Lupus eritematoso sistémico en una zona austral de Chile / Systemic lupus erythematosus in a southern zone of Chile

Introducción. El lupus eritematoso sistémico (LES) se caracteriza por un amplio espec-tro de manifestaciones clínicas y serológicas. La última serie de enfermos chilenos fue publicada el año 1994 y contempló un total de 218 pacientes. Objetivo. Contribuir con nuevos datos epidemiológicos en una cohorte de 67 enfer-mos con LES en una zona austral de nuestro país.Pacientes y métodos. De forma retrospectiva se revisaron 100 fichas de pacientes con diagnóstico de LES realizado por médico reumatólogo del Hospital de Puerto Montt (HPM), identificados a través de registros obtenidos a contar de julio de 2013 cuando esta patología se incluyó dentro de las Garantías Explícitas en Salud (GES). 67 cumplían al menos cuatro criterios Systemic Lupus International Collaborating Clinics (SLICC) 2012 y los datos obtenidos fueron sometidos a análisis estadístico utilizando el programa SPSS versión 15.0. Resultados: 63 (94%) son mujeres. La edad promedio al momento del diagnóstico fue 38,1 años y el tiempo transcurrido desde el inicio de los síntomas fue 12,3 me-ses. Las manifestaciones clínicas más frecuentes fueron sinovitis (65.7%), alopecia (47.8%), compromiso renal (43.3%) y alteraciones cutáneas (38.8%). Sesenta (90%) tenían ANA positivo, 34 (50.7%) anti-DNA positivo y 45 (67.2%) hipocomplementemia. Se identificaron 29 (43.3%) pacientes con compromiso clínico y/o histológico renal, de los cuales a 13 se les realizó biopsia renal, correspondiente en el 69% de los casos a nefritis lúpica membrano-proliferativa.Conclusiones. Nuestra cohorte no difiere sustantivamente de otras, salvo por la baja prevalencia de manifestaciones cutáneas. Se detectó la falta de acceso a biopsia renal y exámenes serológicos autoinmunes dado principalmente por falta de profesionales idóneos en nuestra zona que permitan el acceso universal a estos procedimientos.Este estudio permite proporcionar información actualizada de pacientes con LES en una zona austral de Chile.

Introduction. Systemic lupus erythematosus (SLE) is characterized by a broad spec-trum of clinical and serological manifestations. The last series of chilean patients was published in 1994 and included a total of 218 patients.Objective. To contribute with new epidemiological data in a cohort of 67 patients with SLE in a Southern area of our country.Patients and methods. In a retrospective way, 100 records of patients diagnosed with SLE were reviewed by a rheumatologist at the Hospital de Puerto Montt (HPM), identified through records obtained as of July 2013 when this pathology was included in the Explicit Health Guarantees. (GES) 67 met at least four criteria Systemic Lupus International Collaborating Clinics (SLICC) 2012 and the data obtained were subjected to statistical analysis using the SPSS program version 15.0.Results: 63 (94%) are women. The average age at diagnosis was 38.1 years and the time elapsed since the onset of symptoms was 12.3 months. The most frequent clinical manifestations were synovitis (65.7%), alopecia (47.8%), renal involvement (43.3%) and skin alterations (38.8%). Sixty (90%) had positive ANA, 34 (50.7%) positive anti-DNA and 45 (67.2%) hypocomplementemia. We identified 29 (43.3%) patients with clinical and / or renal histological involvement, of whom 13 were under-going a renal biopsy corresponding to 69% of the cases of membranous proliferative lupus nephritis.Conclusions. Our cohort does not differ substantively from others, except for the low prevalence of cutaneous manifestations.The lack of access to renal biopsy and self-immune serological tests was detected, mainly due to the lack of qualified professionals in our area that allow universal access to these procedures.This study allows us to provide updated information on patients with SLE in a Southern zone of Chile.

Vasculite reumatoide - Relato de caso / Rheumatoid Vasculitis - Case Report

Resumo A artrite reumatoide (AR) é uma doença crônica autoimune inflamatória sistêmica e sua principal manifestação é a sinovite persistente, que compromete articulações periféricas de forma simétrica. Apesar do seu potencial destrutivo, a evolução da AR é muito variável. Alguns pacientes podem ter apenas um processo de curta duração oligoarticular com lesão mínima, enquanto outros sofrem uma poliartrite progressiva e contínua e evoluem com acometimento de outros órgãos e sistemas, como pele, coração, pulmões, músculos e mais raramente vasos sanguíneos, que leva à vasculite reumatoide. O objetivo deste estudo foi descrever um caso de vasculite reumatoide, uma condição rara e grave.

