RESUMO
Objective: To investigate the association of high baseline serum levels of metalloproteinases-3 [MMP-3] with structural damage to hand and feet joints, assessed by ultrasonography [US], in patients with early, treatment-naive rheumatoid arthritis [RA], without initial X-ray-visible erosions, during 24 months follow-up
Methods: Sixty-three early RA [European League Against Rheumatism/American College of Rheumatology 2010], disease-modifying anti-rheumatic drugs/glucocorticoid naive patients [mean age 53.4 +/-14.1] with symptom duration =
Results: Complete data were collected from 52 out of 63 patients. High baseline serum levels of MMP-3 [MMP-3-positive] were found in 46/63 patients. 122 bone erosions in total [1.9 bone erosions/patients] were detected by US at baseline visit and 213 erosions [4.3/patients] after 24 months. MMP-3 positive patients had significantly higher total number of erosions than MMP-3-negative [p = 0.039] and higher increase in size of bone erosions in the feet but not in the hand joints after follow-up [OR 4.82 [1.23-18.9], p = 0.024; OR 1.17 [0.320-4.26], p = 0.816 respectively]
Conclusion: After 2 years of follow-up, US assessment showed a higher number of new bone erosions in MMP-3-positive compared to MMP-3-negative patients with early RA and no visible initial radiographic changes. High baseline levels of MMP-3 predict significantly higher structural damage progression at the level of feet, but not at the level of hand joints
RESUMO
The aim of this paper is to report the first case of drug-induced eosinophilic myocarditis [EM] in a patient with hereditary periodic fever syndrome [PFS]. Case: A 28-year-old man with hyper-IgD syndrome, one of the PFS, developed a sulfasalazine-induced systemic hypersensitivity reaction complicated by EM. Thirteen days after sulfasalazine introduction, which had been given for arthritis, the patient developed fever, facial/neck edema, rash and cardiogenic shock, and died within 8 h. The autopsy revealed hemophagocytosis, while acute heart failure caused by necrotizing EM was established as the cause of death. This was a case of drug-induced EM in a patient with PFS that had an atypical presentation, rapid evolution and poor outcome