Bilateral uveitis in silent ulcerative colitis: case report

Silent or subclinical inflammatory bowel diseases (IBD) is a relatively new term that has been used to describe individuals with asymptomatic active mucosal bowel inflammation, often unaware of their disease due to either the lack of or mild inflammatory symptoms. These patients are at risk for gastrointestinal and extra-gastrointestinal manifestations, with more advanced complications. In this article we intend to describe a case report of a patient with chronic history of many organ involvements including ocular, skin, and musculoskeletal, which was later placed under the umbrella of silent ulcerative colitis. (AU)

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.

Oligoartritis, paniculitis y pioderma gangrenoso como manifestaciones de un Linfoma no Hodgkin / Oligoarthritis, panniculitis and pyoderma gangrenosum associated with non-Hodgkin lymphoma: report of one case

An assortment of clinical and laboratory abnormalities may occur as paraneoplastic syndromes in lymphomas. Rheumatological and dermatological manifestations such as paraneoplastic arthritis and pyoderma gangrenosum must be underscored. We report a 28 years old woman who developed pyoderma gangrenosum and two years later presented with arthritis of knees and ankles associated with panniculitis interpreted as erythema induratum that was pathologically confirmed. She developed a reactivation of pyoderma gangrenosum, that was refractory to treatment. Complementary studies showed a pulmonary nodule and a right paravertebral mass with involvement of the psoas muscle. Biopsies of both masses and a new pathological skin study demonstrated a large B-cell non-Hodgkin's lymphoma.

Clinical and immunological characteristics of patients with systemic lupus erythematosus in Tibet plateau, China / 北京大学学报(医学版)

OBJECTIVE@#To describe the clinical, immunological characteristics and organ involvement of patients with systemic lupus erythematosus (SLE) in Tibet plateau, China.@*METHODS@#We retrospectively investigated 70 patients admitted in the Tibet Autonomous Region People's Hospital between May 2014 and April 2016. In the study, 120 hospitalized patients with SLE from the Department of Rheumatology and Immunology of the Peking University People's Hospital were randomly selected as the control (plain) group. The major organ involvement, clinical and immunological characteristics were compared between the two groups.@*RESULTS@#The female to male ratio of Tibet plateau group was 10.7, while the corresponding ratio of plain group was 11.0. The mean age at disease diagnosis was (32.21±11.40) and (35.38±13.25) years, respectively. the most common initial manifestations of SLE were arthritis (78.6%), alopecia (55.7%) and malar rash (48.6%) in Tibet plateau group, the prevalence of arthritis and alopecia was significantly higher than in plain group (P<0.05). The incidence of neuropsychiatric and kidney involvement was significantly lower in Tibet plateau group compared with plain group (P<0.05). As for the serological manifestations, the positivity of anti-double-stranded DNA (dsDNA) (57.1%), anti-Smith (Sm) antibody (55.7%), anti-Sjögren syndrome A (SSA) antibody (72.3%), anti-Sjögren syndrome B (SSB) antibody (41.4%) and anti-u1-ribosenuclear protein (u1RNP) antibody (45.7%) was significantly higher in Tibet plateau group (P<0.05). While the incidence of low serum complement C3 (61.4%), C4 (38.6%) less frequent in Tibet plateau group. Mean SLE disease activity index (SLEDAI) score was similar in the Tibet plateau group (12.18±5.58) and plain group (12.69±7.28). Moreover, there were 13 (18.6%) SLE patients suffering from tuberculosis and 7 (10%) SLE patients infected with hepatitis B virus in Tibet plateau group. The number of recent-onset SLE patients with lower 25-dihydroxy-vitamin D3 (25-OH-VD3) in Tibet plateau group was fewer than that in the plain group (76.7% vs. 90.0%, P=0.046). Serum 25-OH-VD3 levels in Tibet plateau plateau group were (31.14±18.74) nmol/L, those in plain group were (26.91±14.27) nmol/L, and the difference was not significant.@*CONCLUSION@#The age, gender and SLEDAI scores in Tibet plateau group was similar to those in plain group. But there are significant differences in clinical manifestations, distributions of antibodies and immunological changes between Tibet plateau group and plain group. The patients with lower serum 25-OH-VD3 levels were more in plain group than in Tibet plateau group, while there was no significant difference in the 25-OH-VD3 level between the two groups.

