Tuberculosis osteoarticular en un paciente pediátrico / Osteoarticular tuberculosis in a pediatric patient

Introducción: La tuberculosis osteoarticular es una enfermedad inflamatoria crónica, muy rara con un cuadro clínico atípico y se presenta con una incidencia de 1-2 por ciento del total de los casos de tuberculosis. Objetivo: Exponer una forma de presentación poco frecuente de tuberculosis en Honduras Presentación del caso: Se trata de una niña de dos años con diagnóstico inicial de sinovitis en rodilla derecha de cinco meses de evolución y tratada con antibiótico y analgésico. Sin mejoría se presenta a emergencia con cambios inflamatorios. Se realiza rayos x de rodilla que muestran lesiones osteolíticas a nivel de rótula y cóndilo del fémur derecho. Baciloscopia de esputo y prueba de tuberculina negativas. Familiar de tercer grado positivo para tuberculosis hacía un año y medio. Por biopsia de tejido blando y óseo de rodilla derecha se establece el diagnóstico de artritis por Mycobacterium tuberculosis por estudio inmuno-histoquimico con tinción Ziehl Nielsen. Conclusiones: Es el primer informe de caso de tuberculosis osteoarticular en un paciente pediátrico descrito en Honduras. Por la larga evolución de la enfermedad, lo atípico de su clínica y su baja incidencia es difícil establecer el diagnóstico final. Fue imprescindible el estudio anatomopatológico por biopsia que permitiera esclarecer a los clínicos el diagnóstico e iniciar el tratamiento oportuno(AU)

Introduction: Osteoarticular tuberculosis is a chronic inflammatory disease, very rare, and with an atypical clinical picture and occurs with an incidence of 1-2 percent of all TB cases. Objective: Show a rare form of TB´s presentation in Honduras Case presentation: Two-year-old girl with an initial diagnosis of right knee synovitis of five months of evolution and treated with antibiotics and analgesics. Without improvement, she attends to emergencies service with inflammatory changes. Knee x-rays show osteolytic lesions at the kneecap level and the condyle of the right femur. Sputum bacilloscopy and negative tuberculin test were performed. She had a third-grade relative positive to tuberculosis a year and a half ago. A right knee soft tissue and bone biopsies confirm the diagnosis of arthritis by Mycobacterium tuberculosis by immuno-histochemical study with Ziehl Nielsen staining. Conclusions: It is the first osteoarticular TB case report in a pediatric patient described in Honduras. Because of the long evolution of the disease, the atypicalness of its clinic features and its low incidence, it is difficult to establish the final diagnosis. Anatomopathological study by biopsy was essential to clarify the diagnosis to clinicians and initiate timely treatment(AU)

Artroscopia diagnóstica en cirugía maxilofacial / Diagnostic arthroscopy in Maxillofacial Surgery

Introducción: los desarreglos internos de la articulación temporomandibular (ATM) son los más comunes. La artroscopia es de gran utilidad en cirugía maxilofacial como alternativa para el diagnóstico y el tratamiento de los desarreglos internos de la ATM. El objetivo de la presente revisión es describir la artroscopia diagnóstica de la ATM. Métodos: se realizó una revisión narrativa de la literatura y una búsqueda en las bases de datos PubMed, ProQuest, SciELO, Mendeley y Elsevier empleando los descriptores (artroscopia diagnóstica, articulación temporomandibular) en español e inglés. Se seleccionaron los artículos publicados en un período de 40 años (1980-2020), incluyendo en el estudio un total de 26 artículos y 6 libros de 702 documentos revisados. Discusión: en la artroscopia de la ATM se puede observar la posición, calidad y textura del cartílago articular, la vascularización y la redundancia de la membrana sinovial y se pueden realizar procedimientos como técnicas de artroscopia avanzada. Conclusiones: la artroscopia diagnóstica facilita el diagnóstico y manejo de las patologías intraarticulares, por lo que el conocimiento de esta técnica resulta imprescindible.

