Controlled release alginate-chitosan microspheres of tolmetin sodium prepared by internal gelation technique and characterized by response surface modeling

Tolmetin sodium (TS) is a powerful non-steroidal mitigating drug for the treatment of rheumatoid joint inflammation, osteoarthritis, and adolescent rheumatoid joint pain. In addition to its gastrointestinal (GIT) problems, TS has a short biological half-life (1 hr). In a trial to overcome these side effects and control the rate of (TS) release, chitosan coated alginate microspheres are recommended. A Box-Behnken experimental design was employed to produce controlled release microspheres of TS in the sodium alginate and chitosan copolymers (Alg-Ch) by emulsification internal gelation methodology. The effect of critical formulation variables namely, drug to polymer ratio (D:P ratio), speed of rotation and span 80% on drug encapsulation efficiency (% EE), drug release at the end of 2 hours (Rel2) and drug release at the end of 8 hours (Rel8) were analyzed using response surface modeling. The parameters were assessed using the F test and mathematical models containing only the significant terms were generated for each parameter using multiple linear regression analysis. The produced microspheres were spherical in shape with extensive pores at D:P ratio 1:1 and small pores at a drug to polymer ratio (D:P ratio) 1:3. Differential scanning calorimetry (DSC) affirmed the steady character of TS in microspheres and revealed their crystalline form. All formulation variables examined exerted a significant influence on the drug release, whereas the speed emerged as a lone factor significantly influencing % EE. Increasing the D: P ratio decreases the release of the drug after two and 8 hours. The increase in speed results in an increase in drug release after two and eight hours. The drug release from the microspheres followed zero order kinetics. TS Alg-Ch microspheres exhibited a significant anti-inflammatory effect on incited rat paw edema after eight hours. These results revealed that the internal gelation technique is a promising method to control TS release and eradicate GIT side effects using Alg-Ch copolymers.

Guía dietética para pacientes con hiperuricemia y gota agar / Dietary guide for patients with hyperuricaemia and drop agar

Gota proviene del latin Gutta es un término acuñado en el siglo V que significa exceso o derrame de flema por exceso de vino, comida y sexo. Llamada "Rey de las enfermedades yenfermedad de reyes" fue uno de los primeros desordenes reumáticos en ser reconocidos como entidad clínic a. Es la artritis por deposito de microcri s tales más común debida a desequilibrio en el metabolismo de las purinas que conlleva a hiperuricemia y el depósito de cristales de urato monosódico, caracterizada por ser de inicio monoarticular, que a fecta con mayor frecuencia la primera articulación metatarso de pie y que progresa en su forma crónica a poliarticular, asociada a destrucción progresiva y a la formación de tofos, falla renal y enfermedad cardiovascular. Predomina sexo masculino, su pr evalencia se calcula de 0.08% a nivel mundial, aumentando la frecuencia de sus ataques con el alto contenido de carnes, mariscos, cervezas y bebidas espirituosas. El objetivo de la presente revisión bibliográfica es proporcionar una guía dietética para lo s médicos enfatizando y destacando su contenido de purinas en alimentos de uso cotidiano en la población guatemalteca, para obtener un mejor control de la artritis gotosa y disminuir la frecuencia de sus ataques ...(AU)

Gota comes from Latin Gutta is a term coined in the fifth century that means excess or spill of phlegm for excess wine, food and sex. Called "King of diseases and disease of kings" was one of the first rheumatic disorders to be recognized as a clinical entity. Arthritis is the most common microcritical deposit due to imbalance in the metabolism of purines that leads to hyperuricemia and the deposition of monosodium urate crystals, characterized by monoarticular initiation, which most often occurs with the first metatarsal joint. standing up and progressing in its form chronic to polyarticular, associated with progressive destruction and the formation of tophi, renal failure and cardiovascular disease. Male sex predominates, its pr evance is estimated at 0.08% worldwide, increasing the frequency of its attacks with the high content of meats, seafood, beers and spirits. The aim of this bibliographical review is to provide a dietary guide for physicians emphasizing and highlighting their content of purines in foods of daily use in the Guatemalan population, to obtain a better control of gouty arthritis and to reduce the frequency of their attacks. .. (AU)

