Pulmonary involvement in patients with juvenile systemic sclerosis / Afección pulmonar en pacientes con esclerosis sistémica juvenil

Abstract Background: Pulmonary involvement in juvenile systemic sclerosis (JSSc) is rare in children and contributes to morbimortality. This study aimed to describe the pulmonary function and clinical, radiologic, and tomographic findings in JSSc. Methods: Patients with JSSc between 5-14 years of age were included. Clinical, functional, and imaging characteristics were assessed. Patients were excluded if they showed lung disease not associated with JSSc: mixed connective tissue disease, overlap syndrome, or acute cardiopulmonary failure at the time of the study. All patients underwent physical examination, electrocardiogram, spirometry, chest X-ray, high-resolution computed tomography (HRCT) of the chest, echocardiography, lung function tests, and the 6-minute walk test (6-MWT). Descriptive statistics were employed for data analysis. Results: We studied 15 patients with the following characteristics: median age, 11 years; median since symptoms onset, 6 years; median since JSSc diagnosis and the finding of pulmonary involvement, 2 years. Lung disease was detected in 73%, interstitial lung disease (ILD) the most common affection (67%); pulmonary hypertension was found in 6.6%. 6-MWT was positive in 26.6%, forced vital capacity (FVC) was abnormal in 26.6%. No pulmonary involvement was found in four patients. Conclusions: The most frequent pulmonary affection in JSSc was ILD. Thus, early JSSc detection and periodic lung monitoring are mandatory to avoid further complications once JSSc is diagnosed.

Resumen Introducción: La afección pulmonar en la esclerosis sistémica juvenil (ESJ) es rara en niños y contribuye a la morbimortalidad. El objetivo de este estudio fue describir los hallazgos de función pulmonar, clínicos, radiológicos y tomográficos en la ESJ. Métodos: Se incluyeron pacientes con ESJ de 5-14 años de edad. Se evaluaron las características clínicas, funcionales y de imagen. No se incluyeron pacientes con enfermedades pulmonares no asociadas con ESJ en el momento del estudio: enfermedad mixta del tejido conectivo, síndrome de superposición o insuficiencia cardiopulmonar aguda. Se realizaron exploración física, electrocardiograma, espirometría, radiografía de tórax, tomografía computarizada de alta resolución de tórax, ecocardiografía, pruebas de función pulmonar y prueba de caminata de 6 minutos (PC6M). Se utilizó estadística descriptiva para el análisis de los datos. Resultados: Se estudiaron 15 pacientes con las siguientes características: mediana de edad, 11 años; mediana desde el inicio de los síntomas, 6 años; y mediana desde el diagnóstico de ESJ y hallazgo de afección pulmonar, 2 años. Se detectó enfermedad pulmonar en el 73%. La enfermedad pulmonar intersticial (EPI) fue la afección más común (67%) y se encontró hipertensión pulmonar en el 6.6%. La PC6M fue positiva en el 26.6%, y la capacidad vital forzada resultó anormal en el 26.6%. Cuatro pacientes no presentaron afección pulmonar. Conclusiones: La afección pulmonar más frecuente en la ESJ fue la EPI. La detección temprana de ESJ y la monitorización pulmonar periódica son obligatorias para evitar más complicaciones una vez diagnosticada la ESJ.

Pulmonary involvement in patients with juvenile systemic sclerosis.

Background: Pulmonary involvement in juvenile systemic sclerosis (JSSc) is rare in children and contributes to morbimortality. This study aimed to describe the pulmonary function and clinical, radiologic, and tomographic findings in JSSc. Methods: Patients with JSSc between 5-14 years of age were included. Clinical, functional, and imaging characteristics were assessed. Patients were excluded if they showed lung disease not associated with JSSc: mixed connective tissue disease, overlap syndrome, or acute cardiopulmonary failure at the time of the study. All patients underwent physical examination, electrocardiogram, spirometry, chest X-ray, high-resolution computed tomography (HRCT) of the chest, echocardiography, lung function tests, and the 6-minute walk test (6-MWT). Descriptive statistics were employed for data analysis. Results: We studied 15 patients with the following characteristics: median age, 11 years; median since symptoms onset, 6 years; median since JSSc diagnosis and the finding of pulmonary involvement, 2 years. Lung disease was detected in 73%, interstitial lung disease (ILD) the most common affection (67%); pulmonary hypertension was found in 6.6%. 6-MWT was positive in 26.6%, forced vital capacity (FVC) was abnormal in 26.6%. No pulmonary involvement was found in four patients. Conclusions: The most frequent pulmonary affection in JSSc was ILD. Thus, early JSSc detection and periodic lung monitoring are mandatory to avoid further complications once JSSc is diagnosed.