Introduction: Internal disorders of the TMJ are the most common. Arthroscopy is very useful in Maxillofacial Surgery as an alternative for the diagnosis and treatment of internal disorders of the Temporomandibular Joint. The aim of this review is to describe the diagnostic arthroscopy of the Temporomandibular Joint. Methods: A narrative literature review and search of PubMed, ProQuest, SciELO, Mendeley and Elsevier databases were performed in English and Spanish using the descriptors (Diagnostic arthroscopy, Temporomandibular Joint) in Spanish and English. Articles published over a period of 40 years (1980-2020) were selected, including a total of 26 articles and 6 books from 702 reviewed documents in the study. Discussion: In the arthroscopy of the Temporomandibular Joint the position, quality, texture of the articular cartilage, the vascularization, and the redundancy of the synovial membrane can be observed, and procedures such as advanced arthroscopic techniques can be performed. Conclusions: Diagnostic arthroscopy facilitates the diagnosis and management of intra-articular pathologies. Being necessary and essential knowledge of this technique.

Síndrome RS3PE en paciente con cáncer de próstata en estadio IV / RS3PE Syndrome in a Patient with Stage IV Prostate Cancer

La polisinovitis aguda edematosa benigna del anciano, también llamada síndrome RS3PE (acrónimo de remitting seronegative symmetrical synovitis with pitting edema), es una enfermedad reumatológica heterogénea que forma parte de las artritis inflamatorias y es de causa desconocida. Se presenta de forma exclusiva en la población de adultos mayores con afección poliarticular asociada a edema, tumefacción y limitación funcional que tiene por lo general buen pronóstico. Se describe el caso de un hombre de 70 años que cumple con seis de los siete criterios diagnósticos para esta enfermedad(AU)

Acute benign edematous polysynovitis in the elderly, also called RS3PE syndrome (acronym for remitting seronegative symmetrical synovitis with pitting edema), is a heterogeneous rheumatologic disease that is part of inflammatory arthritis and whose cause is unknown. It is presented exclusively in the population of aged adults with polyarticular affection associated with edema, swelling and functional limitation and has, in general, a good prognosis. We describe the case of a 70-year-old man who presents six of the seven diagnostic criteria for this disease(AU)

Artritis seudoséptica presenta sinovitis por cuerpo extraño en un paciente con gota / Pseudoseptic arthritis with foreign body synovitis in a patient with gout

La monoartritis es un reto diagnóstico para el clínico, ya que es extensa la lista de patologías asociadas. En pacientes con diagnóstico establecido de enfermedad articular inflamatoria, se acepta que la monoartritis corresponde a la exacerbación de la enfermedad de base; sin embargo, ignorar el abordaje sistematizado de las monoartritis puede generar omisiones e implicaciones diagnósticas erróneas. En este reporte se analiza el abordaje de un caso de artritis seudoséptica, simulando un ataque agudo de artritis por urato monosódico recurrente en un paciente con retención de cuerpo extraño intraarticular.

Monoarthritis is a diagnostic challenge for the clinician, as the list of associated conditions is quite long. It is accepted that in patients with a diagnosis of inflammatory joint disease monoarthritis represents exacerbation of the underlying disease. However, ignoring the systematized approach to monoarthritides may lead to omissions and mistaken diagnostic implications. This report describes the approach to a case of pseudoseptic arthritis that mimicked an acute episode of recurrent arthritis due to monosodium urate in a patient with retention of an intraarticular foreign body.

Assessment of synovitis in early rheumatoid arthritis by CXCL13 serum levels and power doppler ultrasonography: correlation with disease activity

