Artrosis y discapacidad: un estudio desde el marco conceptual de la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud / Osteoarthritis and disability: A study from the conceptual framework of the International Classification of Functioning, Disability and Health

Introducción: La artrosis es una enfermedad reumatológica calificada y certificada en Chile a través de la Comisión de Medicina Preventiva y de Invalidez, conforme al marco de la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud; pero se desconoce cómo la discapacidad derivada de la artrosis se relaciona con indicadores de salud y sociodemográficos a nivel local. Objetivo: Investigar asociaciones entre variables relacionadas con la condición de salud, sociodemográficas y de calificación de discapacidad de las personas con diagnóstico de artrosis inscritas en el Registro Nacional de la Discapacidad en la Región de los Ríos, entre los años 2017-2019. Métodos: Estudio observacional, transversal, realizado de forma prospectiva y descriptiva en 427 personas con diagnóstico principal de artrosis. La muestra fue seleccionada de manera no probabilística desde la base de datos otorgada por la Comisión de Medicina Preventiva y de Invalidez de la región mencionada. Se utilizó el test de Chi-cuadrado y se consideró un resultado estadísticamente significativo si el valor de p < 0,05. Resultados: La muestra presentó predominantemente un grado leve de discapacidad y movilidad reducida, sexo femenino, 56-75 años de edad, casados, dueños de casa, con educación básica como máximo nivel alcanzado, residencia en zonas urbanas y adscritos al Fondo Nacional de Salud. Estas variables presentaron una asociación estadísticamente significativa con el grado de discapacidad. En variables vinculadas a la condición de salud, predominó la presencia de comorbilidades y la localización de artrosis en el miembro inferior. Hubo una asociación significativa entre el número de articulaciones afectadas y el grado de discapacidad. Conclusiones: Existe asociación entre los factores analizados y el grado de discapacidad. Los factores sociodemográficos presentaron una implicancia importante(AU)

Introduction: Osteoarthritis is a rheumatological disease that produces a significant impact in functionality on people who suffer from it, generating disability at different levels. This disability is measured and certified in Chile through the Commission for Preventive Medicine and Disability under criteria established in the framework of the International Classification of Functioning. However, it is unknown if sociodemographic indicators and the disability caused by osteoarthritis are related locally. Objective: To investigate associations between variables related to health condition, sociodemographic indicators, and disability index on people with a diagnosis of osteoarthritis registered in the National Disability Registry in the Los Rios Region between the years 2017 and 2019. Methods: Observational, cross-sectional study, carried out in a prospective and descriptive way in 427 people with osteoarthritis as a main diagnosis, registered in the National Disability Registry in the Los Rios Region. The sample was selected in a non-probabilistic way from the database provided by in the aforementioned region. The Chi-Squared test was used, and results were considered statistically significant if p < 0.05. Results: 53.9% of the participants presented a mild degree of disability and reduced mobility. 61.1% of the sample were female, predominantly between 56-75 years of age, married, homemakers, primary school as highest level of educational attainment, residence in urban areas, and registered with the National Health Fund. These variables presented show a statistically significant association with the degree of disability. As for those variables related to health condition, the presence of comorbidity and osteoarthritis located mainly in the lower limb predominated, and there was a significant association between the number of affected joints and the degree of disability. Conclusions: there is an association between the analyzed factors and the degree of disability, in which sociodemographic factors represented meaningful implications(AU)

Tendencia temporal y evaluación demográfica de hospitalizaciones por osteoartritis / Temporal trends and demographic evaluation of hospitalizations due to osteoarthritis

OBJETIVO: Describir la tendencia temporal de osteoartritis (OA) según egresos hospitalarios considerando ubicación anatómica, distribución por sexo, edad, condiciones más frecuentes, y ubicación geográfica en Chile entre los años 2012 y 2018. METODOLOGÍA: Estudio descriptivo, retrospectivo, poblacional, que analizó las bases de datos públicas del Departamento de Estadísticas e Información en Salud (DEIS) del Ministerio de Salud de Chile, en particular los registros con codificación de M15 a M19. Se calcularon las tasas por 100 mil egresos hospitalarios, así como también el porcentaje de OA según las categorías analizadas. RESULTADOS: Se encontraron 11.622.605 egresos hospitalarios entre 2012 y 2018. El número total de egresos hospitalarios por OA fue de 78.700. Se observó que la distribución por sexo fue similar a lo largo de los años ( 40% y 60% en hombres y mujeres, respectivamente). El rango de edad más afectado fue el de 65 a 79 años, cuya tasa promedio fue de 2.046 por 100 mil egresos; además, fue el grupo que presentó el mayor aumento (60%) en su tasa de 2012 a 2018. La Región Metropolitana (291,7 egresos) y de Valparaíso (89,6 egresos) presentaron las tasas más altas. La cadera (56,6%) y la rodilla (31%) fueron las ubicaciones más frecuentes de casos de OA, con distribución similar por sexo, edad y geografía en comparación a los egresos totales por OA. CONCLUSIONES: Los egresos hospitalarios por OA en Chile aumentaron entre 2012 y 2018, preferencialmente en casos de OA en las articulaciones de cadera y rodilla en el grupo de mujeres de edad avanzada de la zona centro del país. NIVEL DE EVIDENCIA: Estudio descriptivo.

OBJECTIVE: To describe the temporal trends of osteoathritis (OA) according to hospital discharges considering anatomical location, distribution by gender, age, more frequent conditions, and geographic location in Chile between 2012 and 2018. METHODOLOGY: A retrospective, descriptive and population study which analyzed the public databases of the Department of Health Statistics and Information (Departamento de Estadísticas e Información en Salud, DEIS, in Spanish) of the Ministry of Health of Chile, in particular the records with codes M15 through M19. Rates per 100 thousand hospital discharges were calculated, as well as the percentage of OA according to the categories analyzed. RESULTS: A total of 11,622,605 hospital discharges were found between 2012 and 2018. The total number of hospital discharges due to OA was of 78,700. The distribution by gender was similar over the years ( 40% and 60% among men and women respectively). Adults aged between 65 and 79 years were the most affected, and their average rate was of 2,046 per 100 thousand discharges. It was also the group that presented the highest increase (60%) in rate from 2012 to 2018. The Metropolitan Region (291.7 discharges) and Valparaíso (89.6 discharges) presented the highest rates in Chile. The hip (56.6%) and knee (31%) were the most frequent locations of OA, which presented similar distribution by gender, age and geography when compared with the total discharges due to OA. CONCLUSIONS: Hospital discharges due to OA in Chile increased between 2012 and 2018, preferentially in cases of hip and knee-joint OA in the group of elderly women in the central area of the country. LEVEL OF EVIDENCE: Descriptive study.