Introducción: La afección pulmonar en la esclerosis sistémica juvenil (ESJ) es rara en niños y contribuye a la morbimortalidad. El objetivo de este estudio fue describir los hallazgos de función pulmonar, clínicos, radiológicos y tomográficos en la ESJ. Métodos: Se incluyeron pacientes con ESJ de 5-14 años de edad. Se evaluaron las características clínicas, funcionales y de imagen. No se incluyeron pacientes con enfermedades pulmonares no asociadas con ESJ en el momento del estudio: enfermedad mixta del tejido conectivo, síndrome de superposición o insuficiencia cardiopulmonar aguda. Se realizaron exploración física, electrocardiograma, espirometría, radiografía de tórax, tomografía computarizada de alta resolución de tórax, ecocardiografía, pruebas de función pulmonar y prueba de caminata de 6 minutos (PC6M). Se utilizó estadística descriptiva para el análisis de los datos. Resultados: Se estudiaron 15 pacientes con las siguientes características: mediana de edad, 11 años; mediana desde el inicio de los síntomas, 6 años; y mediana desde el diagnóstico de ESJ y hallazgo de afección pulmonar, 2 años. Se detectó enfermedad pulmonar en el 73%. La enfermedad pulmonar intersticial (EPI) fue la afección más común (67%) y se encontró hipertensión pulmonar en el 6.6%. La PC6M fue positiva en el 26.6%, y la capacidad vital forzada resultó anormal en el 26.6%. Cuatro pacientes no presentaron afección pulmonar. Conclusiones: La afección pulmonar más frecuente en la ESJ fue la EPI. La detección temprana de ESJ y la monitorización pulmonar periódica son obligatorias para evitar más complicaciones una vez diagnosticada la ESJ.

Estimating and Characterizing COVID-19 Deaths, Puerto Rico, March-July 2020.

OBJECTIVES: Using the Council of State and Territorial Epidemiologists (CSTE) classification guidelines, we characterized coronavirus disease 2019 (COVID-19)-associated confirmed and probable deaths in Puerto Rico during March-July 2020. We also estimated the total number of possible deaths due to COVID-19 in Puerto Rico during the same period. METHODS: We described data on COVID-19-associated mortality, in which the lower bound was the sum of confirmed and probable COVID-19 deaths and the upper bound was excess mortality, estimated as the difference between observed deaths and average expected deaths. We obtained data from the Puerto Rico Department of Health COVID-19 Mortality Surveillance System, the Centers for Disease Control and Prevention's National Electronic Disease Surveillance System Base System, and the National Center for Health Statistics. RESULTS: During March-July 2020, 225 COVID-19-associated deaths were identified in Puerto Rico (119 confirmed deaths and 106 probable deaths). The median age of decedents was 73 (interquartile range, 59-83); 60 (26.7%) deaths occurred in the Metropolitana region, and 140 (62.2%) deaths occurred among men. Of the 225 decedents, 180 (83.6%) had been hospitalized and 93 (41.3%) had required mechanical ventilation. Influenza and pneumonia (48.0%), sepsis (28.9%), and respiratory failure (27.1%) were the most common conditions contributing to COVID-19 deaths based on death certificates. Based on excess mortality calculations, as many as 638 COVID-19-associated deaths could have occurred during the study period, up to 413 more COVID-19-associated deaths than originally reported. CONCLUSIONS: Including probable deaths per the CSTE guidelines and monitoring all-cause excess mortality can lead to a better estimation of COVID-19-associated deaths and serve as a model to enhance mortality surveillance in other US jurisdictions.

Síndrome de Tjalma (pseudo-pseudo Meigs) como manifestación inicial de lupus eritematoso sistémico de inicio juvenil / Tjalma syndrome (pseudo-pseudo Meigs') as initial manifestation of juvenile-onset systemic lupus erythematosus

El síndrome de Tjalma o pseudo-pseudo Meigs es una entidad clínica que se presenta con derrame pleural, ascitis y elevación de CA-125 sin asociación a tumor ovárico benigno o maligno en un paciente con lupus eritematoso sistémico (LES). Tjalma describió el primer caso de un paciente con LES, ascitis, derrame pleural y elevación de CA-125. Presentamos el primer caso en una paciente pediátrica de 14 años, que se presentó con ascitis y derrame pleural refractarios a tratamiento con elevación de CA-125, sin encontrar tumor ovárico, que ameritó manejo agresivo