Risk Factors for Osteoarthritis and Contributing Factors to Current Arthritic Pain in South Korean Older Adults

PURPOSE: Although previous studies have focused on risk factors for osteoarthritis, there is some debate on this issue. Furthermore, associated factors with arthritic symptom (arthralgia) have not been sufficiently investigated, despite its clinical importance in the management of osteoarthritis. This study was performed to examine the risk factors for osteoarthritis and the contributing factors to current arthritic pain in older adults. MATERIALS AND METHODS: The Fourth Korean National Health and Nutrition Examination Surveys was conducted in 2009. Therein, 720 males and 1008 females aged 65 years and older were included. Comprehensive data on habitual, socioeconomic, medical, nutritional, and psychological factors were collected along with the presence of osteoarthritis and arthritic pain. After univariate analysis, binary logistic regression analysis was performed to identify risk factors for osteoarthritis and contributing factors to current arthritic pain. RESULTS: Age (p=0.005), female gender (p<0.001), higher body mass index (BMI) (p<0.001), and osteoporosis (p<0.001) were significant risk factors for osteoarthritis, while higher education level (p=0.025) was a protective factor for osteoarthritis. Higher BMI (p=0.047), lack of weekly moderate intensity activity (p<0.001), and unfavorable subjective health status (p<0.001) were significant factors contributing to current arthritic pain among subjects with osteoarthritis. Both osteoarthritis and current arthritic pain adversely affected health related quality of life. CONCLUSION: Higher BMI, lack of weekly moderate intensity activity, and unfavorable subjective health status were significant factors contributing to current arthritic pain. More attention needs to be paid to psychiatric effects on osteoarthritis and joint related pain.

Degenerative joint disease in cattle and buffaloes in the Amazon region: a retrospective study / Doença articular degenerativa em bovinos e búfalos na Amazônia: estudo retrospectivo

A retrospective study of the epidemiological and clinic-pathological aspects of cattle and buffaloes with degenerative joint disease (DJD) was conducted in the state of Pará, Brazil. From 1999 to 2014, eleven cattle and 24 buffaloes were evaluated. All the treated animals with suspected DJD underwent a clinical examination of the musculoskeletal system. In seven cattle and eight buffaloes with clinical signs of the disease postmortem examination was performed. The common clinical signs observed in both species were chronic lameness, stiff gait, postural changes, audible crackles in the affected limb, prolonged recumbency, difficulty in getting up and progressive weight loss. The lesions observed at necropsy were: irregular articular surfaces, erosion of the articular cartilage and the underlying bone tissue, and proliferation of the periarticular bone tissue with formation of osteophytes. The most affected joints in cattle and buffaloes wereof the hind limb. In buffaloes, the main predisposing factor to the onset of DJD was phosphorus deficiency. In cattle, defects of the anatomical conformation of the hind limbs, chronic trauma due to the activities performed, such as semen collection, and advanced age possibly contributed to the emergence of the disease...