Artropatías en el adulto mayor / Arthropathies in the elderly

Introducción: Los pacientes mayores de 65 años son la parte de la población más afectada por las enfermedades reumáticas. El diagnóstico reumatológico en los ancianos se complica por las manifestaciones clínicas que imitan los cambios relacionados con la edad. Objetivo: Sintetizar los aspectos generales del manejo clínico, el diagnóstico y la terapéutica de las principales enfermedades reumáticas inflamatorias y no inflamatorias en este subgrupo de población. Desarrollo: Los principales trastornos musculoesqueléticos no inflamatorios que afectan a los adultos mayores son la osteoartritis, la osteoporosis y el dolor de espalda, mientras que las artritis inflamatorias predominantes comprenden la artritis reumatoide, la artropatía cristalina, la polimialgia reumática y las formas inflamatorias de la osteoartritis. Conclusiones: Para el diagnóstico y la terapéutica de las principales enfermedades reumáticas (inflamatorias y no inflamatorias) en este subgrupo de población, es necesario el enfoque multidisciplinar(AU)

Introduction: It is recognized that patients older than 65 years are the part of the population most affected by rheumatic diseases. The rheumatological diagnosis in the elderly is complicated by clinical manifestations, which mimic the changes related to age. Objective: To synthesize the general aspects of clinical management, diagnosis and therapy of the main rheumatic diseases inflammatory and non-inflammatory in this subgroup of the population. Development: The main non-inflammatory musculoskeletal disorders that affect older adults are osteoarthritis, osteoporosis and back pain, while the predominant inflammatory arthritis include rheumatoid arthritis, crystalline arthropathy, polymyalgia rheumatica and the inflammatory forms of osteoarthritis. Conclusions: It is vital for academics to be involved in the rheumatological aspects of aging and call attention to the imperative that is to promote reflective discussion within community medicine to address the impact of musculoskeletal problems that affect function and mobility of the elderly and immune dysregulation in aging, among other issues(AU)

Insuficiencia renal oculta y factores asociados en pacientes con enfermedades crónicas / Occult renal failure and associated factors in patients with chronic conditions

Resumen Introducción: El diagnóstico oportuno y la intervención terapéutica temprana disminuyen la mortalidad prematura asociada con insuficiencia renal crónica. Objetivo: Identificar la prevalencia y factores asociados con insuficiencia renal oculta en pacientes con enfermedades crónicas. Método: Estudio transversal de 1268 pacientes con diabetes mellitus tipo 2 e hipertensión arterial sistémica. Se usó un instrumento de medición con preguntas sobre factores asociados como artrosis, tratamiento de padecimiento crónico, tabaquismo, ingesta de analgésicos, alcoholismo, índice de masa corporal, actividad física y niveles séricos de glucosa, colesterol y triglicéridos. Resultados: La prevalencia de insuficiencia renal oculta fue de 13.2 % (167/1268), 13.4 % en pacientes diabéticos (117/876) y 14.9 % en hipertensos (150/1010). En el analisis multivariado, los factores asociados con insuficiencia renal oculta fueron edad > 60 años (RMa = 1.96, IC 95 % = 1.22-2.49), sexo femenino (RMa = 2.17, IC 95 % = 1.30-2.82), padecer hipertensión arterial sistémica (RMa = 1.96, IC 95 % = 1.22-2.50) y no tener sobrepeso u obesidad (RMa = 0.49, IC 95 % = 0.41-0.8). Conclusiones: La prevalencia de insuficiencia renal oculta fue de 13 %. Los pacientes mayores de 60 años, con sobrepeso u obesidad e hipertensión arterial sistémica deben ser examinados detalladamente por el médico familiar para la detección temprana de insuficiencia renal oculta.

Abstract Introduction: Timely diagnosis and early therapeutic intervention reduce premature mortality associated with chronic renal failure. Objective: To identify the prevalence and factors associated with occult renal failure in patients with chronic diseases. Method: Cross-sectional study of 1268 patients with type 2 diabetes mellitus and systemic arterial hypertension. A measuring instrument with questions about associated factors such as osteoarthritis, treatment of chronic conditions, smoking, analgesic consumption, alcoholism, body mass index, physical activity and serum glucose, cholesterol and triglyceride levels was used. Results: The prevalence of occult renal failure was 13.2 % (167/1,268), 13.4 % in diabetic patients (117/876) and 14.9 % in hypertensive patients (150/1,010). In the multivariate analysis, the factors associated with occult renal failure were being older than 60 years (aOR = 1.96, 95 % CI = 1.22-2.49), belonging to the female gender (aOR = 2.17, 95 % CI = 1.30-2.82), suffering from systemic arterial hypertension (aOR = 1.96, 95% CI = 1.22-2.50) and not having overweight/obesity (aOR = 0.49, 95 % CI = 0.41-0.8). Conclusions: The prevalence of occult renal failure was 13 %. Female patients older than 60 years with overweight/obesity and systemic arterial hypertension should be examined in detail by the family doctor for occult renal failure early detection.

Caracterización clínico epidemiológica de la osteoartritis en el Cantón Colt / Clinical epidemiological characterization of osteoarthritis in the Canton Colta

Introducción: la osteoartritis es la afección reumática más frecuente y se conceptualiza como una enfermedad crónica y degenerativa en la cual existe una disminución del cartílago articular que ocasiona dolor, rigidez, deformidad, discapacidad y afectación de la percepción de calidad de vida relacionada con la salud de los pacientes. Objetivo: determinar las características sociodemográficas y clínicas de la osteoartritis en los pacientes con osteoartritis del cantón Colta. Método: estudio descriptivo, de corte transversal, en 475 pacientes con diagnóstico de osteoartritis pertenecientes al cantón Colta. Se realizó revisión de historias clínicas y se aplicó un cuestionario confeccionado exclusivamente para la investigación. Resultados: promedio de edad de edad de 45,51 años con predominio de pacientes femeninas (70,95 por ciento) y de afectación de rodillas (39,37 por ciento) y manos (33,47 por ciento). Elevado por ciento de comorbilidades (57,47 por ciento) con predominio de la hipertensión arterial (30,40 por ciento) y la obesidad (20,88 por ciento). El dolor y las deformidades fueron las manifestaciones clínicas de mayor representatividad con un 91,79 por ciento y 42,36 por ciento respectivamente. Conclusiones: la osteoartritis es una enfermedad degenerativa que no solo se presenta en edades avanzadas, sino que su inicio puede estar en edades mucho menores. Como enfermedad trae asociado un elevado número de comorbilidades donde destacan la hipertensión arterial, la obesidad y el consumo de cigarrillos. El dolor y la deformidad son las manifestaciones clínicas que motivan la asistencia de los pacientes a la consulta médica(AU)