Abstract Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease and its main manifestation is persistent synovitis affecting peripheral joints symmetrically, In spite of its destructive potential, the evolution of RA is highly variable. Some patients may have only a short-term process oligoarticular with minimum lesion, while others suffer a polyarthritis evolving with progressive and continuous involvement of other organ systems such as skin, heart, lungs, muscles and blood vessels rarely leading to rheumatoid vasculitis. The aim of this study was to describe a case of rheumatoid vasculitis a rare and severe condition.

Screening for frailty in older adults using a self-reported instrument / Rastreamento de fragilidade em idosos por instrumento autorreferido

OBJECTIVE To validate a screening instrument using self-reported assessment of frailty syndrome in older adults. METHODS This cross-sectional study used data from the Saúde, Bem-estar e Envelhecimento study conducted in Sao Paulo, SP, Southeastern Brazil. The sample consisted of 433 older adult individuals (≥ 75 years) assessed in 2009. The self-reported instrument can be applied to older adults or their proxy respondents and consists of dichotomous questions directly related to each component of the frailty phenotype, which is considered the gold standard model: unintentional weight loss, fatigue, low physical activity, decreased physical strength, and decreased walking speed. The same classification proposed in the phenotype was utilized: not frail (no component identified); pre-frail (presence of one or two components), and frail (presence of three or more components). Because this is a screening instrument, “process of frailty” was included as a category (pre-frail and frail). Cronbach’s α was used in psychometric analysis to evaluate the reliability and validity of the criterion, the sensitivity, the specificity, as well as positive and negative predictive values. Factor analysis was used to assess the suitability of the proposed number of components. RESULTS Decreased walking speed and decreased physical strength showed good internal consistency (α = 0.77 and 0.72, respectively); however, low physical activity was less satisfactory (α = 0.63). The sensitivity and specificity for identifying pre-frail individuals were 89.7% and 24.3%, respectively, while those for identifying frail individuals were 63.2% and 71.6%, respectively. In addition, 89.7% of the individuals from both the evaluations were identified in the “process of frailty” category. CONCLUSIONS The self-reported assessment of frailty can identify the syndrome among older adults and can be used as a screening tool. Its ...

OBJETIVO Validar instrumento de rastreamento por avaliação autorreferida da síndrome de fragilidade entre idosos. MÉTODOS Estudo transversal com dados do estudo Saúde, Bem-estar e Envelhecimento, realizado em São Paulo, SP. A amostra probabilística foi constituída por 433 idosos (idade ≥ 75 anos) avaliados em 2009. O instrumento autorreferido utilizado pode ser aplicado a idosos ou proxi-informantes e foi composto por questões dicotômicas relacionadas diretamente a cada componente do fenótipo de fragilidade considerado padrão-ouro: perda de peso não intencional, fadiga, baixa atividade física, redução de força e de velocidade de marcha. Manteve-se a classificação proposta no fenótipo: não frágil (nenhum componente identificado); pré-frágil (presença de um ou dois componentes) e frágil (presença de três ou mais componentes). Por tratar-se de instrumento de rastreamento, incluiu-se a categoria processo de fragilização (pré-frágil e frágil). Utilizou-se o coeficiente α de Cronbach na análise psicométrica para avaliar confiabilidade e validade de critério, sensibilidade, especificidade e valores preditivos positivo e negativo. Para verificar a adequação do número de componentes propostos, utilizou-se a análise fatorial. RESULTADOS Os componentes “redução de velocidade de caminhada” e “redução de força” apresentaram boa consistência interna (α = 0,77 e α = 0,72, respectivamente) e a “baixa atividade física” (α = 0,63) foi um pouco menos satisfatória. A sensibilidade e a especificidade para identificação dos pré-frágeis foram de 89,7% e 24,3% e dos frágeis, 63,2% e 71,6%, respectivamente. A categoria “processo de fragilização” identificou, igualmente, 89,7% das pessoas em ambas as avaliações. CONCLUSÕES O instrumento de avaliação de fragilidade autorreferida é capaz de identificar a síndrome entre as pessoas idosas, podendo ser utilizado como instrumento de rastreamento, ...

