Artropatias iatrogênicas droga-induzidas / Iatrogenic drug-induced arthropathy

Um grupo de pacientes idosos apresenta várias doenças, levandoa consumir inúmeras drogas. Por outro lado, o metabolismo dessasdrogas se encontra bastante alterado pelas condições especiais doprocesso de envelhecimento. Portanto, um determinado sintoma aser combatido pode não ser causado pela devida doença, mas sim,por algum tipo de droga que o paciente esteja usando. Este capítulotem como escopo enumerar as síndromes reumáticas que podem seruma conseqüência das várias drogas administradas aos idosos.

Osteoarticular complications related to HIV infection and highly active antiretroviral therapy

With the significant increase in life expectancy for HIV-infected patients in the era of high potency antiretroviral therapy, major metabolic changes have been observed due to the prolonged period of the viral infection and the treatment itself. Osteoarticular changes resulting from these processes are mainly reported in long term HIV-infected patients receiving high potency antiretroviral therapy and include osteopenia/osteoporosis, osteonecrosis, carpal tunnel syndrome and adhesive capsulitis of the shoulder.

Quinolone induced arthropathy in adolescents and adults

To ascertain the incidence, clinical pattern and outcome of arthropathy in adolescents and adults induced by different quinolones. Cases of enteric fever treated with different quinolones having no previous history of joint disorders who developed arthropathy and improved well with conservative treatment were labelled as quinolone induced arthropathy. In-patients of Rajshahi and Khulna Medical College Hospitals and private clinics of the authors. Four hundred and three cases of enteric fever were treated with various quinolones during the period January 1995 to June 1999. Main outcome measures: Clinical characteristics, incidence, relation with quinolones used and outcome of quinolone induced arthropathy. The age of the 403 [males 260 and females 143] patient ranged from 13-60 years. They were treated with either ciprofloxacin, pefloxacin or ofloxacin. Out of them 31 [7.7%] patients developed arthropathy. It was highest with pefloxacin [12.5%]. The arthropathy was maximum [11.8%] in the age group of 11-20 years. Patterns of arthropathy were oligoarthropathy [23], polyarthropathy [7] and monoarthropathy [1]. Although quinolones use is not advocated in children for development of arthropathy, it also occurs in adolescents and adults in considerable number of cases. It improves well with conservative treatment without residual effect

Ciprofloxacin use: acute arthropathy and long-term follow up.

OBJECTIVE: To assess whether children treated with ciprofloxacin in 1990 had developed any permanent joint damage. DESIGN: Retrospective questionnaire-based follow-up study. SETTING: Adverse Drug Reaction (ADR) Monitoring Center in Mumbai. SUBJECTS: 3341 children treated with ciprofloxacin in 1990, including 7 who had developed a ciprofloxacin-related acute arthropathy. METHODS: A questionnaire was sent in January 1995 to 147 pediatricians who had reported to us children in whom ciprofloxacin was prescribed in 1990. The information sought for included the number of children who had followed-up beyond 2 years and details of any joint-related complaints noted in them on long-term follow-up. RESULTS: Long-term follow-up was reported in 582 of these 3341 children. No joint-related complaints had developed in 581 children, either as an acute ADR in 1990 or as a delayed ADR during a minimum follow-up period of 2 years. Long-term follow-up was available in only 1 of the 7 children in whom a ciprofloxacin-related acute arthropathy had developed in 1990, and this child was now asymptomatic. New information was received about 13 children treated with ciprofloxacin during 1991-1994 who had developed a ciprofloxacin-related acute arthropathy. In the total 20 children, aged 2-12 years, reported to us for acute ADR, the arthropathy (joint pains, restriction of joint movements and/or swelling of joint) had developed on day 1 to 8 of ciprofloxacin therapy, and in 18 the acute arthropathy had resolved within 1 day to 4 weeks of either discontinuing or completing ciprofloxacin therapy. Outcome in the remaining 2 children was not available. CONCLUSIONS: Ciprofloxacin use can cause an acute reversible arthropathy, but in this study there is no evidence that its use can cause a delayed arthropathy or any permanent joint damage.

Manifestaciones osteomioarticulares de causa tóxico-farmacológica / Osteomyoarticular manifestations due to toxico-pharmacological cause

Los autores hacen referencia a productos industriales y farmacológicos que pueden inducir osteomioartropatias tóxicas. Al respecto detallan aspectos patogénicos y las medidas a tomar