Introduction: osteoarthritis is the most frequent rheumatic disease and is conceptualized as a chronic and degenerative disease in which there is a decrease in joint cartilage that causes pain, stiffness, deformity, disability and affect the perception of quality of life related to health from the patients. Objective: to determine the sociodemographic and clinical characteristics of osteoarthritis in patients with osteoarthritis of the canton Colta. Method: descriptive, cross-sectional study in 475 patients diagnosed with osteoarthritis belonging to the canton Colta. A review of clinical histories was carried out and a questionnaire made exclusively for research was applied. Result: the average age was 45.51 years, with a predominance of female patients (70.95 percent) and of knees (39.37 percent) and hands (33.47 percent). High percentage of comorbidities (57.47 percent) with predominance of arterial hypertension (30.40 percent) and obesity (20.88 percent). Pain and deformities were the most representative clinical manifestations with 91.79 percent and 42.36 percent respectively. Conclusions: osteoarthritis is a degenerative disease that not only occurs at advanced ages, but its onset may be at much younger ages. As a disease, it is associated with a high number of comorbidities, including high blood pressure, obesity and cigarette smoking. Pain and deformity are the clinical manifestations that motivate the assistance of patients to medical consultation(AU)

Prevalencia y distribución de signos degenerativos en cóndilo de la ATM presentes en radiografías panorámicas en población chilena / Prevalence and distribution of degenerative signs in ATM condyle in panoramic radiographs in a Chilean population

La articulación temporomandibular (ATM), como todas las articulaciones, es afectada por enfermedades inflamatorias o degenerativas, traumatismos, malformaciones, infecciones, quistes y tumores. La artrosis u osteoartrosis (OA) es la enfermedad degenerativa más frecuente de las articulaciones del cuerpo humano, incluyendo la ATM. El propósito de este estudio fue determinar la prevalencia de signos imagenológicos de trastornos degenerativos en el proceso condilar de la ATM, presentes en radiografías panorámicas digitales (RPD) de población chilena. Para ello se realizó un estudio de corte transversal que utilizó 651 radiografías de individuos adultos, en las que se buscó la presencia de los siguientes signos imagenológicos de osteoartrosis: esclerosis, pérdida de la cortical, erosión, osteofitos y quistes endocondrales. La prevalencia de signos radiográficos de OA fue de un 35 % (n=230); donde el 50 % de los individuos con signos de OA fueron mayores de 50 años, mientras la diferencia se distribuyó de forma homogénea en los distintos rangos etáreos. El signo más prevalente fue el osteofito (25 %) y la pérdida de cortical fue la menos observada (3 %). Además, la esclerosis presentó una prevalencia del 6 %, la erosión del 4 % y los quistes endocondrales del 6 %. Por su parte la frecuencia de signos observada en hombres fue mayor, detectándose un aumento en relación directa con la edad independiente del sexo. La radiografía panorámica por su accesibilidad, baja dosis de radiación y constituir un examen de rutina, constituye un medio apropiado para pesquizar hallazgos de signos degenerativos de la ATM.

The temporomandibular joint (TMJ), like all joints, is affected by inflammatory or degenerative diseases, traumatisms, malformations, infections, cysts and tumors. Osteoarthrosis (OA) is the most common degenerative disease of the joints of the human body, including the temporomandibular joint. The purpose of this study was to estimate the prevalence of imaging signs of degenerative disorders in the TMJ condyle, present in digital panoramic radiographs in Chilean population. A cross-sectional study was conducted using 651 radiographs of adult individuals. The presence of the following imaging signs of osteoarthrosis was recorded: sclerosis, cortical loss, erosion, osteophytes and endochondral cysts. The prevalence of radiographic signs of OA was 35 % (n = 230); where 50 % of the individuals with signs of OA were older than 50 years, while the difference was distributed homogeneously in the different age ranges. The most prevalent sign was osteophyte (25 %) and cortical loss was the least observed (3 %). In addition, sclerosis presented a prevalence of 6 %, erosion of 4 % and endochondral cysts of 6 %. On the other hand, the frequency of signs observed in men was greater, detecting an increase in direct relation with age independent of sex. The data of this study allows us to conclude that the prevalence of OA in the studied population was 35 % with a higher representation in men and older people. Both the value of the prevalence of OA and that corresponding to each sign are affected by the modality of radiographic analysis and methodological considerations.

Análise das internações por osteoartrite em mulheres em idade menopausal / Analysis of hospitalizations for osteoarthritis of women in menopausal

OBJETIVO: Identificar e avaliar dados epidemiológicos referentes à osteoartrite em mulheres em idade menopausal. MÉ- TODOS: Pesquisa e análise de informações de saúde disponibilizadas pelo Departamento de Informática do Sistema Único de Saúde (DATASUS), utilizando-se as variáveis artrose, sexo feminino, faixa etária de 40 a 59 anos, período de janeiro de 2012 a dezembro de 2016. RESULTADOS: Nos 5 anos estudados, notificaram-se 13.077 internações por osteoartrite em mulheres em idade menopausal, 2.180 delas (16,67%) em 2012, 2.557 (19,55%) em 2013, 2.686 (20,53%) em 2014, 2.792 (21,35%) em 2015 e 2.862 (21,88%) em 2016. A Região Sudeste se destacou, com 54,84% do total de internações, das quais 1.983 se deram de 40 a 49 anos e 5.313, de 50 a 59 anos. Nas outras regiões, o número de internações, de 40 a 49 anos, foi de 94 pacientes no Norte, 370 no Nordeste, 955 no Sul e 214 no Centro-Oeste; já de 50 a 59 anos, o Norte notificou 182 internações; Nordeste, 684; Sul, 2.827; e Centro-Oeste, 455. O Nordeste apresentou maior média de permanência hospitalar (5,9 dias), porém teve o segundo menor gasto por internação (R$2.836,00); já o Sudeste foi responsável pelo montante de R$22.640.928,14 em gastos totais. CONCLUSÃO: De 2012 a 2016, o índice de internações por osteoartrite em mulheres de 40 a 59 anos no território brasileiro mostrou ligeiro aumento. Isso é um dado preocupante, pois esta é uma afecção de manejo predominantemente ambulatorial; logo, infere-se que são necessárias mais ações de prevenção, tratamento e reabilitação, principalmente, na Região Sudeste, que detém mais de 50% das internações. (AU)

