Ruptura tendinosa en paciente pluripatológica / Tendon rupture in patients with multiple diseases

Las fluoroquinolonas son un grupo de antibacterianos útiles en una amplia variedad de situaciones clínicas por su amplio espectro de actividad y su biodisponibilidad oral. La tendinopatía es una complicación rara asociada a estos fármacos. Entre los factores de riesgo destacan la edad avanzada, el tratamiento previo con esteroides y la insuficiencia renal crónica. Reviste una gran importancia medir cuidadosamente el perfil de beneficio riesgo en aquellos pacientes que presentan factores predisponentes, así como informar con claridad de los síntomas compatibles para poder suspender precozmente el tratamiento. Presentamos un caso clínico de una mujer de 86 años pluripatológica valorada en consultas de atención primaria y de reumatología, que tras el tratamiento con quinolonas presenta ruptura unilateral del tendón de Aquiles. Una indicación más adaptada a las características de la paciente podría haber evitado dicho efecto (AU)

Fluoroquinolones are a group of antibacterial drugs useful in a wide range of clinical conditions due to their wide spectrum of activity and oral bioavailability. Tendon injury is a rare complication associated to these drugs. Standing out among the risk factors are elderly age, previous treatment with steroids and chronic renal failure. It is very important to carefully measure the risk-benefit profile of those patients who have predisposing factors, and to clearly inform on the consistent symptoms in order to be able to discontinue the treatment early. We present a clinical case of an 86-year old woman with multiple conditions evaluated in primary care and rheumatology after treatment with quinolones who presented unilateral rupture of the Achilles tendon. An indication more adapted to the patient's characteristics could have avoided this effect (AU)

Identification of possible areas of high prevalence of Paget's disease of bone in Spain.

OBJECTIVE: In view of the fact that Paget's disease of bone (PD) tends to appear in so-called 'foci', a case-control study was undertaken with the dual aim of: 1) identifying areas having a higher likelihood of constituting PD 'foci'; and 2) detecting the geographic origin of 'PD-carrier' families. METHODS: Two data sets were analysed, one covering the place of birth of 231 cases and 436 controls, and the other covering the place of birth of cases, controls and their parents. Analysis was restricted to six Autonomous Regions accounting for 60% of Spain's towns and cities. To identify geographical areas of high prevalence we used the scan statistic. RESULTS: In the first analysis, 6 possible clusters were detected, corresponding to the districts of Avila (Avila), Lozoya-Somosierra (Madrid), Tierra de Campos(Palencia), the Guadalajara Range, South-west Madrid and Cuenca Hills. The second analysis confirmed the 6 groupings identified by the above procedure and, in addition, detected a further 8 possible clusters. Geographical proximity suggests that in some cases, rather than individual groupings, these may instead constitute larger foci. CONCLUSION: The results point to the possible existence of different PD foci, some coinciding with clusters that have already been reported, and others indicating familial origin in areas that had never previously received PD-specific attention.

Is clinical expressiveness of Paget's disease of bone decreasing?

Recent data have suggested secular changes implying a current trend toward decreased clinical severity of Paget's disease of bone (PD). To test this hypothesis, we conducted a study comparing the characteristics of two groups of PD patients, as disclosed from a sample assessed systematically. The investigation was a hospital-based study of all cases followed up at our unit since 1980. Throughout the follow-up period, diagnosis was based on standard X-ray criteria and the same clinical assessment was applied. Group I (n = 124) represented patients born before 1926, whereas group II (n = 109) included those born after that year. A bone scan performed with 99mTc-EHDP was available for all patients. X-rays of the pelvis and spine, and views of any hot spot observed on the scintigraphy scans were reviewed. The skeletal extent of PD, based on bone scan uptake, was determined by using the index proposed by Coutris. Alkaline phosphatase and hydroxyproline excretion levels were determined in blood and urine, respectively. Baseline characteristics were recorded on a purpose-designed computerized database. The proportion of males (47% in group I vs. 65% in group II; p = 0.007) and the mean (+/-SD) age at diagnosis (69.0 +/- 8.15 vs. 54.3 +/-9.14; p < 0.001) differed significantly between groups. The year of birth showed a strong negative correlation with age at diagnosis (r = -0.83, p < 0.0001) and a weak, but significant, negative correlation with extent of bone lesion (r = -0.20; p = 0.002). Likewise, subjects born prior to 1926 showed a greater percentage of affected skeleton cases (9.6 plus minus 8.01 vs. 7.06 +/- 5.79; p = 0.001). Group I individuals who had pelvic and/or femoral bone lesions were more prone to suffer "pagetic coxopathy" (65% vs. 40%; p = 0.003) with "protrusio acetabuli" (32% vs. 17%; p = 0.01), and the percentage of patients showing radiographic Monckeberg-type vascular calcifications (36% vs. 14%; p = 0.0006) was higher than in those born after 1926. No other epidemiologically clinically, or biochemically relevant differences were seen in the crude analysis. Multivariate analysis identified extent of skeletal lesions (OR = 0.76; p = 0.01), age at diagnosis (OR = 0.79; p = 0.008), number of bones involved (OR = 1.53; p = 0.03), and occupation (p < 0.0001) as the predictive variables linked to year of birth. Our data are consistent with a temporal tendency toward a smaller number of bone lesions and a decreased percentage of instances of affected skeleton. An earlier age at recent diagnosis times and absence of any relevant clinical or biochemical differences seems more likely linked to recent changes in referral and sociological patterns.