Foi realizado um estudo retrospectivo sobre os aspectos epidemiológicos e clínico-patológicos em bovinos e búfalos com doença articular degenerativa (DAD) no estado do Pará, Brasil. Durante os anos de 1999 a 2014 foram avaliados 11 bovinos e 24 bubalinos. Todos os animais atendidos com suspeita clínica de DAD foram submetidos a exame clínico do sistema locomotor. Foram necropsiados sete bovinos e oito bubalinos com sinais clínicos da enfermidade. Os sinais clínicos comuns observados em ambas as espécies foram claudicação crônica, andar rígido, alterações posturais, crepitações audíveis no membro acometido, decúbito prolongado, dificuldade para levantar, e emagrecimento progressivo. As lesões articulares evidenciadas na necropsia consistiram em irregularidade da superfície articular, presença de erosão na cartilagem articular e no tecido ósseo subjacente, proliferação de tecido ósseo periarticular com formação de osteófitos. Tanto nos bovinos como nos bubalinos as articulações mais acometidas foram as dos membros posteriores. Nos bubalinos, possivelmente o principal fator predisponente ao surgimento de DAD foi à deficiência de fósforo, ao contrário dos bovinos, nos quais os defeitos de conformação anatômica dos membros posteriores, traumas crônicos em virtude da atividade exercida, como a coleta de sêmen e a idade avançada, foram o que, possivelmente, contribuíram para surgimento da enfermidade...

S100A8/A9 as a biomarker for synovial inflammation and joint damage in patients with rheumatoid arthritis

S100A8 and S100A9 are major leukocyte proteins, known as damage-associated molecular patterns, found at high concentrations in the synovial fluid of patients with rheumatoid arthritis (RA). A heterodimeric complex of S100A8/A9 is secreted by activated leukocytes and binds to Toll-like receptor 4, which mediates downstream signaling and promotes inflammation and autoimmunity. Serum and synovial fluid levels of S100A8/A9 are markedly higher in patients with RA than in patients with osteoarthritis or miscellaneous inflammatory arthritis. Serum levels of S100A8/A9 are significantly correlated with clinical and laboratory markers of inflammation, such as C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, and the Disease Activity Score for 28 joints. Significant correlations have also been found between S100A8/A9 and radiographic and clinical assessments of joint damage, such as hand radiographs and the Rheumatoid Arthritis Articular Damage score. In addition, among known inflammatory markers, S100A8/A9 has the strongest correlation with total sum scores of ultrasonography assessment. Furthermore, baseline levels of S100A8/A9 are independently associated with progression of joint destruction in longitudinal studies and are responsive to change during conventional and biologic treatments. These findings suggest S100A8/A9 to be a valuable diagnostic and prognostic biomarker for RA.

IL-17-deficient allogeneic bone marrow transplantation prevents the induction of collagen-induced arthritis in DBA/1J mice

IL-17-producing CD4+ T cells (Th17) play important functions in autoimmune diseases and allograft rejection of solid organs. We examined the effects of IL 17 and its mechanism of action on arthritis in a murine collagen-induced arthritis (CIA) model using bone marrow transplantation (BMT) system. DBA/1J mice were administered a lethal radiation dose and then rescued with bone marrow derived from either wild-type (WT) or IL-17-/- mice on C57BL/6 background mice. CIA was induced after the bone marrow transplant, and disease progression was characterized. DBA/1J mice with CIA that received IL-17-/- donor bone marrow showed potently inhibited development and severity of clinical arthritis as compared with CIA mice that received WT bone marrow. Reduced secretion of the pro-inflammatory cytokines tumor necrosis factor-alpha, IL-1beta, and IL-6, and collagen-specific T cell responses were observed in mice that received IL-17-/- bone marrow. IL-17 blockade also inhibited effector T cell proliferation by reciprocally regulating the Treg/Th17 ratio. IL-17 blockade prevented joint destruction in mice with CIA. These findings suggest that CIA with BMT is a viable method of immunological manipulation and that IL-17 deficiency suppresses severe joint destruction and inflammation in CIA mice. There may be clinical benefits in blocking IL-17 and BMT in the treatment of rheumatoid arthritis.