OBJECTIVE: To identify and evaluate epidemiological data regarding osteoarthritis in menopausal women. METHODS: Research and analysis of health information provided by the Department of Informatics of the Unified Health System (DATASUS), using the variables osteoarthritis, female gender, age range of 40-59 years, from January 2012 to December 2016. RESULTS: In the 5 years studied, 13,077 hospitalizations for osteoarthritis were reported in menopausal women, 2180 of them (16.67%) in 2012; 2557 (19.55%) in 2013; 2686 (20.53%) in 2014; 2792 (21.35%) in 2015; and 2862 (21.88%) in 2016. The Southeast region stands out with 54.84% of the total hospitalizations, of which 1983 were reported between 40-49 years old, and 5313, from 50 to 59 years. In the other regions, the number of hospitalizations between 40-49 years old was of 94 patients in the North, 370 in the Northeast, 955 in the South, and 214 in the Midwest; from 50-59 years old, the North reported 182 hospitalizations; Northeast, 684; South, 2827; and Center-West, 455. The Northeast had the highest average hospital stay (5.9 days), but had the second lowest hospitalization cost (R$ 2,836); on the other hand, the Southeast accounted for the amount of R$22,640,928.14 in total expenses. CONCLUSION: From 2012 to 2016, the rate of hospitalizations for osteoarthritis in women aged 40-59 years in Brazil showed a slight increase. These data are worrying, because it is predominantly a condition for outpatient management; therefore, it is inferred that more actions of prevention, treatment and rehabilitation are necessary, mainly in the Southeast, which is responsible for >50% of hospitalizations. (AU)

Infecciones osteoarticulares en un hospital pediátrico de alta complejidad: epidemiología y características clínicas asociadas con bacteriemia / Osteoarticular infections in a tertiary care children's hospital: Epidemiology and clinical characteristics in association with bacteremia

Introducción. Las infecciones osteoarticulares son una importante causa de morbilidad y pueden presentar bacteriemia. La epidemiología de estas infecciones se ha modificado en los últimos años. Objetivos. Describir las características epidemiológicas, clínicas y evolutivas de los niños con infecciones osteoarticulares y comparar los pacientes con bacteriemia con los que no la presentaron. Población y métodos. Cohorte retrospectiva. Se incluyeron pacientes menores de 18 años, admitidos en el Hospital Juan P. Garrahan entre el 1/1/2016 y el 31/12/2016 con sospecha de infecciones osteoarticulares en quienes se hubiese realizado artrocentesis y/o biopsia articular. Se excluyeron niños con patología previa. Se compararon las características clínicas y de laboratorio según tuvieran bacteriemia o no. Se utilizó Stata 10. Resultados. N: 62. La mediana de edad fue 59.5 meses (rango intercuartilo -RIC- 24-84). Presentaron fiebre 44 pacientes (70%). Predominaron las artritis (54 pacientes, 87%). Se identificó un agente etiológico en 29 pacientes (47%). Predominó Staphylococcus aureus (n: 20, 32%). Tuvieron bacteriemia 15 de ellos (24%). Recibieron clindamicina como tratamiento empírico 56 pacientes (90%). La mediana de tratamiento endovenoso fue 7 días (RIC 5-11) y de internación, 7 días (RIC 4-12). Los pacientes con bacteriemia tuvieron menor edad (26 meses vs. 60, p < 0,05), mayor valor de proteína C reactiva inicial (101 vs. 33 U/L, p < 0,05), menor valor de hemoglobina al ingresar (10,8 g/dl vs. 12.5 g/dl, p 0,04) y mayor frecuencia de fiebre (100% vs. 57%, p < 0,05). Conclusiones. Predominó Staphylococcus aureus. Los niños con bacteriemia tuvieron menor edad, mayor valor de proteína C reactiva, menos hemoglobina al ingresar y, más frecuentemente, fiebre.

Introduction. Osteoarticular infections are an important cause of morbidity and may present with bacteremia. The epidemiology has changed in recent years. Objectives. To describe the epidemiological, clinical, and evolutionary characteristics of children with osteoarticular infections and compare patients with and without bacteremia. Population and methods. Retrospective cohort. Patients younger than 18 years admitted between January 1st, 2016 and December 31st, 2016 suspected of osteoarticular infections who had undergone an arthrocentesis and/or joint biopsy were included. Clinical and laboratory characteristics were compared between patients with and without bacteremia. The Stata 10 software was used.Results. N: 62. Patients' median age was 59.5 months (interquartile range [IQR]: 24-84). Fever developed in 44 patients (70%). Arthritis predominated (54 patients, 87%). An etiologic agent was identified in 29 patients (47%). Staphylococcus aureus was prevalent (n: 20, 32%). Among these, 15 developed bacteremia (24%). Clindamycin was administered to 56 patients (90%) as empirical therapy. The median intravenous treatment duration was 7 days (IQR: 5-11) and the median length of stay, 7 days (IQR: 4-12). Patients with bacteremia were younger (26 months versus 60 months, p < 0.05), had a higher baseline C-reactive protein level (101 U/L versus 33 U/L, p < 0.05), a lower hemoglobin level at the time of admission (10.8 g/dL versus 12.5 g/dL, p = 0.04), and a higher frequency of fever (100% versus 57%, p < 0.05).Conclusions. Staphylococcus aureus was prevalent. Children with bacteremia were younger, had a higher C-reactive protein level, a lower hemoglobin level at the time of admission, and 100% presented fever

Obesity, sarcopenia, sarcopenic obesity and reduced mobility in Brazilian older people aged 80 years and over / Obesidade, sarcopenia, obesidade sarcopênica e mobilidade reduzida em idosos brasileiros com 80 anos ou mais

ABSTRACT Objective: To analyze which abnormalities in body composition (obesity, sarcopenia or sarcopenic obesity) are related to reduced mobility in older people aged 80 years and older. Methods: The sample included 116 subjects aged 80 years and older. The body composition was measured using dual-energy X-ray absorptiometry (DXA) and mobility was assessed by motor tests. The χ2 test was used to analyze the proportion of older people with sarcopenia, obesity and sarcopenic obesity based on sex as well as to indicate an association between obesity, sarcopenia, sarcopenic obesity and mobility. Binary logistic regression, adjusted for the variables (sex and osteoarticular diseases), was used to express the magnitude of these associations. One-way analysis of variance was used to compare the mobility of four groups (Normal, Obesity, Sarcopenia and Sarcopenic Obesity). Results: The Sarcopenia Group had lower performance in the lower limbs strength test and in sum of two tests compared with Obesity and Normal Groups. Older people with sarcopenia had higher chance of reduced mobility (OR: 3.44; 95%CI: 1.12-10.52). Conclusion: Older people aged 80 years and older with sarcopenia have more chance for reduction in mobility.