Poliartritis agudas virales / Viral acute polyarthritis

Las poliartritis agudas son cuadros de menos seis semanas de duración, cuyas causas pueden o no ser infecciosas. Entre las primeras, destacan las virales, con gran varie-dad de agentes causales. Entre ellos se distinguen por su frecuencia: virus hepatitis B,virus hepatitis C, parvovirus B19, virus rubéola y la fiebre Chicungunya. Tienen elementos comunes, como su expresión poliarticular, generalmente simétrica, con predilección por las pequeñas articulaciones de las manos, siendo habitualmente autolimitadas. A su vez, poseen elementos propios, clínicos y de laboratorio, que permiten diferenciarlos, teniendo algunos una evolución más agresiva con morbilidad más significativa. A su vez, por sus características clínicas y de laboratorio, plantean el diagnóstico diferencial con enfermedades inmunoreumatológicas, como la artritis reumatoidea y el lupus eritematoso sistémico, entre otras.Se realiza una revisión del cuadro clínico y de laboratorio de las poliartritis causadas por los virus señalados, su diagnóstico diferencial y posibilidades terapéuticas.

The acute polyarthritis are pictures of less six weeks duration, whose causes can be or not to be infectious. Among the first, the viral ones stand out with a variety of causal agents. Among there distinguished by their frequency: virus hepatitis B, hepatitis C virus, parvovirus B19, rubella virus and the fever Chicungunya. They have common elements, such as his expression polyarticular, usually symmetrical, with a predilection for the small joints of the hands, being usually self-limiting. At the same time, they have own laboratory and clinical elements that allow differentiation, some having a more aggressive evolution with more significant morbidity. At the same time, for its clinical and laboratory characteristics, raise the differential diagnosis of immunohematological diseases, such as arthritis rheumatoid and systemic lupus erythematosus among others.Is done a review of clinical and laboratory of the polyarthritis caused by the mentioned viruses, differential diagnosis and therapeutic possibilities.

Monoartritis del codo e infarto óseo como presentación inicial de enfermedad linfoproliferativa / Elbow monoarthritis and bone infarction as a form of presentation of B cell lymphoma: case report

We report a 68-year-old woman presenting with pain and swelling in her left elbow. An elbow magnetic resonance with gadolinium evidenced bone marrow infiltration and a bone infarct. Given these findings, a body CT scan was performed which showed multiple mesenteric adenopathies and a large retroperitoneal mass. A lymph node biopsy confirmed a B cell lymphoma. Monoarthritis with no systemic manifestations represents a highly uncommon form of presentation of lymphoma. Moreover it usually affects inferior limbs, particularly in the presence of bone infarction.

Chronic polyarthritis as the first manifestation of childhood systemic polyarteritis nodosa / Poliartrite crônica como primeira manifestação de poliarterite nodosa sistêmica pediátrica

ABSTRACT Arthritis has been reported as an acute pattern, generally evanescent with oligoarthritis, mostly affecting knees and ankles in childhood systemic polyarteritis nodosa. However, chronic polyarthritis with morning stiffness mimicking juvenile idiopathic arthritis has not been reported. We describe the case of a 4-year old girl who had additive and chronic polyarthritis with edema, tenderness, pain on motion and morning stiffness for 2 months. After 45 days, she also presented painful subcutaneous nodules and erythematous-violaceous lesions in the extensor region of upper and lower limbs. She was admitted to university hospital due to high fever, malaise, myalgia, anorexia, loss of weight (1kg), painful skin lesions and severe functional disability. She was bedridden by chronic polyarthritis with limitation on motion. Systolic and diastolic blood pressures were greater than 95th percentile for height. Urine protein/creatinine ratio was 0.39g/day, and immunological tests were negative. Anti-streptolysin O was 1,687UI/mL. Skin biopsy revealed necrotizing vasculitis in medium- and small-sized vessels compatible with polyarteritis nodosa. Therefore, we had the diagnosis of systemic polyarteritis nodosa. Prednisone 2mg/kg/day was administered with complete resolution of skin lesions and arthritis, and improvement of proteinuria (0.26g/day) after 15 days. The diagnosis of childhood systemic polyarteritis nodosa should be considered for patients with chronic polyarthritis associated to cutaneous vasculitis triggered by streptococcal infection.