[Pathological study of arthritis induced by type 2 bovine collagen and freund's complete adjuvant in rat]

Because of the pathological similarities between collagen induced arthritis [CIA] and rheumatoid arthritis, the CIA model has been the subject of extensive investigations. This study initiated to evaluate the pathologic lesions of induced arthritis by collagen in a total of 50 female rats [Rattus norvegicus.]. Arthritis was induced by two intrademial injections [14 days interval] of type 2 bovine collagen solution and Freund's complete adjuvant [FCA] into the tail and right leg paw of 40 rats. Severity of arthritis in affected leg was represented in grade to 4. Three weeks after beginning of the experiment, 22, 12, 5 and 1 affected rats were clinically diagnosed with 1, 2, 3 and 4 grades of arthritis respectively. Rats were intradermally injected into the tail showed only slight and moderate [grade 1 and 2] arthritis. Macroscopically, the involved joints were enlarged, swollen and stiff and deformity and ankylosis of affected joints were noticed in severe cases. Deep healing ulcers in planter of the paw were diagnosed in 14 rats. Histopathologic examinations revealed infiltration of mononuclear inflammatory cells and papillary hyperplasia of synovial membrane in mid and moderately affected animals [grade 1 and 2] and erosion of articular cartilage with formation of fibrovascular pannus on its surface in synovial membrane in severe cases [grade 3]. In very severe cases [grade 4], complete destruction of articular cartilage and access of granulation tissue to subchondral bone were noticed. Pathologic lesions of the involved joints were very similar to those reported from rheumatoid arthritis in human, erosive polyarthritis in dog and caprine arthritis/encephalitis

Avaliação musculoesquelética / Musculoskeletal assessment

Esta 5ª edição totalmente colorida oferece uma abordagem clara e sistemática para a realização de avaliações neuromusculoesqueléticas, desvendando a lógica por trás de seus vários aspectos. Nesta obra, cada articulação do corpo é tratada em capítulos exclusivos, que abrangem tópicos como: os princípios da avaliação, marcha, postura, os amputados, avaliação primária e de emergências do esporte, cabeça e face. O leitor também encontrará: ilustrações e fotos que mostram claramente os métodos de avaliação, testes, etiologia etc. ; um novo capítulo sobre avaliação primária, que aborda o papel cada vez mais relevante dos fisioterapeutas ; uma completa revisão da avaliação ortopédica baseada em evidências, com informações e detalhes necessários para entender e aplicar métodos de avaliação neuromuscular ; informações sobre ciências fundamentais, aplicações clínicas e testes especiais, que incorporam as últimas pesquisas e as práticas mais utilizadas ; estudos de caso que auxiliam no desenvolvimento de técnicas de avaliação, com exemplos reais ; tabelas e quadros, que organizam e resumem as informações importantes, além de destacar pontos-chave de fácil aprendizagem e memorização.

Rol actual de la ecografía en la evaluación de la artritis psoriática / The current role of the ultrasound in the assessment of psoriatic arthritis

La artritis psoriática es una enfermedad inflamatoria crónica y heterogénea que afecta articulaciones, tendones, entesis, piel y uñas. Indudablemente, a lo largo de los últimos años la ecografía se ha ido perfilando como un método de imágenes imprescindible en la práctica cotidiana reumatológica, no sólo por su bajo costo y su mayor sensibilidad respecto al examen físico, sino por la capacidad de detectar compromiso subclínico y permitir el monitoreo de la evolución de la enfermedad. El incesante crecimiento tecnológico orientado al diseño de equipos dotados de sondas de alta frecuencia y módulos power Doppler altamente sensibles permite actualmente apreciar alteraciones morfo-estructurales con una resolución inferior al décimo de milímetro, y detectar el mínimo flujo sanguíneo presente en los microvasos de los tejidos superficiales. No obstante estas ventajas, aún son pocos los estudios que demuestran la utilidad de la ecografía en la artritis psoriática. El objetivo principal de esta revisión es demostrar el potencial actual de la ecografía en el estudio de pacientes con artritis psoriática mediante la ilustración de alteraciones a nivel de articulaciones, tendones, entesis, piel y uñas.

