically sorted in order to prepare a specific diagnosis and consequently offer the patient the most adequate pharmacological and non pharmacological treatment for each case.

Arthroscopic evaluation of refractory knee pain.

The aim of this study was to evaluate the conditions of the articular cartilage and other intra-articular structures in patients with refractory knee pain. A total of 50 patients were taken up for this study based on specific inclusion criteria. Arthroscopy was done using a 30 degrees scope and was introduced most commonly via anterolateral approach after a thorough clinical and radiological evaluation of the affected joint. It was observed that majority (76%) had grade I articular lesion and 10% had grade IV lesion. Arthroscopically 78% of the patients had a meniscal tear while 12% had cyst of lateral meniscus while clinically, meniscal tear was present in 22% of the cases and cyst in 2% cases only. Arthroscopy also detects other intra-articular lesions, which are missed clinically, thus modifying further management of the patient.

Osteonecrosis en pacientes infectados por HIV / Osteonecrosis in HIV-infected patients

Según la literatura, la osteonecrosis tiene una mayor incidencia en los pacientes infectados con HIV que en la población general. Ello sería resultado de la confluencia de factores de riesgo clásicos y de otros propios de esta población o más prevalentes en ella, como el tratamiento con inhibidores de proteasa, la dislepemia producto de su consumo, la presencia de anticuerpos anticardiolipina séricos, la hipercoagulabilidad, la restauración inmune y las vasculitis. Presentamos una serie de 13 pacientes infectados con HIV con osteonecrosis. El motivo de consulta fue dolor en grandes articulaciones. Cuatro eran alcoholistas, 8 tabaquistas y 9 tenían dislipemia. Once habían recibido esteroides en algún momento de la vida aunque sólo uno estaba reciciéndolos al momento de inicio del dolor. En 2 se detectaron anticuerpos anticardiolipina séricos. Doce tenían sida y recebían tratamiento antirretroviral de alta eficacia (11 con inhibidores de proteasa). Ellos lograron una adecuada recuperacíon inmunológica. Consideramos necesario incluir la osteonecrosis como diagnóstico diferencial de artralgia persistente en pacientes infectados con HIV e investigar infección por HIV en todo paciente con osteonecrosis sin claros factores predisponentes.

Acute Calcific Periarthritis of Proximal Interphalangeal Joint in a Professional Golfer's Hand

This report describes a 22-yr-old professional golfer with acute calcific periarthritis of the proximal interphalangeal joint of the 4th finger. We considered that the major cause for this condition may be the repeated minor traumas to the affected site. Also, since this condition is self-limiting, a correct diagnosis is required to avoid unnecessary tests and surgery.