Assessment of synovitis in rheumatoid arthritis [RA] is a major issue for proper treatment; it has been proven that high resolution ultrasound [US] examination could be of valuable help. The B-cell chemokine, CXCL13, is a proposed serum biomarker of synovitis in RA. We aimed to find out the presence of synovitis in patients with recent-onset RA and its correlation with disease activity. We evaluated 30 patients with early RA for the presence and degree of synovitis by performing high resolution US and obtaining serum CXCL13 levels. In addition, we correlated these results with disease activity score 28 [DAS 28]. Results of high resolution US and serum CXCL13 were also obtained for 20 healthy age- and sex-matched volunteers and served as controls. Serum CXCL13 level was significantly increased in early RA patients vs. controls [p < 0.001]. High resolution US revealed that RA patients had a significant increased synovial thickness and high power Doppler US score. In RA patients, DAS 28 had a significant correlation with serum CXCL13 [r = 0.42, p = 0.02], synovial thickness [r = 0.39, p = 0.03] and power Doppler US score [r = 0.43, p = 0.02]. Serum CXCL13 level correlated with synovial thickness [r = 0.63, p = 0.001] and power Doppler US score [r = 0.69, p = 0.001] Recent-onset RA patients suffer from synovitis as evidenced by significantly increased serum CXCL13 and by high resolution US. Serum CXCL13 is a reliable marker of synovial inflammation which correlates better with synovial thickening and power Doppler US scores than DAS28

Tuberculous Synovitis of Knee Joint.

Tuberculosis of the appendicular skeleton is an uncommon infection by tubercle bacilli. Thirty percent of the skeletal tuberculosis involves joints, the knee being the third most common joint affected. We report a case of tuberculous synovitis of the knee joint in a 69 years old male. The diagnosis was done by Ziehl – Neelsen stain and culture on Lowenstein – Jensen medium of the synovial fluid along with X-ray finding of the knee joint. Though the sputum sample was negative for AFB, X-ray of the chest showed finding suggestive of old pulmonary tuberculosis. The patient was treated with the anti tubercular regimen and responded well .

Fluxograma diferencial entre a artrite séptica e sinovite transitória do quadril em crianças / Flowchart distinguishing between septic arthritis and transitory synovitis of the hip in children

O diagnóstico diferencial entre a artrite séptica e a sinovite transitória do quadril não é fácil de ser realizado, pois não há um exame que seja simples, nem satisfatoriamente sensível e específico para diferenciá-las. Sendo assim, é muitas vezes utilizada uma propedêutica armada de exames que demanda maior custo e requer melhor infra-estrutura da instituição de saúde. Perante isso, torna-se evidente a necessidade de uma análise multifatorial dos dados clínicos e laboratoriais envolvidos para a proposição de um fluxograma em que se possa racionalizar exames visando a correta abordagem e evitar a indicação de procedimentos, muitas vezes, desnecessários como a ressonância magnética ou mais invasivos como a artrocentese e a própria drenagem cirúrgica. Realizamos uma ampla revisão da literatura nas bases de dados do Pubmed e Cochrane até maio de 2009 em que foi analisada a importância do exame clínico, dos testes laboratoriais e de imagem para a diferenciação entre as duas afecções. Mediante o cruzamento dos dados foi elaborado um fluxograma para o diagnóstico e conduta na criança e no adolescente, com idade de seis meses a dezoito anos, com sintoma de dor no quadril, na suspeita de quadro inflamatório. Nivel de Evidência III, estudos diagnósticos, investigação de um exame para diagnóstico.

The distinguishing diagnosis between the septic arthritis and the transitory synovitis of a hip is not easy to be carried through; therefore, there is not a simple, nor sensible and satisfactorily specific examination to differentiate them. Thus, the use of a propedeutic set of examinations becomes necessary to demand greater cost and depend on a bigger infrastructure of the health institution. First of all, the necessity of a multifactorial analysis on a flowchart is evident, so it can rationalize the indication of unnecessary or more invasive procedures as artrocentesis, magnetic resonance and the surgical draining. A revision of literature on the databases of Pubmed and Cochrane until May of 2009 was carried through, and the importance of the clinical examination, laboratorial tests and imaging exams was analyzed. By studies on the data, it was elaborated a flowchart for the diagnosis and the conduction of the management on the patient, between the ages of six months and eighteen years old, with complaint of pain on the hip under suspicion of inflammatory picture. Level of Evidence: Level III, diagnostic studies - investigating a diagnostic test.