Psoriatic arthritis (PsA) is a chronic and heterogeneous inflammatory disease that involves joints, tendons, enthesis, skin and nails. Without doubt, ultrasound has become a rapidly evolving technique that is gaining more and more importance among rheumatologists. The continuous technological advances in the field of ultrasound has allowed the development of equipment provided with high and variable frequency probes and very sensitive power Doppler, which permit both the detailed study (with resolution power of 0.1 mm) of morphostructural changes and the sensitive detection of blood flow, even in small vessels of superficial tissues. To date most of the studies have been aimed at investigating its capacity in the assessment of joints, tendons and entheses in psoriatic arthritis patients. Less attention has been paid to demonstrate the potential of ultrasound in the evaluation of skin and nails.The aim of this study is to show the main high frequency greyscale and power Doppler ultrasound findings in patients with psoriatic arthritis at joint, tendon, enthesis, skin and nail level.

Clinical and Radiographic Features of Adult-onset Ankylosing Spondylitis in Korean Patients: Comparisons between Males and Females

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.

Perfil dos pacientes adultos atendidos em ambulatório de reumatologia em um hospital geral em Porto Alegre – RS / Characteristics of adult persons consulting in an outpatient rheumatology office in a general hospital in Porto Alegre – RS

Introdução: O conhecimento do perfil dos pacientes atendidos em um serviço médico é de fundamental importância para o planejamento de ações preventivas e curativas. As doenças reumáticas são reconhecidas pela cronicidade das queixas e grande morbidade que as acompanham, acarretando grande prejuízo em qualidade de vida e custo elevado para os sistemas de saúde. Objetivo: Verificar o perfil dos pacientes adultos atendidos no ambulatório de reumatologia do Complexo Hospitalar Santa Casa de Porto Alegre, RS. Métodos: Estudo ransversal descritivo, realizado através da aplicação de questionário na primeira consulta de pacientes atendidos no ambulatório de Reumatologia da Santa Casa, em período de seis meses. Resultados: Foram entrevistados 276 pacientes com média de idade de 52,5 anos, sendo 77,5% do sexo feminino e 56% procedentes de Porto Alegre. O tempo de ocorrência das queixas era de mais de um ano em 34,8% dos questionados, sendo que 12,7% tinham doença por tempo maior do que cinco anos. Trinta e quatro por cento dos pacientes já haviam buscado reumatologista previamente, sendo que 37,5% destes já haviam consultado cinco ou mais vezes pela mesma queixa. Médicos de outras especialidades foram procurados por 66%, sendo os traumatologistas os mais prevalentes (52%). Conclusão: Doenças articulares representam a segunda principal causa de incapacidade para o trabalho e o custo anual no atendimento desses pacientes repercute fortemente sobre os serviços de saúde. O investimento em políticas de saúde pública, com ações preventivas e curativas parte do conhecimento do perfil dos pacientes atendidos em determinado serviço de saúde.

Introduction: Knowledge of the profile of patients cared for at a medical service is critical for planning preventive and therapeutic strategies. Rheumatic diseases are known for the chronicity of complaints and associated high morbidity, leading to decreased quality of life for the patients and elevated costs for the health systems. Aim: To determine the profile of adults patients cared for at a rheumatology service of the Hospital Complex Santa Casa of Porto Alegre, RS. Methods: This is a descriptive cross-sectional study carried out through the application of a questionnaire responded by outpatients at their first visit to the above-mentioned rheumatology service during 6 months. Results: 276 patients (mean age = 52.5 years) were interviewed, of whom 77.5% were females and 56% lived in Porto Alegre. The reported beginning of complaints were older than one year among 34.8% of the sample, and 12.7% had the disease for longer than 5 years. 34% of the respondents had consulted with a rheumatologist in the past, and among these, 37.5% had already consulted five or more times because of the same complaint. Physicians of specialties other than rheumatology were consulted by 66% of the patients, traumatologists being the most prevalent ones (52%). Conclusion: Joint disorders are the second leading cause of disability for work, and the annual cost for caring for these patients exacts a heavy toll from health systems. The investment in public health policies, with preventive and therapeutic strategies, should start from knowledge of the profile of patients cared for at a particular health service.