RESUMO Objetivo: Analisar quais agravos na composição corporal (obesidade, sarcopenia ou obesidade sarcopênica) estão relacionados à redução da mobilidade em idosos com 80 anos ou mais. Métodos: A amostra foi constituída por 116 sujeitos com idade igual ou superior a 80 anos. A composição corporal foi mensurada pela técnica de absorciometria de raios X de dupla energia (DXA), e a mobilidade foi avaliada por testes motores. O teste χ2foi utilizado para analisar a proporção de idosos com sarcopenia, obesidade e obesidade sarcopênica, de acordo com o sexo, bem como para indicar a associação entre obesidade, sarcopenia, obesidade sarcopênica e mobilidade. A análise de regressão logística binária, ajustada pelas variáveis (sexo e doenças osteoarticulares), foi utilizada para expressar a magnitude das associações. A análise de variância foi usada para comparar a mobilidade entre os quatro grupos (Normal, Obesidade, Sarcopenia e Obesidade Sarcopênica). Resultados: O Grupo Sarcopenia apresentou menor desempenho no teste de força de membros inferiores e na soma dos dois testes, comparado aos Grupos Obesidade e Normal. Idosos com sarcopenia apresentaram maior chance de redução da mobilidade (OR: 3,44; IC95%: 1,12-10,52). Conclusão: Idosos com idade igual ou superior a 80 anos com sarcopenia têm mais chance de redução da mobilidade.

Prevalence of temporomandibular disorders in postmenopausal women and relationship with pain and HRT

Abstract The prevalence of temporomandibular disorders (TMD) is higher in females, reaching their high peak during reproductive years, probably because of the action of some female hormones, which alter pain threshold. This study aimed to investigate the prevalence of TMD in postmenopausal women and its relationship with pain and hormone replacement therapy (HRT). In total, 284 patients were evaluated and classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain was measured using the Visual Analogue Scale (VAS), and patients were also asked about the use of HRT. All data was analyzed using analysis of variance (ANOVA) and chi-square test. In total, 155 subjects did not have TMD and 129 had TMD; TMD group patients were classified according to RDC/TMD axis I classification as follows: muscle disorder group (1.6%), disk displacement group (72.87%), and arthralgia, osteoarthritis, and osteoarthrosis group (37.98%). Pain was registered in 35 patients who belonged to the TMD group, while 48 patients reported the use of HRT. There was a similar percentage of TMD and non TMD patients; moreover, the use of exogenous hormones was no associated with TMD, suggesting that there is no influence on the pain threshold.

Avaliação da magnitude da desvantagem da osteoartrite na vida das pessoas: estudo MOVES / Assessing the magnitude of osteoarthritis disadvantage on people's lives: the MOVES study

Introdução A osteoartrite (OA) é uma das dez doenças mais incapacitantes nos países desenvolvidos e uma das principais causas de dor e incapacitação no mundo. O diagnóstico precoce aumenta a probabilidade de prevenção da progressão da doença. Objetivos Estimar a prevalência de osteoartrite auto-referida e a qualidade de vida em adultos portugueses com 45 ou mais anos de idade. Métodos Estudo observacional, transversal, implementado em domicílios por entrevista interpessoal. Resultados Foram incluídos no estudo 1039 indivíduos com idade média de 62 anos, sendo 54,2% do gênero feminino. A prevalência de osteoartrite auto-referida foi de 9,9%. Os joelhos e as mãos foram o local mais freqüente da doença. A prevalência de OA foi maior em mulheres e em participantes sem atividade profissional. A presença de OA foi maior em participantes com comorbidades. A maioria dos indivíduos já tinham passado por algum tratamento em alguma ocasião de suas vidas para esta doença: 94,5% tiveram tratamento farmacológico, 49,5% fisioterapia, e 19,8% atividade física. A dor estava associada com a estatura, com alguns locais da doença, especificamente pescoço, coluna lombar e ombros, pontuação do SF12 para qualidade de vida, e medidas de impacto no cotidiano dos participantes, gravidade da doença e incapacitação. O impacto da OA no dia-a-dia foi maior em indivíduos que tinham gozado licença por doença ou que pararam de trabalhar por causa da OA, apresentavam-se com pior saúde física e mental, e exibiam maior gravidade da doença. Conclusão Este estudo confirmou que a osteoartrite é uma doença muito relevante, com impacto potencial elevado na qualidade de vida, no funcionamento e na capacidade para o trabalho e, por causa de sua prevalência, exerce um impacto social muito elevado e crescente. .

Introduction Osteoarthritis (OA) is one of the ten most disabling diseases in developed countries and one of the leading causes of pain and disability over the world. Early diagnosis increases the likelihood of preventing disease progression. Objectives To estimate the prevalence of self-reported osteoarthritis and quality of life in Portuguese adults with 45 or more years old. Methods Observational, cross-sectional study, implemented in households by face-to-face interview. Results 1039 subjects with mean age of 62 years and 54.2% female were included. The prevalence of self-reported osteoarthritis was 9.9%. Knees and hands were the most frequent site of disease. The prevalence of OA was higher in women and in participants without professional activity. Presence of OA was higher in participants with comorbidities. Most subjects have done some treatment at some point in time for this disease: 94.5% had drug therapy, 49.5% physiotherapy, and 19.8% physical activity. Pain was associated with height, with some disease locations specifically neck, lower spine and shoulders, SF12 scores of quality of life, and measurements of impact in daily living, severity of disease and disability. The impact of OA in daily living was greater in subjects that had been on sick leave or stopped working due to OA, had worse physical and mental health, and with more severe of disease. Conclusion This study confirmed that osteoarthritis is a very relevant disease with a high potential impact on quality of life, function and work ability and because of its prevalence with a very high growing social impact. .

Clinical and epidemiological characteristics of septic arthritis of the hip, 2006 to 2012, a seven-year review

OBJECTIVE: To epidemiologically characterize the population treated at our orthopedic clinic with a diagnosis of septic arthritic of the hip between 2006 and 2012. METHODS: Fifteen patients diagnosed with septic arthritis of the hip between 2006 and 2012 were retrospectively evaluated. The patients' clinical and epidemiological characteristics were surveyed; a sensitivity profile relating to the microorganisms that caused the infections and the complications relating to the patients' treatment and evolution were identified. RESULTS: Septic arthritis was more common among males. Most diagnoses were made through positive synovial fluid cultures, after joint drainage was performed using the Smith-Petersen route. Among the comorbidities found, the most prevalent were systemic arterial hypertension, diabetes mellitus, and human immunodeficiency virus. The pathological joint conditions diagnosed prior to joint infection were osteoarthrosis and developmental dysplasia of the hip. The infectious agent most frequently isolated was Staphylococcus aureus. From the clinical and laboratory data investigated, 53.33% of the cases presented with fever, and all except one patient presented with increased measures in inflammation tests. Gram staining was positive in only 26.66% of the synovial fluid samples analyzed. Six patients presented with joint complications after treatment was administered. CONCLUSION: S. aureus is the most common pathogen in acute infections of the hip in our setting. Factors such as clinical comorbidities are associated with septic arthritis of the hip. Because of the relatively small number of patients, given that this is a condition of low prevalence, there was no statistically significant correlation in relation to worse prognosis for the disease. .