Escore US7 modificado na avaliação de sinovite em pacientes com artrite reumatoide inicial / The modified US7 score in the assessment of synovitis in early rheumatoid arthritis

Objetivo: Avaliar o escore US7 modificado (escore MUS7 SIN) na avaliação de pacientes com artrite reumatoide inicial (ARI). Além disso, foram examinados recessos dorsais e palmares dos punhos, bem como pequenas articulações das mãos e dos pés, para o diagnóstico de sinovite, mediante uma avaliação global das articulações. Métodos: A amostra do estudo compreendeu 32 pacientes tratados para artrite, com 13 meses como duração média da doença. Foi utilizado um aparelho de ultrassonografia (US) com transdutor de alta frequência. As mãos dos participantes também foram radiografadas e analisadas pelo escore de Larsen. Resultados: Nas 832 articulações examinadas, detectou-se sinovite em 173 (20,79%), tenossinovite em 22 (4,91%) e erosões em três (1,56%). A sinovite foi predominantemente detectada no recesso dorsal (73,38%) das articulações MCF e IFP, quando comparado com o recesso palmar (26%). A presença de sinovite nas articulações avaliadas teve correlação com os resultados clínicos (HAQ-DI, DAS28), laboratoriais (anti-PCC, FR, PCR) e ultrassonográficos (r = 0,37 a r = 0,42; p = 0,04 a p = 0,003). Encontramos correlação do escore MUS7 SIN para US na técnica da escala de cinzas (gray scale) ou na técnica de Doppler de amplitude (power Doppler) com os valores do instrumento DAS28 (PCR) (r = 0,38; p = 0,0332) e com os resultados da PCR (r = 0,39; p = 0,0280), respectivamente. Conclusão: O recesso dorsal, o punho e as pequenas articulações podem ser considerados como locais importantes para a detecção de sinovite pelo escore MUS7 SIN em pacientes com ARI. .

Objective: To evaluate the modified US7 score (MUS7 score SYN) in the assessment of patients with early rheumatoid arthritis (ERA). In addition, dorsal and palmar recesses of the wrists as well as of small joints of the hands and feet were examined for the presence of synovitis by means of a global assessment of joints. Methods: The study sample comprised 32 patients treated for arthritis, with an average disease duration of 13 months. An ultrasound machine with high frequency transducer was used. Hands were also X-rayed and analysed by Larsen score. Results: Out of the 832 examined joints, synovitis was detected in 173 (20,79%), tenosynovitis in 22 (4,91%), and erosions in 3 (1,56%). Synovitis was predominantly detected in the dorsal recess (73,38%) of MCP and PIP joints, when compared with palmar recess (26%). The presence of synovitis in the joints evaluated correlated with clinical (HAQ-DI, DAS28), laboratory (ACPA, RF, CRP), and ultrasound results (r = 0,37 to r = 0,42; p = 0,04 to p = 0,003). We found correlation of the MUS7 score SYN of the gray scale US or of the power Doppler US with DAS28 (PCR) values (r = 0,38; p = 0,0332), and with CRP results (r = 0,39; p = 0,0280), respectively. Conclusion: The dorsal recess, the wrist, and small joints can be considered as important sites to detect synovitis by the MUS7 score SYN in patients with ERA. .

Ultrassonografia em portadores de artrite reumatoide: o que o reumatologista clínico deve saber / Ultrasonography in rheumatoid arthritis: what rheumatologists should know

Recentemente, a ultrassonografia vem ganhando prestígio como método adjuvante no diagnóstico e no acompanhamento terapêutico da artrite reumatoide, embora a radiografia ainda seja a modalidade de imagem tradicionalmente utilizada em larga escala com esses propósitos. O grande trunfo do estudo ultrassonográfico, que vem motivando pesquisas entusiastas na área, reside em sua capacidade de detectar sinovite e erosão óssea em fase pré-radiográfica, o que tem sido cada vez mais valorizado na prevenção do dano estrutural tardio e definitivo. Por ser um assunto relativamente novo, vários artigos científicos vêm sendo publicados em anos recentes sobre as potenciais aplicações da ultrassonografia em portadores de artrite reumatoide, alguns voltados a pesquisadores, outros voltados ao reumatologista clínico. O objetivo deste artigo é depurar a bibliografia atualmente disponível e descrever apenas os conceitos de aplicabilidade prática na rotina diária do reumatologista clínico.

Ultrasonography has recently gained prestige as an adjuvant method for the diagnosis and therapeutic follow-up of rheumatoid arthritis, although radiography remains the imaging modality traditionally and widely used for those purposes. The great advantage of the ultrasonographic study, which has motivated enthusiastic research in the area, resides in its capacity to detect synovitis and bone erosion at a pre-radiographic phase, which has been increasingly valued in preventing late and definitive structural damage. Because that is a relatively new subject, several scientific articles have been published in recent years about the potential applications of ultrasonography in individuals with rheumatoid arthritis, some of which directed to researchers and others to clinical rheumatologists. This study aimed at assessing the currently available bibliography on the subject and at describing only the concepts that are of practical applicability in the daily routine of clinical rheumatologists.