RESUMO Na poliarterite nodosa sistêmica pediátrica, a artrite caracteriza-se pelo padrão agudo, geralmente evanescente, com oligoartrite, e afeta principalmente joelhos e tornozelos. No entanto, a poliartrite crônica com rigidez matinal e simulando artrite idiopática juvenil ainda não foi relatada. Descrevemos o caso de uma menina de 4 anos que apresentou poliartrite crônica aditiva com edema, dor à palpação e movimento, e rigidez matinal por 2 meses. Após 45 dias, também apresentou nódulos subcutâneos dolorosos e lesões eritêmato-violáceas na região extensora dos membros superiores e inferiores. Foi internada no hospital universitário por conta de febre alta, mal-estar, mialgia, anorexia, perda de peso (1kg), lesões de pele muito dolorosas e incapacidade funcional grave. Estava restrita ao leito devido à poliartrite crônica com limitação do movimento. Pressões sistólica e diastólica foram maiores que percentil 95 para altura. Relação proteína/creatinina urinária estava 0,39g/dia, e os testes imunológicos foram negativos. Antiestreptolisina O era 1.687UI/mL. A biópsia de pele revelou vasculite necrosante de vasos de pequeno e médio calibre, compatível com poliarterite nodosa. Portanto, foi realizado o diagnóstico de poliarterite nodosa sistêmica. Foi administrada prednisona 2mg/kg/dia com resolução completa das lesões de pele e da artrite, além de melhora da proteinúria (0,26g/dia) após 15 dias. O diagnóstico de poliarterite nodosa sistêmica pediátrica deve ser considerado em pacientes com poliartrite crônica associado a lesões cutâneas vasculíticas, sendo a infecção estreptocócica um importante fator desencadeante.

Manifestações articulares atípicas em pacientes com febre reumática / Articular manifestations in patients with atypical rheumatic fever

Objetivos: Descrever as características clínicas e a ocorrência de artrite atípica em crianças com diagnóstico de febre reumática (FR) acompanhadas em ambulatórios terciários em Salvador, Bahia. Metodologia: Estudo descritivo, de uma série de casos, do quadro clínico inicial ou recorrência de 41 crianças com diagnóstico de FR. Resultados: Dos pacientes estudados (n=41), 61% eram do sexo masculino; com média de idade de 9,2 anos e idade no momento do diagnóstico entre 5 e 16 anos. Artrite esteve presente em 75,6% dos pacientes; cardite em 75,6%; coreia em 31,7%; eritema marginado em 14,6% e nódulos subcutâneos em 4,9%. Um padrão atípico foi observado em 22 dos 31 casos com artrite (70,9%): envolvimento de pequenas articulações e/ou esqueleto axial em 12 casos (38,7%); duração maior que três semanas em nove (29%); resposta inadequada ao AINH em dois (6,5%); oligoartrite (≤ quatro articulações) em 22/31 (71%), sendo monoartrite em 6/31 (uma em pés, uma em tornozelo e quatro em joelho). A febre esteve presente em 78% dos casos e 82,9% dos pacientes utilizavam a profilaxia secundária de forma regular. Conclusão: Artrite atípica esteve presente na maioria dos pacientes que cursaram com acometimento articular, constituindo um fator de confundimento diagnóstico e atraso terapêutico adequado. .