The Prevalence of Lumbar Spine Facet Joint Osteoarthritis and Its Association with Low Back Pain in Selected Korean Populations

BACKGROUND: This study was to evaluate the association of lumbar spine facet joint osteoarthritis (LSFJOA) identified by multi-detector computed tomography (MDCT) with age and low back pain (LBP) in an adult community-based population in Korea. METHODS: A sample of 472 participants (age range, 20 to 84 years) who underwent MDCT imaging for abdominal or urological lesions, not for chief complaints of LBP, were included in this study. LSFJOA based on MDCT findings was characterized using four grades of osteoarthritis of the facet joints. The prevalence of LSFJOA according to age group (below 40 years, 40-49 years, 50-59 years, 60-69 years, and above 70 years), gender, and spinal level was analyzed using chi-square tests and the association between LBP and LSFJOA adjusting for age, gender, and spine level was analyzed using multiple binary logistic regression test. RESULTS: Eighty-three study subjects (17.58%) had LSFJOA (grade > or = 2). The prevalence of LSFJOA was not associated with gender (p = 0.092). The prevalence of LSFJOA increased with age (p = 0.015). The highest prevalence of LSFJOA was observed at L4-5 in men (p = 0.001) and at L5-S1 in women (p = 0.003), and at L5-S1 in the overall population (p = 0.000). LSFJOA was not associated with LBP in men (p = 0.093) but was associated with LBP in women (p = 0.003), especially at L3-4 (p = 0.018) and L5-S1 (p = 0.026). CONCLUSIONS: The prevalence of LSFJOA based on the computed tomography imaging was 17.58% in the adult community Korean population. The prevalence of LSFJOA increased with age, and the highest prevalence was noted at L5-S1. LSFJOA was not associated with LBP at any spinal level and age except at L3-4 and L5-S1 in women.

[Radiographical study of osteoarthrosis in dogs]

Degenerative joint disease [DJD] is a non-inflammatory and noninfectious disorder of movable joints characterized by degeneration of articular cartilage and new bone formation around the joints. There is no comprehensive report about the prevalence of DJD in dogs in Iran. The aim of this radiographical study was to evaluate the rate of DJD and the influencing factors such as age, sex, breed and location of the joint in dogs referred to the Radiology Division of the Veterinary Teaching Hospital, University of Tehran. Atotal of 1896 canine cases were studied during a period of five years [1382-1386]. Two hundred and thirty two cases were x-rayed with each having the problem of joint disease. Radiographic evidence of DJD was found in 21.12% of the examined dogs. Degenerative joint disease of the vertebral column was diagnosed in 6.46% of all the cases. Degenerative changes of appendicular joints were found in 14.65% of the cases. The incidence of osteoarthrosis of the forelimbs was 47% among cases with DJD of appendicular joints. The rate of osteoarthrosis of hind limbs was 53%. The highest rate of DJD of appendicular joints was seen in the hip joints [38.23%]. This study demonstrated that radiographic changes of DJD were more discernible in large breed dogs [34.56%], as compared to small breeds [13.63%] [p

Influência de elementos meteorológicos na dor de pacientes com osteoartrite: revisão da literatura / Influence of meteorological elements on osteoarthritis pain: a review of the literature

Apesar de frequente a afirmação de que as condições do tempo modificam a intensidade da dor na osteoartrite (OA), essa influência é controversa e de difícil mensuração. Esta revisão tem como objetivo analisar os artigos relacionados à influência de elementos meteorológicos na dor da OA. A revisão da literatura foi realizada com um levantamento bibliográfico junto aos bancos de dados MEDLINE e LILACS, e por busca ativa em lista de referências bibliográficas dos artigos e revisões recuperados. Os critérios de inclusão para esta análise foram estudos prospectivos que avaliaram a presença da dor em pacientes com OA relacionada a alguma variável meteorológica. Os artigos foram publicados em português, inglês e espanhol. Do total de 247 resumos analisados, foram incluídos oito (3,2%) artigos, provenientes dos bancos de dados eletrônicos consultados (n = 7) e da busca ativa (n = 1). Em cinco dos estudos incluídos, pressão atmosférica foi a variável que apresentou influência na dor de pacientes com OA com mais frequência, enquanto precipitação foi a que menos apresentou relação com os sintomas de OA; vento foi pouco analisado. Apesar da diversidade metodológica e dos vieses dos estudos analisados, existe uma tendência à confirmação da influência das condições do tempo na intensidade da dor em pacientes com OA, em especial nas publicações mais recentes. Ainda são necessários mais estudos para se ter uma boa evidência do efeito dos elementos meteorológicos na dor dos pacientes com OA e para avaliar sua interferência na realização das atividades diárias e na qualidade de vida.

Despite the frequent assertion that the weather conditions change the intensity of pain in osteoarthritis (OA), this influence is controversial and difficult to measure. This analysis aims to review articles related to the influence of meteorological elements in the OA pain. The literature review was performed with the bibliographical survey databases of the Medical Literature Analysis and Retrieval System Online (MEDLINE) and the Latin American and Caribbean Health Sciences (LILACS), and active search in the list of references of the articles and reviews retrieved. The inclusion criteria for this analysis were prospective studies that evaluated the presence of pain related to some variable of weather in OA patients. The articles were published in Portuguese, English, and Spanish. Of the 247 abstracts analyzed, eight (3.2%) included articles from the electronic database consulted (n = 7), and active case finding (n = 1). Atmospheric pressure was the most frequently variable with some influence on OA pain in five of the included studies, while precipitation was less related to the symptoms of OA; wind was not analyzed. Despite the methodological diversity and biases of the analyzed studies, there is a trend to confirm the influence of weather in OA pain intensity, mainly in more recent publications. Besides checking the effect of meteorological elements in the OA pain, it is necessary to evaluate the interference in daily activities and impairing of the quality of life.

A prospective observational study to assess quality of life and prescription pattern in osteoarthritis patients at tertiary health centre in Mumbai.