An experimental study to compare inflammatory response due to liquid or gas joint distension in horses submitted to arthroscopy / Estudo experimental para comparar a resposta inflamatória decorrente da distensão líquida ou gasosa em cavalos submetidos à artroscopia

PURPOSE: To assess comparatively the inflammatory response that follows CO2 or Ringer's lactate joint capsular distension of horses submitted to experimental arthroscopy METHODS: Each animal was submitted to a bilateral tarsocrural arthroscopy employing gas distention in one joint and fluid distention in the contralateral joint. Synovial fluid was evaluated at 0, six, 12, 24 and 48 hours post-operative. RESULTS: The use of CO2 for arthroscopy causes an acute and mild synovitis alike to the liquid capsular distension, showing similar synovial fluid increase of leukocytes, TP, and TNF-α. Although synovial fluid PGE2 content was higher in joints submitted to CO2 distension, lower levels of hemoglobin and leukocytes oxidative burst after surgery indicates that CO2 arthroscopy decreased intra-articular bleeding and activation of infiltrating leukocytes. CONCLUSIONS: The use of CO2 for arthroscopic examination causes acute and mild synovitis that is similar to the effects caused by the liquid capsular distension. CO2 also seems to decrease intra-articular bleeding and activation of leukocytes.

OBJETIVO: Avaliar comparativamente a resposta inflamatória decorrente da distensão líquida ou gasosa em cavalos submetidos ao exame artroscópico. MÉTODOS: Cada animal foi submetido a uma artroscopia bilateral tarsocrural empregando uma distensão com gás em uma articulação e líquido na articulação contralateral. O líquido sinovial foi avaliado as zero, seis, 12, 24 e 48 horas do pós-operatório. RESULTADOS: A utilização de CO2 para a artroscopia provoca uma sinovite aguda e leve tal como a distensão capsular por líquido, mostrando um aumento similar de leucócitos, TP (proteína total) e TNF-a. Embora no líquido sinovial a quantidade de PGE2 tenha sido maior nas articulações submetidas à distensão por CO2, níveis mais baixos de hemoglobina e explosão oxidativa de leucócitos após a cirurgia indica que a artroscopia com CO2 diminuiu o sangramento intra-articular e ativação de leucócitos. CONCLUSÕES: A utilização de CO2 para exame artroscópico provoca uma sinovite aguda e leve que são semelhantes aos efeitos causados pela distensão capsular por líquido. O CO2 também parece diminuir o sangramento intra-articular e a ativação de leucócitos.

Radiosinovectomía de muñeca guiada por ultrasonido: experiencia de un caso clínico y revisión del tema / Ultrasound-guided wrist radiosynovectomy: case report and topic review

Radiosynovectomy is a local form of radiotherapy used as second-line treatment in the management of inflammatory and non-inflammatory arthropathies with unsatisfactory response to local or systemic corticosteroid therapy. Its efficacy is similar to that of surgical synovectomy, with the advantages of being a low-cost and minimally- invasive treatment that requires a shorter recovery time. Its efficacy is greater in the treatment of inflammatory arthritis characterized by synovitis, such as rheumatoid arthritis and juvenile chronic arthritis with mono/oligoarticular involvement, especially in upper extremity joints. A number of isotopes can be used in colloidal suspensions. Rhenium-186-sulphide colloid is currently indicated for the treatment of medium-sized joints. The ultrasound-guided injection is suitable for small joints, such as wrist. For proper and safe use and administration of this technique the collaboration of a trained and experienced radiologist is critical to successful treatment.

La radiosinovectomía es una forma local de radioterapia utilizada como tratamiento de segunda línea en el manejo de artropatías inflamatorias y no inflamatorias con respuesta insatisfactoria a la terapia sistémica o local con corticoesteroides. Tiene una eficacia similar a la sinovectomía quirúrgica, con las ventajas de ser un tratamiento de menor costo, menos cruento y con menor tiempo de convalecencia. Su eficacia es mayor en artropatías inflamatorias caracterizadas por sinovitis, como la artritis reumatoide y artritis crónica juvenil, con compromiso mono u oligoarticular y en articulaciones de extremidades superiores. Existen múltiples isótopos que se pueden utilizar en suspensiones coloidales, siendo el sulfuro coloidal de renio-186 el utilizado para la articulación radiocarpiana. Una técnica de administración adecuada es fundamental para el éxito del tratamiento, siendo la inyección con guía ultrasonográfica adecuada para articulaciones de volumen pequeño, instancia en la que la colaboración del médico radiólogo entrenado es fundamental.

