Manifestações musculoesqueléticas no hiperparatireoidismo primário / Musculoskeletal manifestations in primary hyperparathyroidism

OBJETIVO: Avaliar as manifestações musculoesqueléticas do hiperparatireoidismo primário (HPP). PACIENTES E MÉTODOS: Foram avaliados dados clínicos, com ênfase nas manifestações musculoesqueléticas, dados laboratoriais e densitométricos de 21 pacientes com HPP acompanhados no nosso Serviço. RESULTADOS: Foram estudadas apenas mulheres no período menopausa, com média de idade de 67,9 ± 11,2 anos, sendo 16 (76,2 por cento) de cor branca. Os níveis séricos do cálcio total, fósforo, 25 hidroxivitamina D e paratormônio (PTH), no diagnóstico, foram respectivamente de 10,6 ± 0,9 mg/dL, 2,9 ± 0,7 mg/dL, 16,6 ± 6,6 ng/mL e 113,7 ± 74,8 pg/mL. Treze (61,9 por cento) pacientes apresentavam osteoatrite, sete (33,3 por cento) artralgias difusas, seis (28,6 por cento) mialgias difusas, três (14,3 por cento) condrocalcinose e duas (14,3 por cento) tendinopatias. Das 14 (67,8 por cento) com osteoporose, metade apresentava história clínica de fratura óssea (duas de rádio distal, quatro de coluna vertebral, duas de quirodáctilos, duas de tornozelos). Com relação às comorbidades, foi observada hipertensão arterial sistêmica em 11 (52,4 por cento) casos, cinco (23,8 por cento) hipotireoidismo, quatro (18,0 por cento) úlcera péptica, três (14,3 por cento) litíase renal, duas (9,5 por cento) depressão e duas (9,5 por cento) psoríase. Quinze pacientes (71,4 por cento) foram submetidas à paratiroidectomia, sendo sete com diagnóstico de adenoma de paratireoide, e 61,5 por cento destas pacientes evidenciaram melhora dos sintomas após a cirurgia. CONCLUSÕES: O HPP apresenta uma expressão clínica variável na qual predominam as manifestações musculoesqueléticas. O conhecimento dessa enfermidade e a sua inclusão no diagnóstico diferencial das doenças reumatológicas possibilitam seu diagnóstico precoce, minimizando suas complicações clínicas.

OBJECTIVE: To evaluate the musculoskeletal manifestations of primary hyperparathyroidism (PHP). PATIENTS AND METHODS: Clinical, with emphasis on musculoskeletal manifestations, laboratorial, and densitometric data of 21 PHP patients followed-up in our service were evaluated. RESULTS: Only post-menopausal patients, with mean age of 67.9 ± 11.2 years, of which 16 (76.2 percent) were Caucasian, participated in this study. Serum levels of calcium, phosphorus, 25 hydroxy vitamin D, and parathyroid hormone (PTH) at the time of diagnosis were 10.6 ± 0.9 mg/dL, 2.9 ± 0.7 mg/dL, 16.6 ± 6.6 ng/mL, and 113.7 ± 74.8 pg/mL, respectively. Thirteen (61.9 percent) patients had osteoarthritis, 7 (33.3 percent) diffuse arthralgia, 6 (28.6 percent) diffuse myalgia, 3 (14.3 percent) chondrocalcinosis, and 2 (14.3 percent) tendinopathy. Half of 14 (67.8 percent) patients with osteoporosis had a history of bone fracture (2 of the distal radius, 4 of the vertebral spine, 2 of the fingers, and 2 of the ankles). Eleven (52.4 percent) patients had hypertension, 5 (23.8 percent) hypothyroidism, 4 (18.0 percent) peptic ulcer, 3 (14.3 percent) kidney stones, 2 (9.5 percent) depression, and 2 (9.5 percent) psoriasis. Fifteen patients (71.4 percent) underwent parathyroidectomy, seven had a diagnosis of adenoma of the parathyroid, and an improvement of the symptoms was observed in 61.5 percent of those patients. CONCLUSIONS: Primary hyperparathyroidism has variable clinical manifestations in which musculoskeletal symptoms predominate. Knowledge of this disorder and its inclusion in the differential diagnosis of rheumatic diseases allows the early diagnosis, therefore minimizing clinical complications.

Musculoskeletal Manifestation in the Thyroid Disease: Cases report

Both hypothyroidism and hyperthyroidism can display signs and symptoms of neuromuscular dysfunction overshadowed by primary disease. Whatever the mechanism by which the thyroid affects muscles and nerves, prompt diagnosis and restoration of normal thyroid function leads to resolution of most neuromuscular symptoms. Therefore patients with thyroid dysfunction should be questioned for musculoskeletal complaints and referred to a specialist if necessary. Thyroid disorders should be considered as one of the causes in patients presenting musculoskeletal manifestation. We described four patients with thyroid disorders who presented with musculoskeletal manifestations.

Musculoskeletal manifestations and factors elevating hepatic enzyme in patients with hepatitis B and C viral infection / 대한내과학회지

BACKGROUND: To investigate the musculoskeletal manifestations and factors aggravating hepatic enzyme in patients with hepatitis B (HBV) and C (HCV) viral infection. METHODS: Eighty seven patients with HBV (72 patients) and HCV (15 patients) infection complaining of musculoskeletal symptoms were investigated retrospectively. RESULTS: Extrahepatic manifestations of patients with hepatitis viral infection were arthralgia/ arthritis (77%/72%), dermatologic manifestations(16%), neurologic manifestations (11%), and constitutional symptoms (6%). The kinds and the incidence of extrahepatic symptoms were not different between two viral infections. The rheumatologic diagnosis of patients with hepatitis viral infection were RA (41%), fibromyalgia (13%), Sj gren's syndrome (7%), SLE (5%), sacroiliitis (5%), Behcet's disease (5%), carpal tunnel syndrome (3%), and unclassified arthritis (32%). The diagnosis were not different between the two groups. There was no association of the hepatitis viral infection with any specific rheumatic disease. The patterns of arthritis were polyarthritic (79%), oligoarthritic (16%), and monoarthritic (5%) and the involvement sites were peripheral (89%), root (38%), and axial(29%). The involvement of root joint in patients with HBV (41%) infection was more frequent than HCV (22%) infection (p<0.05). The involvement of axial and peripheral joint was not different between the two groups. The prevalence of rheumatoid factor and anti-nuclear antibody were 48% and 21% in patients with hepatitis viral infection respectively. Patients taking steroid, hydroxychloroquine, bucillamine, or combined disease modifying antirheumatic drugs (DMARDs) tended to have aggravated hepatic enzyme level (p<0.05). CONCLUSION: The patients with hepatitis viral infection showed various musculoskeletal manifestations without relation to any specific rheumatic disease. The patients with HBV infection had more involvement in root joint than HCV infection. The steroid, hydroxychloroquine, bucillamine, or combined DMARDs were related to aggravated hepatic enzyme.