Background: Osteoarthritis (OA) is a major cause of disability and is focused in "Bone and Joint Decade" declared by WHO which substantially affect different dimensions of quality of life. The aim of present study was to find the disease pattern in OA patients, monitoring prescription pattern to assess prognosis of osteoarthritis by WOMAC index. Materials and Methods: An observational study on prospective data collected for the evaluation of Quality of Life (QOL) in OA was conducted at tertiary health care centre in Mumbai. Patients with a diagnosis of OA were enrolled. The patient's history and clinical examination was based on classification criteria of the American College of Rheumatology; drugs prescribed were noted on case record form. Same procedure was carried out for the first and second follow-ups at 6 th and 12 th weeks respectively. Results: The patients belong to primary OA (84%) as compared to secondary OA (16%). Females (70.56% and 10%) were affected more commonly than males (13.44% and 6%). Knee Joint was worst affected in 76%, followed by hip joint in 16% and shoulder, ankle, wrist, elbow joint each having 2% (n=1) involvement. NSAIDs continued to dominate prescriptions given to 84% of patients followed by antiarthritic drugs and calcium supplements in 54% cases. The WOMAC score was higher in most of patients. After medication hydroxy chloroquine sulfate has shown maximum reduction in average WOMAC sore followed by paracetamol, indomethacin and diclofenac sodium. Conclusion: Osteoarthritis has a significant impact on quality of life, only partly ameliorated by anti-arthritic drugs, as assessed by the WOMAC scale in this study population. Further, a study with larger sample size is needed to further support our findings.

Manifestações osteoarticulares de doenças não reumatológicas em idosos: [revisão] / Osteoarticulars disorders in nonrheumatic diseases in elderly: [review]

O envelhecimento populacional é um fenômeno mundial. Com o aumento da população idosa vem crescendo a prevalência de doenças com manifestações osteoarticulares que se associam a dor, deformidades articulares e incapacidade funcional. As doenças reumatológicas são as mais comumente associadas a desordens osteoarticulares, entretanto, várias doenças não reumatológicas também as apresentam, ampliando o diagnóstico diferencial. Este artigo disserta sobre as desordens não reumatológicas com sinais e sintomas osteoarticulares e estabelece diagnóstico diferencial para manifestações reumáticas em idosos.

Retardo de consolidación y seudoartrosis de la tibia / Delay in consolidation and pseudoarthrosis of the tibia

Se realizó una revisión bibliográfica y actualización acerca del retardo de la consolidación y la seudoartrosis que ocurren en las fracturas abiertas de la tibia, con el objetivo de facilitar el estudio de estas debatidas complicaciones muy temidas por los ortopédicos, por existir múltiples tipos de tratamientos, una evolución prolongada y un pronóstico desfavorable en muchas ocasiones. Se expone el concepto, sus principales diferencias, incidencias, causas, clasificación y métodos de tratamientos quirúrgicos en pacientes con estos inconvenientes de las lesiones traumßticas óseas. En las causas se profundizó sobre los factores dependientes del trauma, del paciente, del propio hueso y las relaciones con el tratamiento. Con respecto a las formas de procedimientos, se aclaran las ventajas y desventajas de cada método entre los que se encuentran: el uso de enyesados, fijación intramedular, placas AO, la aplicación de injertos y fijadores externos que se pueden asociar a la estimulación eléctrica. Así cada médico puede seleccionar el tipo de tratamiento que requiera un paciente afecto de estas temibles complicaciones.

A literature review and an updating on the delay in consolidation of fractures and pseudoarthrosis occurring in open tibial shaft fractures was made to facilitate the study of these discussed complications, so much feared by orthopedists, since types of treatment are varied, recovery takes a long time and prognosis is unfavourable in most occasions. The concept, the main differences, incidence, causes, classification and surgical treatment methods in patients with bone lesions caused by trauma were explained. Factors depending on trauma, patient, the bone itself and the relations with the treatment were studied in depth. Regarding the procedures, advantages and disadvantages of each method were explained; for example, use of plaster casts, intramedullary fixation, AO plates, application of grafts and external fixation that can be associated to electrical stimulation. Thus, every physician may select the type of required treatment for a patient affected by these terrible complications.

Islamic praying and osteoarthritis changes of weight bearing joints

Find out whether daily physical activities of Islamic praying predispose to or protect from osteoarthritis [OA] of weight bearing joints. Comparison of prevalence of primary OA of knees and/or hips between age and weight matching prayers and non-prayers men. Civil official and employees from different establishments in Erbil City [191 Subjects] and [21 subjects] from out-patient clinics of Rizgary and Erbil Teaching Hospital-Erbil, over a period of eight months starting on Jan 2004. This constituted one hundred and eleven prayers and 101 subjects not practicing Islamic praying. Subjects fulfilling our inclusion criteria underwent clinical evaluation and radiology of their knee and hip joints. We assessed, by Chi-squared test, differences in frequency of OA between prayers and non-prayers, and between the > 20 year prayers who lay hand first on prostrating from erect posture and the same duration prayers who lay their knees first. No single OA of hip was encountered. OA of knees was significantly less [p<0.01] prevalent among prayers than those who did not practice Islamic praying. Differentially, laying knees first on prostrating from erect posture was associated with significantly [p<0.05] higher frequency of OA of knees as compared with those who lay their hands first on the praying rug [ground]. Islamic praying in 46-60 year-old men, of normal or marginal overweight [BMI 20-27 kg/m2], protects from primary OA of the knees. Laying palms first on prostrating from standing position appears to preclude a likely harmful effect on the knee joints presumably form repeated "hitting" of ground under the praying rug if laid first on prostration

Etiología y presentación clínica de las infecciones osteoarticulares en niños hospitalizados en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell 2003-2005 / Etiology and clinical presentation of osteoarticular infections in children hospitalized in the Pediatric Hospital of the Pereira Rossell Hospital Center 2003-2005

Introducción: en el año 2001, en Uruguay, se comenzó a observar en niños un aumento en la frecuencia de aislamientos de S. aureus meticilino resistente en niños con infecciones adquiridas en la comunidad (SAMR-AC). Resulta necesario conocer la epidemiología y las manifestaciones clínicas de las infecciones osteoarticulares para adecuar las recomendaciones terapéuticas. Objetivo: describir la etiología, presentación y evolución clínica de los niños hospitalizados con infecciones osteoarticulares en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell. Material y método: se incluyeron los niños hospitalizados entre el 1º de enero de 2003 y el 31 de diciembre de 2005, con diagnóstico al egreso de osteomielitis, osteoartritis y artritis séptica. Para la definición de caso se consideraron: manifestaciones clínicas, hallazgos en el centellograma óseo, germen aislado de hemocultivo o cultivo óseo, o ambos, o articular. Se analizó etiología, presentación clínica, evolución y tratamiento. Resultados: se incluyeron 106 niños; edad media 7 años. Se aisló germen en 56 (52%): S. aureus meticilino sensible 41% (n=23), SAMR-AC 27% (n=15), S. pneumoniae 14% (n=8), S. pyogenes 5,5% (n=3), otros 12,5% (n=7). Comparados con otras etiologías los niños con infecciones por SAMR-AC tuvieron presentación clínica más grave: pandiafisitis (n=7), focos múltiples (n=1), trombosis venosa profunda y tromboembolismo pulmonar (n=2). Estos 15 niños requirieron drenaje quirúrgico; presentaron estadía más prolongada (promedio 31 versus 13 días) y más secuelas (6 versus 1). Los dos fallecimientos ocurrieron en niños con esta etiología. Conclusiones: SAMR-AC constituye un nuevo agente de las infecciones osteoarticulares en niños en nuestro medio. Frente a la sospecha clínica de esta infección es necesario insistir en la punción ósea diagnóstica e iniciar una antibioticoterapia empírica apropiada para este agente.