Sinovitis transitoria de cadera / Transient synovitis of the hip

Patología inflamatoria aguda, también llamada cadera irritable o sinovitis tóxica, es la principal causa de dolor en la cadera de los niños. Se indica cómo realizar la ecografía para un correcto diagnóstico.

Paraparesia espástica tropical y sinovitis proliferativa asociadas al HTLV / Tropical spastic paraparesis and HTLV-I-associated proliferative synovitis

Introducción: el virus linfotrópico de las células T humanas tipo I (HTLV-I) es endémico en la cuenca del Caribe, donde se reconoce como agente etiológico de la paraparesia espástica tropical. En Cuba se ha reportado una seroprevalencia de 0,037 por ciento. Objetivos: demostrar la asociación de la infección por HTLV-I en una paciente con paraparesia espástica tropical y sinovitis proliferativa de rodilla. Métodos: se estableció el diagnóstico clínico de paraparesia espástica y sinovitis proliferativa crónica de rodilla. Se realizaron estudios humorales e imagenológicos para sustentar los diagnósticos positivo y diferencial; se emplearon sistemas de ELISA y western blot para la detección de anticuerpos contra HTLV-I. Resultados: los estudios serológicos confirmaron la infección por HTLV-I. Los síntomas y signos resultaron compatibles con la guía para el diagnóstico establecida por la Organización Mundial de la Salud y se hizo el reporte número 33 de la relación de individuos con infección por HTLV-I diagnosticados en Cuba. Conclusiones: se presentó, por primera vez en una paciente cubana infectada por HTLV-I, la asociación de paraparesia espástica tropical con manifestaciones articulares.

Background: the Human T Cell Lymphotropic Virus type I (HTLV-I) is considered to be endemic in the Caribbean area, where it is recognized as the etiologic agent of the tropical spastic paraparesis (TSP). In Cuba, 0.037 percent seroprevalence has been reported. Objectives: to demonstrate the association of the HTLV-I infection in a patient showing tropical spastic paraparesis and chronic proliferative knee synovitis. Methods: the clinical diagnosis of spastic paraparesis and chronic proliferative knee synovitis was made. Humoral and diagnostic imaging studies were performed to support the differential and positive diagnoses. ELISA´s and Western Blot techniques were used for the detection of HTLV-I antibodies. Results: the HTLV-I infection was confirmed by serologic studies. The symptoms and signs were compatible with those established in the WHO guidelines for the diagnosis of this disease. The case no. 33 with diagnosis of HTLV-I infection in Cuba was reported. Conclusions: it was the first time that the association of TSP and joint manifestations was found in a Cuban HTLV-I infected patient.

Idiopathic Palmar Fasciitis with Polyarthritis Syndrome

A 31-yr-old Korean woman was presented with 4-month history of bilateral hand swelling and stiffness. On clinical examination, she had a painful synovitis of both hands, wrists, knees and ankles. The radiologic and histological examinations confirmed it with palmar fasciitis and polyarthritis syndrome (PFPAS). PFPAS is an uncommon disorder characterized by progressive flexion contractures of both hands, inflammatory fasciitiis, fibrosis, and a generalized inflammatory arthritis. Although most reported cases of PFPAS have been associated with various malignancies, our patient have not been associated with malignancy during 24 months follow up period from her first symptom onset. Her symptoms were improved with moderate dose of corticosteroid and she is currently taking prednisone 5 mg daily without any evidence for internal malignancy. We present here in a young Korean patient with idiopathic PFPAS who was successfully treated with administration of corticosteroid.