Objectives: To describe the clinical characteristics and the occurrence of atypical arthritis in children diagnosed with rheumatic fever (RF) and followed in tertiary care clinics in Salvador, Bahia, Brazil. Methodology: A descriptive study of a case series, of the initial clinical presentation, and of recurrence in 41 children diagnosed with RF. Results: Of the patients studied (n=41), 61% were male, mean age of 9.2 years, and mean age at diagnosis between 5 and 16 years. Arthritis was present in 75.6% of patients; carditis in 75.6%; chorea in 31.7%; erythema marginatum in 14.6%; and subcutaneous nodules in 4.9%. An atypical pattern was observed in 22 of 31 cases of arthritis (70.9%): involvement of small joints and/or axial skeleton in 12 cases (38.7%); >3 weeks of duration in 9 (29%); inadequate response to NSAIDs in 2 (6.5%); oligoarthritis (≤4 joints) in 22/31 (71%), with monoarthritis in 6/31 (1 in the foot, 1 in the ankle, and 4 in the knee). Fever was present in 78% of the cases, and 82.9% of patients were regularly on secondary prophylaxis. Conclusion: Atypical arthritis was present in most patients presenting with joint involvement, being a confounding factor against a proper diagnosis and of therapeutic delay. .

Artrite enteropática no Brasil: dados do registro brasileiro de espondiloartrites / Enteropathic arthritis in Brazil: data from the brazilian registry of spondyloarthritis

As doenças inflamatórias intestinais (doença de Crohn e retocolite ulcerativa) apresentam manifestações extraintestinais em um quarto dos pacientes, sendo a mais comum a artrite enteropática. MÉTODOS: Estudo prospectivo, observacional e multicêntrico, realizado com pacientes de 29 centros de referência participantes do Registro Brasileiro de Espondiloartrites (RBE), que se incorpora ao grupo RESPONDIA (Registro Ibero-americano de Espondiloartrites). Dados demográficos e clínicos de 1472 pacientes foram colhidos, e aplicaram-se questionários padronizados de avaliação de mobilidade axial, de qualidade de vida, de envolvimento entesítico, de atividade de doença e de capacidade funcional. Exames laboratoriais e radiográficos foram realizados. Objetivamos, neste presente artigo, comparar as características clínicas, epidemiológicas, genéticas, imagenológicas, de tratamento e prognóstico de enteroartríticos com os outros espondiloartríticos nesta grande coorte brasileira. RESULTADOS: Foram classificados como enteroartrite 3,2% dos pacientes, sendo que 2,5% tinham espondilite e 0,7%, artrite (predomínio periférico). O subgrupo de indivíduos com enteroartrite apresentava maior prevalência de mulheres (P < 0,001), menor incidência de dor axial inflamatória (P < 0,001) e de entesite (P = 0,004). O HLA-B27 foi menos frequente no grupo de enteroartríticos (P = 0,001), mesmo se considerado apenas aqueles com a forma axial pura. Houve menor prevalência de sacroiliíte radiológica (P = 0,009) e também menor escore radiográfico (BASRI) (P = 0,006) quando comparado aos pacientes com as demais espondiloartrites. Também fizeram mais uso de corticosteroides (P < 0,001) e sulfassalasina (P < 0,001) e menor uso de anti-inflamatórios não hormonais (P < 0,001) e metotrexato (P = 0,001). CONCLUSÃO: Foram encontradas diferenças entre as enteroartrites e as demais espondiloartrites, principalmente maior prevalência do sexo feminino, menor frequência do HLA-B27, associados a uma menor gravidade do acometimento axial.