Paquidermodactilia transgressiva: relato de um caso / Transgrediens pachydermodactyly: report of a case

A paquidermodactilia é forma rara de fibromatose digital envolvendo as porções proximais dos dedos, que afeta homens jovens. Apresenta-se caso de paciente de 25 anos com quadro de nódulos assintomáticos nas mãos há dois anos, e há três meses com lesões semelhantes nos pés e no joelho direito. O exame histopatológico revelou espessamento da derme com proliferação de fibroblastos e de fibras colágenas e aumento de mucina. O caso descrito corresponde à paquidermodactilia do tipo transgressiva.

Pachydermodactyly is a rare form of digital fibromatosis involving the proximal portions of the fingers that usually affects young males. We present a 25-year-old male patient with a twoyear history of asymptomatic nodules in the fingers. Three months before the visit, he had observed similar lesions on the feet and right knee. Histopathological analysis showed thickened dermis with proliferation of fibroblasts and collagenous fibers, with deposition of mucinous material. This represents a rare case of pachydermodactyly of transgrediens form.

Efeito analgésico do laser de baixa intensidade (LILT) na artrite reumatóide aguda / Effect analgesic of low intensity laser (LILT) in rheumatoid arthritis acute

Introdução - Avaliar a efetividade da laserterapia de baixa intensidade (LILT) na promoção da analgesia em portadores de artrite reumatóide. Material e Métodos - Dez sujeitos, portadores de artrite reumatóide (05 pertencentes ao grupo irradiado e 05 pertencentes ao grupo placebo) foram submetidos à 10 sessões de LILT, divididas em 5 semanas (2 sessões/semana). O Questionário de Dor Br-MPQ foi aplicado no início e ao final do protocolo. Resultados - Obteve-se um resultado significativo de menor algia no grupo controle (80%) e um resultado de maior algia no grupo irradiado(40%), o que não se implica em um resultado efetivo ao estudo. Conclusão - A LILT (904 nm) não foi efetiva na analgesia em portadores com artrite reumatóide.

Introduction - Evaluating the effectiveness of low power laser therapy in order to promote analgesic effect in rheumatoid arthritis bearers. Material and Methods - Ten subjects bearer of rheumatoid arthritis (05 belonging to radiated group and 05 belonging to placebo group) were evaluated in ten session of LILT, divided in five weeks (two session/week). The Brazilian version of Dor Br - MPQ questionnaire from McGill Pain Questionnaire was used and applied at the beginning and at the end of the protocol. Results - We got a pretty smaller result from the control group (80%) and a bigger result from the radiated group (40%), what does not mean an effective result to this study. Conclusion - The LILT (904 nm) was not effective in the analgesic effect in rheumatoid arthritis bearers.

Farber disease: a rare neurodegenerative disorder

This is the case report of a two-and-a-half-year old male infant with Farber disease, which is a rare neurodegenerative mucolipidosis. The child presented with regression of milestones, laryngeal involvement and painful joints with swellings around the joints. Neuroimaging findings and the biopsy of the soft tissue swellings helped to reach the diagnosis

Rheumatoid arthritis cytokines and hypoxia. What is the link?

