ABSTRACT
Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.
Subject(s)
Arthritis, Rheumatoid , Osteoporosis, Postmenopausal , Osteoporosis , Spinal Fractures , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/epidemiology , Bone Density , Case-Control Studies , Female , Humans , Lumbar Vertebrae/injuries , Risk Factors , Spinal Fractures/epidemiology , Spinal Fractures/etiologyABSTRACT
En pacientes infectados por VIH en tratamiento con tenofovir se ha comunicado la ocurrencia de hipofosfatemia y osteomalacia. Presentamos un caso que debutó clínicamente con fracturas vertebrales y dolor óseo. La suspensión de la medicación y la corrección de la acidosis mejoraron la sintomatología. El caso ilustra la importancia de considerar la osteomalacia en pacientes tratados con tenofovir
Cases of hypophosphatamia and osteomalacia have been reported in HIVpositive patients on tenofovir-containing active antiretroviral therapy. We present a case in which vertebral fractures and bone pain were the presenting features. The symptoms resolved after discontinuation of tenofovir and with mineral supplementation. The case highlights the importance of considering the diagnosis of osteomalacia in patients treated with tenofovir
Subject(s)
Humans , Male , Middle Aged , HIV Infections/complications , Anti-Retroviral Agents/adverse effects , Fanconi Syndrome/chemically induced , HIV Infections/drug therapy , Osteomalacia/chemically induced , Hypophosphatemia/chemically induced , Spinal Injuries/etiologyABSTRACT
La melorreostosis es una rara forma de displasia ósea esclerosante de etiología desconocidaque se acompaña de lesión de partes blandas adyacentes en muchoscasos.La lesión toma asiento habitualmente en una sola extremidad, donde puede haberuno o más huesos afectados, siendo mucho más frecuente la afectación delmiembro inferior. Aparece por igual en ambos sexos, y suele aparecer clínicamenteantes de los 20 años de edad, con dolor y limitación de movimiento delas zonas afectas.Se presenta el caso de un varón de 45 años con melorreostosis de tibia y tarsoizquierdos, que se presentó clínicamente como una artropatía de tobillo, condolor y deformidad del mismo.El tratamiento sintomático con antiinflamatorios no esteroideos fue satisfactorioen el caso presentado, no siendo preciso el empleo de cirugía, la cual puederequerirse en casos con contracturas o deformidades importantes
Melorheostosis is a rare sclerosing bone dysplasia of unknown etiology. Althoughit affects bone primarily, it may also involve soft tissues.Changes commonly are limited to a single limb, in which one or more bonesmay be affected. The lower extremity is involved more frequently than the upperextremity. Men and women are affected equally and generally the diseaseis evident by the age of 20 years. Pain and limitation of motion of the affectedlimb are frequent findings.We present the case of a 45-year-old man in whom melorheostosis of the tibiaand tarsus on the left limb was associated with ankle arthropaty manifested bypain and deformation.Treatment with NSAIDs resulted in a clear improvement in the bone pain.Surgical correction may be required in cases of considerable deformity and disability
Subject(s)
Male , Middle Aged , Humans , Joint Diseases/etiology , Melorheostosis/complications , Joint Diseases/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Foot Deformities, Acquired/complicationsABSTRACT
Reflex sympathetic dystrophy (RSD) has been related to a variety of inciting and predisposing factors. However, there are few reports of a familiar or genetic background in RSD. This paper describes two cases of RSD polytopic and recurrent in lower limbs of two brothers with similar HLA.
Subject(s)
Bone Diseases/etiology , Reflex Sympathetic Dystrophy/complications , Reflex Sympathetic Dystrophy/genetics , Bone Diseases/diagnostic imaging , Bone Diseases/therapy , Female , Genetic Predisposition to Disease/genetics , HLA Antigens/analysis , Humans , Lower Extremity/diagnostic imaging , Lower Extremity/pathology , Male , Middle Aged , Radiography , Recurrence , Reflex Sympathetic Dystrophy/therapyABSTRACT
La distrofia simpático refleja (DSR) puede estar relacionada con diferentes factores desencadenantes o predisponentes. No obstante, en la literatura médica no hay muchas publicaciones referentes a un terreno genético o familiar en la DSR. Por ello, presentamos el caso de 2 hermanos con similar HLA y con DSR de extremidades inferiores, politópica y recurrente (AU)