Wrist ultrasound analysis of patients with early rheumatoid arthritis

In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS) and gray scale ultrasound (GSUS) with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data. Twenty-one patients (17 women and 4 men) with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP). The average disease duration was 14 months. The patients were 66.6 percent Caucasians and 33.3 percent non-Caucasians, with a mean age of 42 and 41 years, respectively. A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz) transducer. All patients were X-rayed, and the Larsen score was determined for the joints, with grades ranging from 0 to V. This study showed significant correlations between clinical, sonographic and laboratory data: GSUS and swollen right wrist (r = 0.546), GSUS of right wrist and swelling of left wrist (r = 0.511), PDUS of right wrist and pain in left wrist (r = 0.436), PDUS of right wrist and C-reactive protein (r = 0.466). Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.

thorns I come across in my imaging practice

Establishing the diagnosis of residual thorn foreign bodies in soft tissue is not an easy task, when it is not palpable. This study is done to evaluate the high resolution Ultrasound imaging features of residual date palm tree thorns and to find out the associated complications with these injuries. Here we intend to give wide ultrasound imaging features of date palm tree thorn injury and associated complications

Arthroscopic synovectomy in management of chronic synovitis of the knee

Arthroscopic synovectomy was done for 23 knees in 21 patients during the period from February 1996 till January 1999. The age ranged from 16 to 54 years old with an average of 31.9 years. The aetiology was rheumatoid arthritis in 9 knees [7 patients], chondromatosis synvii in 2 knees, pigmented villonodular synovitis in 3 knees, chondrocalcinosis in one knee, tuberculous synovitis in 2 knees and post traumatic synovitis in 6 knees. The follow up period ranged from 6 to 38 months with an average of 18.34 months. Satisfactory results were obtained in 78.26% of cases. Arthroscopic synovectomy yielded satisfactory results as those published for open synovectomy but with less postoperative morbidity, with better functional capacity with more rapid return to activity with shorter hospital stay

Sinovitis por aluminio: a propósito de un caso / Synovitis by aluminium: a purpose of a case

Se trata de paciente masculino de 21 años quien sufre herida por arma de fuego en rodilla izquierda, se ingresa con la impresión diagnóstica de Sinovitis Plúmbica, se práctica sinovectomía, y al realizar Microscopia Electrónica de Barrido, se demuestra la existencia de Aluminio y no de plomo, por lo que concluimos que se trata de una Sinovitis por Aluminio

Síndrome de RS3PE

La sinovitis simétrica seronegativa remitente con edema blando (Síndorme R S3 P E por las iniciales en ingles) constituye una forma diferente de artritis que se observa en personas de edad, generalmente mayores de 60 años y se caracteriza por tener pronóstico excelente a pesar de iniciarse en forma aguda e incapacitante en la mayoría de los casos. Se presenta el resumen de dos historias que reunen los criterios clínicos establecidos para esta entidad.

Study of the relationship between arthroscopic and histopathological changes in rheumatoid synovitis of the knee joint

The relationship between the arthroscopic appearance of both the synovium and the articular cartilage of the knee and the histopathological changes, in 30 seropositive R.A. patients, was carried out in this investigation. A significant correlation [P < 0.01] was found between total arthroscopic scores and total histopathological scores, but no significant correlation between total arthroscopic and individual histopathological scores. Active villous formation was significantly related [p<0.05]. to synovial cell lining. The intensity of lymphocytic infiltration was significantly related [[p<0.01] to both total arthroscopic score and active villous formation. No correlation between disease activity parameters and both arthroscopic and histopathological picture. Also no correlation between neither synovial hyperaemia nor articular cartilage changes and any of the histological features

Complicaçäo da artroplastia do semilunar: sinovite reacional / Complication of lunate arthroplasty: reactional synovitis

Sinovite reacional do tipo corpo estranho e com destruiçäo óssea focal desenvolveu-se em dois pacientes submetidos anteriormente a artroplastia do semilunar para tratamento da enfermidade de Kienböck. Os pacientes foram submetidos a biópsia e ao exame histopatológico, constatando-se processo inflamatório do tipo corpo estranho com presença de numerosas partículas de silicone. As próteses se encontravam deformadas, na superfície de contato com o rádio, e com coloraçäo amarelada opaca. Os dois casos apresentaram instabilidade rotacional do escafóide e foram submetidos à remoçäo da prótese e à artrodese triescafóide