Fascitis eosinofílica: experiencia en tres casos / Eosinophilic fasciitis: report of 3 cases

Eosinophilic fasciitis (EF) is a scleroderma-like disease of unknown etiology characterized by cutaneous swelling and induration that affects predominantly the extremities, elevated immune globulins, and peripheral eosinophilia. We report three patients with clinical, laboratory and pathologic characteristics of EF. The main symptoms were cutaneous and included "peau d' orange", groove signs and induration of the affected extremities. Two patients had skin changes after exercising and one had a hypothyroidism. None had extra-cutaneous manifestations. All patients had peripheral eosinophilia. Pathologic findings were thickening and inflammation of the fascia and normal epidermis. Only one patient was treated with prednisone 30 mg daily and showed only moderate improvement. There is no follow up information about the other two cases. EF is a rare disorder classified at times as scleroderma variants. However, its clinical picture, capillary microscopy findings, pathology and prognosis differentiate it from systemic sclerosis

Rendimiento del estudio microbiológico en el diagnóstico de la infección osteoarticular / Yield of microbiological study in the osteoarticular infection diagnosis

La infección osteoarticular (IOA) es una patología grave y secuelante, en la que el diagnóstico precoz cambia el curso de la enfermedad. El rendimiento del estudio microbiológico es variable (60-90 porciento) y depende de la localización de la infección, el tipo de muestra y los métodos microbiológicos utilizados. El objetivo de este estudio fue mejorar la confirmación bacteriológica mediante una solicitud ampliada de cultivos y de nuevas estrategias para el transporte e inoculación de las muestras. Se estudiaron los pacientes con sospecha de IAO mediante tinción de gram directa y cultivos aeróbico, en medio de thayer martin, anaeróbico, para hongos, micobacterias y hemocultivos. Todas las muestras de líquido sinovial se inocularon en tubos microbiológicos (becton dickinson) y las muestras de tejido obtenidas por punción bajo tomografía axial computada (tac) fueron innoculadas en botellas de hemocultivos (bact/aler@, organon teknica). Se estudiaron 86 pacientes de los cuales 51 correspondían al ioa. El rendimiento microbiológico global fue de 86 porciento, siendo más alto en osteomielitis aguda e infección de prótesis que en artritis séptica (88, 100 y 82 porciento respectivamente). Staphylococcus aureus fue el patógeno más prevalente, independiente del tipo de ioa, seguido de streptococcus pyogenes y streptococcus pneumoniae. La tinción de gram directa tuvo una sensibilidad de 57 porciento y en 5 pacientes cuyos cultivos fueron negativos, fue positiva. Los hemocultivos fueron positivos como método único en 6 pacientes. La sensibilidad del cultivo de tejido obtenido por punción bajo tac en botella de hemocultivo fue de 90 porciento. La posibilidad del cultivo de muestra de tejido óseo o sinovial fue mejor que la de líquido articular (92 versus 69 porciento) y la confirmación microbiológica global fue mejor en adultos que en niños (94 y 72 porciento respectivamente). Se concluye que la implementación de tubos microbiológicos y la inoculación directa en la botella de hemocultivo son métodos útiles para la recuperación bacteriana. La muestra de tejido debe ser recomendada antes que la de líquido articular y la tinción de gram y el hemocultivo deben ser considerados como métodos de gran aporte en la confirmación microbiológica de las IOA

Capacidad de predecir una recaída de lupus eritematoso generalizado, mediante anticuerpos anti-DNA de hebra doble, por la técnica de Farr / Predictive capacity of double stranded anti DNA antibodies for relapses in patients with inactive systemic lupus erythematosus using Farr technique

Background: Patients with inactive systemic lupus erythematosus (SLE) and elevated high affinity double-stranded anti-DNA antibodies (anti-dsDNA), measured using Farr technique, would have a risk of relapse that fluctuates between 40 to 80 percent according to different series. Aim: To study the association between anti-dsDNA levels measured using Farr technique and disease activity and their predictive capacity for relapses. Material and methods: Anti-dsDNA antibodies were measured according to Farr method in 60 healthy subjects, 69 patients with other connective tissue diseases and in 120 patients with SLE. Farr positive were considered those individuals with anti-dsDNA levels over 10.4 IU/ml. Disease activity, assessed using MEX-SLEDAI score was related with anti-dsDNA levels in 101 patients. Forty seven patients with inactive disease were followed for 17ñ14 months. Results: Anti-dsDNA levels were 3ñ2.5 IU/ml (range 1-26) in subjects without LED, and 127ñ500 IU/ml (range 1-5280) in patients with LED. Sixty subjects had an active SLE and 43 (72 percent) were Farr positive; in 41 the disease was inactive and 13 (32 percent) were Farr positive (p <0.001), OR 5.45. Twelve of the 47 followed patients had a relapse and 10 (83 percent) were Farr positive. Of those that did not have a relapse, 13 (37 percent) were Farr positive (p< 0.02, RR 5.22). Six of 15 patients that were followed for more than on year (40 percent), were Farr positive. Conclusions: Elevated anti-dsDNA antibodies measured using Farr technique in patients with inactive generalised lupus erythematosus, predicted the risk of relapse. However less than half of patients with inactive disease and elevated Farr relapsed in a period of one year. The need to treat patients with inactive SLE and positive Farr should therefore be considered debatable

Artritis seronegativas: reexamen del diagnóstico inicial y pronóstico al cabo de 10 años / Seronegative arthritis: diagnosis and prognostic reassessment after 10 years