Summary Introduction: in the year 2001 an increase in isolation frequencies of methicillin-resistant Staphylococcus aureus (CA-MRSA) was observed in children with communityacquired infections. We need to know the epidemiology and clinical presentation of osteoarticular infections in order to adapt therapeutic recommendations. Objective: to describe etiology, clinical features and evolution of children hospitalized with osteoarticular infections at the Pediatric Hospital of the Pereira Rossell Health Care Center. Method: the study included children hospitalized from January 1, 2003 through December 31, 2005, with a discharge diagnosis of osteomyelitis, osteoarthritis or septic arthritis. The following were considered for case definition: clinical features, bone centellogram findings, blood or bone culture isolated germ, or both cultures or articular isolated germ. Etiology, clinical features, evolution and treatment were analyzed. Results: 106 children were included, average age was 7 years old. The germ was isolated in 56 (52%):41% methicillin-sensitive Staphylococcus aureus (n=23), community 27% acquired methicillin-resistant Staphylococcus aureus (n=15), S. pneumoniae 14% (n=8), S. pyogenes 5.5% (n=3), others 12.5% (n=7). When compared with other etiologies, children with community acquired methicillin-resistant Staphylococcus aureus showed the most serious clinical presentation: pandiaphysis (n=7), multiple foci (n=1), deep venous thrombosis and pulmonarthromboembolism (n=2). 15 children required surgical drainage; and hospitalization time was longer ( average 31 versus 13 days) and more sequels (6 versus 1). Two deaths corresponded to children with this etiology. Conclusions: community acquired methicillin-resistant Staphylococcus aureus constitutes a new agent in osteoarticular infections in children in our country. Upon clinical suspicion of this infection, it is necessary to insist on performing bone puncture as a diagnostic procedure, and to initiate empirical administration of antibiotics that are appropriate for this agent.

Résumé Introduction: en 2001, en Uruguay, on commence à observer (chez des enfants) une augmentation à la fréquence d’isolement de S. aureus méticilline résistant chez des enfants avec infections acquises dans la communauté (SAMR-AC). Il s’avère nécessaire de connaître l’épidémiologie et les manifestations cliniques des infections ostéo-articulaires afin d’y adapter le traitement. Objectif: décrire l’étiologie, la présentation et l’évolution clinique des enfants hospitalisés avec des infections ostéo-articulaires à l’Hôpital Pédiatrique du Centre Hospitalier Pereira Rossell. Matériel et méthode: on inclut les enfants hospitalisés entre le 1er janvier 2003 et le 31 décembre 2005, à diagnostic d’ostéomyélite, ostéoarthrite et arthrite sceptique au moment de la sortie. On tient compte de: manifestations cliniques, données de scintigraphie osseuse, germe isolé d’hémoculture ou culture osseuse, ou les deux, ou articulaire. On analyse l’étiologie, la présentation clinique, l’évolution et le traitement. Résultats: on inclut 106 enfants; moyenne d’âge 7 ans. Prélèvement de germe chez 56 (52%): S.aureus métycilino sensible 41% (n=23), SAMR-AC 27% (n=15), S. pneumoniae 14% (n=8), S. pyogenes 5,5% (n=3), d’autres 12,5% (n=7). Si on compare à d’autres étiologies, les enfants avec infections par SAMR-AC ont eu une présentation clinique plus grave: pandiaphysite (n=7), localisations multiples (n=1), thrombose veineuse profonde et thrombœmbolisme pulmonaire (n=2). Ces 15 enfants ont requis drainage chirurgical; leur séjour fut plus long (moyenne 31 versus 13 jours) et il eurent plus de séquelles (6 versus 1). Les deux décès chez des enfants ayant cette étiologie. Conclusions: SAMR-AC constitue un nouvel agent des infections ostéo-articulaires chez nos enfants. S’il existe un soupçon clinique de cette infection, il faut faire une ponction osseuse diagnostique et commencer une antibioticothérapie empirique appropriée.

Resumo Introdução: em 2001, observou-se no Uruguai, um aumento na freqüência de S.aureus meticilina-resistente isolados em crianças com infecções adquiridas na comunidade (SAMR-AC). Faz-se necessário conhecer a epidemiologia e as manifestações clínicas das infecções osteoarticulares para adequar as recomendações terapêuticas. Objetivo: descrever a etiologia, apresentação e evolução clínica das crianças com infecções osteoarticulares internadas no Hospital Pediátrico do Centro Hospitalar Pereira Rossell. Material e método: foram incluídas todas as crianças internadas entre o dia 1º de janeiro de 2003 e o dia 31 de dezembro de 2005, cujo diagnóstico na alta era osteomielite, osteoartrite ou artrite séptica. A definição como caso foi feita considerando as manifestações clínicas, os resultados da cintilografia óssea, o microrganimo isolado de hemocultura ou de cultura óssea, ou ambas, ou articular. Foram analisadas a etiologia, a apresentação clínica, a evolução e o tratamento. Resultados: cento e seis crianças com idade média de 7 anos foram incluídas no estudo. Em 56 (52%) delas foi feito o isolamento de gérmen: S. aureus meticilina-sensível 41% (n=23), SAMR-AC 27% (n=15), S. pneumoniae 14% (n=8), S. pyogenes 5,5% (n=3), outros 12,5% (n=7). Comparados com outras etiologias, as crianças com infecções por SAMR-AC tiveram quadros clínicos mais graves: pandiafisite (n=7), focos múltiples (n=1), trombose venosa profunda e tromboembolismo pulmonar (n=2). Nestas 15 crianças foi necessário realizar drenagem cirúrgica, o período de internação foi mais prolongado (média 31 versus 13 dias) e foram registradas mais seqüelas (6 versus 1). Os dois óbitos registrados corresponderam a crianças com esta etiologia. Conclusões: o SAMR-AC é um novo agente de infecções osteoarticulares em crianças no nosso meio. Quando houver suspeita clínica desta infecção deve-se insistir na realização de uma punção óssea diagnóstica e iniciar antibioticoterapia empírica apropriada para este agente.