Inflammatory bowel diseases (Crohn's disease and ulcerative rectocolitis) have extraintestinal manifestations 25% of the patients, with the most common one being the enteropathic arthritis. METHODS: Prospective, observational, multicenter study with patients from 29 reference centers participating in the Brazilian Registry of Spondyloarthritis (RBE), which incorporates the RESPONDIA (Ibero-American Registry of Spondyloarthritis) group. Demographic and clinical data were collected from 1472 patients and standardized questionnaires for the assessment of axial mobility, quality of life, enthesitic involvement, disease activity and functional capacity were applied. Laboratory and radiographic examinations were performed. The aim of this study is to compare the clinical, epidemiological, genetic, imaging, treatment and prognosis characteristics of patients with enteropathic arthritis with other types of spondyloarthritis in a large Brazilian cohort. RESULTS: A total of 3.2% of patients were classified as having enteroarthritis, 2.5% had spondylitis and 0.7%, arthritis (peripheral predominance). The subgroup of individuals with enteroarthritis had a higher prevalence in women (P < 0.001), lower incidence of inflammatory axial pain (P < 0.001) and enthesitis (P = 0.004). HLA-B27 was less frequent in the group with enteroarthritis (P = 0.001), even when considering only those with the pure axial form. There was a lower prevalence of radiographic sacroiliitis (P = 0.009) and lower radiographic score (BASRI) (P = 0.006) when compared to patients with other types of spondyloarthritis. They also used more corticosteroids (P < 0.001) and sulfasalazine (P < 0.001) and less non-steroidal anti-inflammatory drugs (P < 0.001) and methotrexate (P = 0.001). CONCLUSION: There were differences between patients with enteroarthritis and other types of spondyloarthritis, especially higher prevalence of females, lower frequency of HLA-B27, associated with less severe axial involvement.

Empleo de la medicina nuclear y las técnicas de imágenes en las afecciones del sistema óseo / Emploi de la médicine nucléaire et des techniques par image dans les affections du système osseux / Use of nuclear medicine and imaging techniques in disorders of the bone system

La medicina nuclear es la especialidad médica que se ocupa del diagnóstico, tratamiento e investigación médica mediante el uso de radioisótopos como fuentes abiertas. A menudo, las personas presentan diferentes condiciones patológicas óseas como la osteoporosis, el cáncer de hueso primario, las metástasis óseas, la artrosis y la artritis. Como objetivo de esta revisión se presentaron estadísticas internacionales y nacionales, y se evaluó la incidencia de esas afecciones. Además, se identificaron los radiofármacos más empleados en la actualidad para el diagnóstico y tratamiento de las enfermedades óseas, así como el uso combinado con las técnicas de imagen más utilizadas mediante la revisión de diferentes estudios clínicos. Se expuso la utilidad de la gammagrafía ósea para el diagnóstico y la confirmación de las afecciones estudiadas. Igualmente, se presentó el empleo de nuevas técnicas como las tomografías por emisión de fotón único o por emisión de positrones. Se observó que el radioisótopo más empleado para el diagnóstico de enfermedades del sistema óseo es el 99mTc por sus características físicas y químicas, mientras que para terapia se emplean 186Re, 188Re, 153Sm, 177Lu, 32P, 89Sr, 85Sr, 117mSn, según el tipo, ubicación y magnitud de las lesiones y la disponibilidad del radioisótopo. En la actualidad, el desarrollo de los radiofármacos se ha centrado en la combinación de estos radioisótopos con diferentes biomoléculas para mejorar sus propiedades y ampliar su campo de aplicaciones(AU)

Nuclear medicine is the medical specialty that deals with clinical diagnosis, treatment and research through the use of isotopes as open sources. Bone diseases such as osteoporosis, primary bone cancer, bone metastases, arthrosis and arthritis are common among the population. The objective of this review was to present international and national statistics, and evaluate the incidence of these disorders. Additionally, a review was conducted of various clinical studies to identify the radiopharmaceuticals most frequently used to diagnose and treat bone disease, and their combination with the most common imaging techniques. A presentation was made of the usefulness of bone gammagraphy and the confirmation of the disorders studied. Reference was also made to the use of new techniques such as single photon emission tomography or positron emission tomography. It was found that the radioisotope most commonly used to diagnose diseases of the bone system was 99mTc, due to its physical and chemical characteristics, whereas 186Re, 188Re, 153Sm, 177Lu, 32P, 89Sr, 85Sr, 117mSn are used for therapeutic purposes, depending on the type, location and magnitude of the lesions and the availability of the radioisotope. At present, radiopharmaceutical development centers on combining these radioisotopes with various biomolecules to improve their properties and broaden their field of application(A)