Seronegative arthritides are a heterogeneous group of diseases that includes rheumatoid arthritis with negative rheumatoid factor. Between 1980 and 1984 we studied 38 patients with seronegative arthritis. Thirty of these patients were reassessed in 1994 after 9 or 20 years of evolution. Seventeen patients had a diagnosis of seronegative rheumatoid arthritis; this diagnosis was maintained in 12, changed to seropositive rheumatoid arthritis in 3, to psoriatic arthritis in 1 and connective tissue disease in 1. Thirteen patients had a diagnosis of undifferentiated arthritis; in 1994 the diagnosis was maintained in 3, 7 patients were diagnosed as having a sppondyloarthropathy, 2 as having a reactive arthritis and 1 as having a connective tissue disease. In 1994, nine patients fulfilled the 1991 criteria for spondyloarthritis and 6 of these did so on admission. Six of 12 patients with seronegative rheumatoid arthritis had an active disease or used antiinflammatory drugs and 64 percent had erosions on hand X ray examination. These figures are in contrast with the enigm evolution classically attributed to this disease and agree with recent reports. The usefulness of classification criteria for rheumatoid arthritis and spondyloarthritis in the initial assessment of patients with seronegative arthritis is emphasized

Infección y artritis reactiva: correlación clínico bacteriológica en artropatía seronegativa / Infection and reactive arthritis: clinical bacteriological correlation in seronegative arthropathies

The aim of this study was to search infections that trigger reactive arthritis. Eigthy-six patients with seronegative arthritis (SNA) were studied; 32 had reactive arthritis, 21 ankylosing spondylitis, 7 psoriatic arthritis and 26 undifferentiated seronegative oligoarthritis. As controls, 70 patients with connective tissue diseases (CTD) and 55 healthy volunteers (HV) were studied. Serological evidence for infection with Chlamydia trachomatis was studied with micro immunofluorescence, looking for L2 and BED serotypes and serological evidence for Yersinia infection, using a commercial kit. Stool cultures were done in seven patients with recent diarrhea and endourethral or endocervical cultures in 35 individuals. Serotypes L2 or BED were positive in 23 of 83 patients with SNA, 3 of 39 patients with CTD and 4 of 55 HV (p<0.03). IgG class antibodies against L2 were detected in 17 percent of SNA patients, 2.6 percent of CTD patients and 5.4 percent of HV (p<0.05). IgM class antibodies were detected in 6 SNA patients, 0 CTD patients and 2 HV (NS). 12 of 35 cultures were positive for Chlamydia. As a whole 30 percent of SNA patients has serological or bacteriological evidence for Chlamydia infection. Serology for Yersinia was positive in 39 of 81 SNA patients, 1 of 54 CTD patients and 3 of 51 HV (p<0.01). Rates of infections were similar among male, female, HLA B27 positive and HLA negative subjects. It is concluded that SNA patients have a high prevalence of infections by Chlamydia trachomatis or Yersinia enterocolitica

Insuficiencia renal y respiratoria en una embarazada con esclerosis sistémica progresiva: caso anatomo-clínico / Renal and respiratory failure in a pregnant woman with progressive systemic sclerosis: anatomical clinical case

Pregnancy in patients with systemic sclerosis may predispose to a fast progression of the disease. We report a woman with systemic sclerosis and a multiple visceral involvement that during the third trimester of pregnancy developed a respiratory failure caused by interstitial fibrosis complicated with alveolar hemorrhage, bronchopneumonia and respiratory distress syndrome and a renal failure. On admission, she was subjected to a cesarean section, delivering a 1205 g newborn. In spite of intensive care support, the multisystemic failure became unmanageable and the patient died 15 days after admission. Literature review, although sometimes controversial, indicates that pregnancy is a situation with definitive death risk for patients with systemic sclerosis, that requires a close follow up

Gota: una revisión clínica / Gout: a clinical review

La gota es una enfermedad articular crónica, habitualmente autolimitada; a través del tiempo con cierta frecuencia se encuentran nódulos llamados tofos y se asocia a litiasis renal. Se analiza el metabolismo del ácido úrico, la incidencia de la enfermedad, el mecanismo de la inflamación. En el cuadro clínico se describe el ataque agudo, la gota crónica tofácea. Se hace énfasis en el tratamiento del ataque agudo, de la gota crónica y de la litiasis renal úrica

Arteritis de la temporal y polimialgia reumática: estudio clínico / Temporal arteritis and polymyalgia rheumatica: a clinical study

La arteritis de la arteria temporal es una vasculitis granulomatosa cuya frecuencia aumenta en las personal de edad. Clínicamente puede manifestarse por compromiso del estado general, síndrome depresivo y síntomas derivados de la obstrucción vascular como claudicación de mandíbula, dolor en el trayecto arterial y ceguera. En el 50% puede presentarse como polimialgia reumática, la que se caracteriza por mialgias y artrialgias proximales, síndrome febril, eritrosedimentación elevada y compromiso del estado general. Se analizan 18 pacientes, diez con polimialgia reumática y ocho con arteritis de la temporal; los hallazgos clínicos más frecuentes son: mialgias proximales y decaimiento 83%, artralgias y cefalea 66%, rigidez 50% y dolor en la arteria temporal 38%. La alteración de laboratorio más frecuente fue eritrosedimentación elevada. Esta serie clínica confirma la presencia de arteritis de temporal y polimialgia reumática en nuestro medio, sugiriendo que son más frecuentes de lo que se ha reportado a la fecha