Rheumatoid arthritis [RA] is a chronic systemic inflammatory disorder that affects approximately 1% of the population, in a female to male ratio of 3:1. The disease can occur at any age, but it is most common among those aged 40-70 years. Despite many years of study, the etiology of RA is still undefined. However, with increased understanding of the immune system the pathogenesis of RA has become clearer. A large bulk of data suggests that T lymphocytes and macrophages play a critical role in the initiation and perpetuation of synovial inflammation. Recently, the cytokine profile of T helper cells has been associated with the disease, the cytokine repertoire of inflamed synovia is categorized as that of T helper 1 response. Moreover, in RA elevated levels of pro-inflammatory or inflammatory cytokines such as Tumor Necrosis Factor - alpha [TNF-alpha] and Interleukin -1 beta [IL-1beta] have been detected. Hypoxia up-regulates TNF-alpha and IL-1beta; therefore, considerable research interest has been focused on the biological consequences of the hypoxic nature of the rheumatoid synovium. Hypoxia might underlie the functional polarization of the T cells and cytokine production, and thus may contribute to the progression and persistence of the disease. In this short review, we discuss our current knowledge of the link between cytokines and RA and the role of hypoxia in the pathogenesis of the disease

[Classification arthropathies with severe hemophilia type A referred to Ali Asghar pediatric in Zahedan in 2003]

Hemarthrosis is the most common sign of severe hemophilia type A in all ages which leads to irreversible complications in joints. These Complications cause morbidity and high expenses that could be decreased by a good organized therapeutic and prophylactic management. There is not any standard quantitative scoring system to evaluate the complications of joints, used in our country systematically and we have not any published data about it. In this study, Petterson and Gilbert's scoring system has been used to evaluate joints status in a cross sectional descriptive analytic manner. Twenty out 32 cases of the severe hemophilia type A patients who came to Ali Asghar hospital in 1381, were included on our study. Based on Petterson and Gilbert's scoring system, knees, ankles and elbows were selected joints. Physical examination was first done by a pediatrician and confirmed by an orthopedic surgeon PA and lateral X-ray of selected joints were reported by a radiologist .All of the above physicians were fix during the study. Finally we reported our results in tables and charts and analyzed with SPSS [One-way Analysis of Variance, Wilcoxon Matched-Pairs, Kruskal-Wallis]. In this study, the most common radiological pathologic finding was osteoporosis [32.5%] and the rarest one was erosion at joint margin [3.3%]. In physical examination, decreasing in range of motion [35%] and instability [0%] was the most common and the rarest pathologies. The most involved joints in radiology and physical exam were right knee [28.7%] and left knee [19.3%] and the rarest one's were left ankle [13.7%] and left elbow [10.6%]. The severity of complications [both physically and radiologically] has been related with the titer of inhibitor, but there was not any correlation with age [one-way analysis of variance]. There was not any statistically significant difference between radiologic and physical scoring in every joint. Ourfindings showed that the majority of our patients had at least one joint involvement [85% physically and 75% radiologically].On the other hand, 45% of 120 evaluated joints had radiological problems and 55% of them were physically insult. This high prevalence of morbidity explained the cause of high expenses for treatment of patients in this province. To increase in titer of inhibitor is the main factor for increasing of morbidity. Considering high morbidity in our patients, the statistical similarity between joints complications in different age groups, showed the importance of prophylaxis protocols for them obviously. It seems there is no relation between radiological scoring and physical score, except for left elbow joint [Wilcoxon Matched-pairs, P=0.454]. Pain is a good alarm, but it had no effect on scores. Prevalence of involved joints can be dependent on kind of culture

Radiographic findings of digital bones and joints in lame cattle of shiraz area

A radiographic study on bone and joint disorders was carried out on 77 cases of lame cattle in some dairy farms of Shiraz area. Various radiographic findings of digital region were recorded as: osteomyelitis, exostosis, alteration of bone density, calcified soft tissue, rotation of phalanges, arthritis, degenerative joint disease, joint bony ankylosis, luxation and angulation. In 70% of the lame cattle, radiographic findings of bone and joint were observed

Arthropathic presentation of Wilson's disease.

A patient is described who presented with polyarthritis involving small and large joints of limbs with later onset of tremors affecting all four extremities. Investigations including genetic study confirmed the diagnosis of Wilson's disease (WD). The case highlights the importance of considering the possibility of WD in young patient presenting with repetitive unexplained joint symptoms with or without tremor.