La médecine nucléaire est la spécialité médicale s'occupant du diagnostic, du traitement et de la recherche médicale au moyen de radioisotopes comme sources ouvertes. Les personnes sont souvent touchées par différentes conditions pathologiques osseuses telles que l'ostéoporose, le cancer d'os primaire, les métastases osseuses, l'arthrose, et l'arthrite. Le but de cette révision est de présenter des statistiques internationales et nationales, et d'évaluer l'incidence de ces affections. Grâce à la révision de différentes études cliniques, on a également identifié les traceurs isotopiques les plus souvent utilisés de nos jours pour le diagnostic et le traitement des maladies osseuses, ainsi que l'emploi combiné des techniques par image les plus fréquentes. L'utilité de la gammagraphie osseuse pour le diagnostic et la confirmation des affections étudiées a été mise en évidence. De nouvelles technologies telles que les tomographies par émission de photon unique ou par émission de positons a été également présentées. On a trouvé que le radioisotope le plus souvent utilisé pour le diagnostic des maladies du système osseux est le 99mTc, dû à ses caractéristiques physiques et chimiques, tandis que pour la thérapie, les 186Re, 188Re, 153Sm, 177Lu, 32P, 89Sr, 85Sr, et 117mSn sont utilisés selon le type, la localisation et la magnitude des lésions, et la disponibilité du radioisotope. Aujourd'hui, le développement des traceurs isotopiques est axé sur la combinaison de ces radioisotopes avec différentes biomolécules pour améliorer leurs propriétés et élargir leur champ d'applications(AU)

Frequency of Lyme arthritis in patients with unknown subacute arthritis

Arthritis is a most common manifestation of lyme disease, which is caused by Borrelia burgdorferi. The birds may be carriers of disease-carrying ticks from Asia to Iran. The aim of this study was to evaluate frequency of lyme arthritis in patients with unknown subacute arthritis. This cross-sectional study was evaluated 180 patients with unknown subacute arthritis. Patients were asked about age, sex, foreign travel history, jungle travel history, animal contact, tick bites. Then, IgG, IgM Ab ELISA test were done. In patient with positive IgG or IgM ELISA test, Western Blot test was done. SPSS was used to analyze data. 20 [11.9%] patients had positive ELISA serologic test, in which 12[60%] had IgM Ab, 5 [25%] IgG Ab and 3 [15%] both IgM Ab and IgG Ab. Western Blot was positive in 2[1.1%] and equivocal in 5[2.8%] patients. The results of this study showed that lyme disease should be considered in each patient with unknown subacute arthritis in Iran

Artrite aguda recorrente como manifestação inicial de lúpuseritematoso sistêmico juvenil / Acute recurrent arthritis as initial manifestation of juvenile systemic lupus erythematosus

Introdução: Artrite aguda (duração inferior a seis semanas) recorrente pode ser a primeira manifestação do lúpus eritematoso sistêmico juvenil (LESJ). Nestes casos, o diagnóstico pode ser confundido com febre reumática e neoplasias,entre outras doenças. Esta apresentação clínica,entretanto, é raramente descrita em pacientes com LESJ. Por um período consecutivo de 27anos, 5367 pacientes foram acompanhados na Unidade de Reumatologia Pediátrica do Instituto da Criança. Destes, 263 (5%) casos tiveram o diagnóstico de LESJ. Uma (0,3%) paciente apresentou artrite recorrente e anemia hemolítica auto-imune e foi descrita. Relato do caso: Os autores reportaram uma escolar do sexo feminino, que apresentou poliartrite aguda recorrente com envolvimento degrande s e pequenas articulações, anemia hemolítica auto-imune, fator anti-núcleo e anti-DNA de dupla hélice positivos. O tratamento realizado incluiu pulsoterapia com metilprednisolona,seguido de prednisona e difosfato de cloroquina, e a paciente evoluiu com remissão clínica e controle da atividade da doença. Conclusão: A possibilidade de LESJ em pacientes com artrite recorrente deve ser sempre considerada, principalmente em indivíduos do sexo feminino e que apresentem envolvimento de outros órgãos e sistemas.