Brucella synovitis in ninevah province

Out of 222 patients complaining from signs and symtomps raised suspicion for brucellosis, 39 [16 males and 23 females] further more they suffered from joint and/or swelling. Blood and synovial fluid [SF] from each patient were subjected to serological tests and culture. Concerning SF specimens the investigations were extended to gross examination, Blood-Synovial Fluid Glucose Difference [G-S.F.G.D], protein determination, total and differential W.B.C. count. The investigations revealed high agglutinin titres in both blood and SF specimens, abnormal gross appearance, high value [beyond normal] of B-S.F.G.D., protein, total and differential W.B.C. count. The authors succeeded in isolating brucellae 34 and 36 of blood and SF specimens respectively, with predominance of Brucella abortus [26 out of 36]. Therefore this study recommends on looking after synovitis due to brucella whenever symptoms rais the suspicion of brucellosis or even when a patient complain from joint pain and also on doing culture for exclusive diagnosis and specific medication. Eventually to have an epidemiological concept, and determining resistance emergency of the isolates

Sjogren's Syndrome Presenting as Remitting Seronegative Symmetric Synovitis with Pitting Edema(RS3PE)

Remitting seronegative symmetric synovitis with pitting edema (RS3 PE) syndrome is characterized by symmetrical and acute synovitis, pitting edema, the absence of rheumatoid factor, increased acute phase reactants, lack of bony erosions on radiography, and benign and short clinical course. Half of all patients with Sjogren's syndrome experience arthritis during the disease course. We here describe the first case of Sjogren's syndrome presenting as RS3PE. She had swelling in knees, ankles, and wrists. After then the swelling spread to her lower legs, feet, face, and both hands. She was admitted to another hospital and was suspected of lupus or rheumatoid arthritis. Three months later, she had dry mouth and had lower lip biopsy. She was admitted to this hospital due to development of swelling in face and lower legs for 3 days. On physical examination, she had pitting edema in both hands and feet dorsum. Laboratory test showed elevated erythrocyte sedimentation rate, positivity of rheumatoid factor, anti-nuclear antibody, and anti-Ro antibody. There was no erosion in the hands radiography. Schirmer's test and lip biopsy was compatible with Sjogren's syndrome. She was diagnosed RS3 PE and Sjogren's syndrome. She was begun with prednisolone and her symptoms improved gradually.

Sjogren's Syndrome Presenting as Remitting Seronegative Symmetric Synovitis with Pitting Edema (RS3PE): comment of the article by Choi et al

No abstract available.

High resolution ultrasonography in assessment of rheumatoid knee synovitis: correlation with clinical and laboratory parameters

The formation of synovial pannus is an early event in the course of rheumatoid arthritis [RA] and could be seen before destruction of the cartilage and bone. Thus, its evaluation is of great benefit in the treatment and follow-up of clinical remission. The aim of this study was to investigate the presence of synovial pannus in the knee of RA patients with high-resolution ultrasonography and correlate the finding with the clinical and laboratory parameters of the disease. Thirty patients suffering from RA diagnosed according to the American College of Rheumatology [ACR] criteria together with 10 apparently healthy volunteers were included in the study. Both patients and controls were subjected to proper history taking and clinical examination including disease activity scoring [Mallya and Mace 1981] and functional assessment [Steinbrocker criteria, 1949] together with high resolution ultrasonography of the knee. Soluble adhesion molecules [SICAM-1 and E selectin] in the serum as well as serum and synovial L1F were also done. A high statistical significant difference was found in all laboratory and clinical findings between the patients group and control group including SIC AM-1, SE-selectin, serum and synovial LIF. Serum and synovial LIF correlated significantly with activity scoring [r- 0.8] and, functional status [r= 0.7]. However, SICAM-1 and SE-selectin correlated with activity scoring only [r= 0.48, r= 0.49 respectively]. Ultrasonographic findings were detected in the majority of the patients with statistically significant difference if compared with the control group. Synovial thickening correlated significantly with disease duration [r- 0.49], functional status [r- 0.58] and synovial LIF [r- 0.59]. Effusion showed a significant correlation with activity scoring [r= 0.5], SICAM-1 [r= 0.42] and synovial LIF [r= 0.59] while cartilage destruction correlated with disease duration [r= 0.51] and serum and synovial LIF [r= 0.53 and 0.65 respectively]. Soluble adhesion molecules may be an additional marker for disease activity while LIF may be an indicator of the severity of the disease. HRUS can evaluate the pannus formation in a trial to assess disease activity and the degree of severity to aid in therapeutic intervention and follow-up for clinical remission