Introduction: Acute recurrent arthritis may be the first manifestation of juvenile systemic lupus erythematosus (JSLE). In these cases, differentiation from rheumatic fever, cancer and other diagnoses might be difficult. Recurrent arthritis as a presentation symptom is rarely described in 145patients with this disease. In a period of 27 years,5367 patients were followed at the Pediatric Rheumatology Unit of the Instituto da Criança. Of these, 263 (5%) cases were diagnosed as JSLE. One patient (0.3%) had recurrent arthritis and autoimmune hemolytic anemia and was described. Case report: The authors reported a school-aged girl who presented with acute recurrent polyarthritis involving large and small joints, auto-immune hemolyticanemia, positive anti-nuclear and double stranded DNA antibodies. Treatment included intravenous methylprednisolone pulses followed by prednisoneand chloroquine, and contributed to clinicalremission and disease inactivity. Conclusion: The possibility of JSLE in patients with recurrentarthritis should be always considered, especially in female patients who have other organs and systems involvement.

Analysis of patients with post-chemotherapy Arthralgia and Arthritis in breast cancer.

Objective: Evaluate the characteristics of arthropathy and musculoskeletal pain after chemotherapy in patients with breast cancer. Materials and Methods: In this study, we evaluate the characteristics of 15 patients with joint symptoms after receiving chemotherapy for breast cancer. Demographic information including sex, age, time of rheumatologic findings after starting of chemotherapy, and time of improvement after starting of medication, and laboratory findings detected for each patient. Results: Patients comprised 15 women with mean age 43.4 ± 10.6 years that received classic chemotherapy for breast cancer according to stage of disease including cyclophosphamide, and tamoxifen. Joint symptoms usually began about 6 months after the first session of chemotherapy. Patients had an average of 2 tender joints and 1 hour of morning stiffness. None of patients were positive for anti-nuclear antibody, and just 1 patient was positive for rheumatoid factor. Non-steroidal anti-inflammatory drugs, disease modifying anti-rheumatic drugs (DMARD), corticosteroids, and venlafaxine were prescribed. 5 patients did not show an improvement and were also given low dose oral corticosteroids. Follow-up was available for all patients. 13 patients showed favorable responses, characterized by a significant decrease (more than 50%) in morning stiffness, pain, and tender joint counts after a mean of 3 months' treatment. 9 patients had complete resolution of symptoms and stopped all medications. Conclusion: Chemotherapy-related arthropathy is not rare, and the prognosis is fairly good with early treatment using NSAID, DMARD, and corticosteroids.

Síndrome de Lõfgren / Lõfgren’s Syndrome

A sarcoidose é uma doença crônica granulomatosa, de origem desconhecida, que pode envolver praticamente qualquer órgão, mas na qual a presença de artrite é incomum. Apresentamos um caso no qual a artrite foi o achado inicial, associada ao eritema nodoso, levando à investigação e ao diagnóstico da síndrome de Lõfgren. Nessa forma de apresentação da sarcoidose, além da artrite ou artralgias e do eritema nodoso, também deve estar presente a linfadenopatia hilar bilateral como critério diagnóstico. A síndrome de Lõfgren é chamada algumas vezes de sarcoidose aguda, estando geralmente associada com um bom prognóstico e resolução espontânea.

Sarcoidosis is a chronic granulomatous disease, of unknown origin, that may involve virtually any organ, but in which the presence of arthritis is uncommon. Here we present a case in which arthritis was the first finding, associated with erythema nodosun, leading to the investigation and diagnosis of Lõfgren Syndrome. In this form of sarcoidosis presentation, in addition to arthritis or arthralgia and erythema nodosun there must be bilateral hilar lymphadenopathy as a diagnostic criterion. Lõfgren’s syndrome is sometimes called acute sarcoidosis, usually being associated with good prognosis and spontaneous resolution.

Monoartrite aguda / Acute monoarthritis

A monoartrite aguda é uma emergência médica que deve ser investigada e tratada adequadamente. Artrite induzida por cristais, trauma e infecção são as causas mais comuns de monoartrite em adultos.