Tjalma syndrome or pseudo-pseudo Meigs' syndrome is a clinical condition characterized by pleural effusion, ascites and elevated CA-125 with no associated benign or malignant ovarian tumor in a patient with systemic lupus erythematosus (SLE). Tjalma described the first case of a patient with SLE, pleural effusion, ascites and elevated CA-125. We report the first case in a 14-year old patient who presented with ascites and pleural effusion refractory to treatment and elevated CA-125, in the absence of an ovarian tumor, that warranted aggressive management

Frecuencia de la afección auditiva y los factores asociados en pacientes con artritis idiopática juvenil / Frequency of auditory involvement and of associated factors in patients with juvenile idiopathic arthritis

Introducción: La artritis idiopática juvenil (AIJ) es una enfermedad autoinmune de curso crónico, caracterizada por la presencia de artritis en menores de 16 años, por más de 6 semanas en ausencia de otra causa conocida. La expresión extra articular en el sistema audiovestibular se relaciona con la afección de las articulaciones de la cadena oscicular, como consecuencia del proceso inflamatorio de la membrana sinovial. Estudios previos realizados en población infantil han reportado que la pérdida auditiva puede ser de tipo neurosensorial y/o conductiva. Objetivo: Determinar la frecuencia de la afección auditiva y los factores asociados en los pacientes con AIJ. Metodología: Estudio prospectivo y analítico. Se incluyó a 62 pacientes con AIJ con edades comprendidas entre 5 y 15 años, a partir de agosto del 2013 a enero del 2014. El estudio fue aprobado por el comité de ética local y los padres firmaron el consentimiento bajo información. Se realizó otoscopia microscópica, audiometría tonal, timpanometría, reflejo estapedial y emisiones otoacústicas transitorias (EOT); la evaluación reumatológica incluyó exploración articular y aplicación de cuestionario para la evaluación del estado de salud en la infancia (CHAQ). Se utilizaron medidas de tendencia y de dispersión; asociación χ2 con una p<0,05 para la significación estadística. Resultados: Se incluyó a 62 pacientes; 56 niñas y 6 niños, edad media 11,9 años, duración media de la enfermedad de 3,4 años; el 46% presentó AIJ poliarticular factor reumatoide (FR) positivo; el 40%, AIJ poliarticular FR negativo; el 15% AIJ sistémica y el 3% oligoarticular. Se encontró enfermedad activa en 29 pacientes y 33 en remisión con medicamentos. Se evaluaron en total 124 oídos; en 78 se encontró curva tipo As de la clasificación de Jerger, curva tipo A en 45 y en uno se reportó curva tipo AD. En la audiometría tonal no se encontró hipoacusia en ningún paciente y esta estuvo acorde con la logoaudiometría. Las EOT se encontraron ausentes en el 4% de los evaluados y sin reflejo estapedial en menos del 10%. Los factores que presentaron una asociación con la afección auditiva fueron la variedad poliarticular FR positivo, el tiempo de evolución, el índice de discapacidad y los niveles de VSG (p<0,001). Conclusión: Se encontró en más de la mitad de los pacientes estudiados alteraciones auditivas presentes en el timpanograma, asociadas con la variedad poliarticular FR positivo, tiempo de evolución, actividad de la enfermedad y la elevación de la VSG

Introduction: Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease characterized by the presence of arthritis in children under 16 years of age for more than 6 weeks in the absence of any other known cause. The extra-articular manifestations, especially in the audiovestibular system, are related to the involvement of the joints of the ossicular chain as a result of the inflammatory process in the synovium. Previous clinical studies in pediatric patients have shown conductive or sensorineural hearing loss. Objective: The aim of this study was to assess the frequency of hearing impairment and of associated factors in patients with JIA. Methodology: A prospective, analytical study was conducted from January 2013 to August 2014 in 62 patients with JIA aged between 5 and 15 years. The study was approved by the local ethics committee and parents signed their informed consent. All subjects underwent audiological examination involving otomicroscopy, audiometry, tympanometry, stapedius reflex and test for transient otoacoustic emissions (TOAE); rheumatologic evaluation included joint examination and the application of a measure of functional ability (disability) using the Childhood Health Assessment Questionnaire (CHAQ). Measures of central tendency and of dispersion were used (chi-square for associations and P<.05 for statistical significance). Results: Sixty-two patients were included: 56 girls and 6 boys, mean age 11.9 years and mean disease duration of 3.4 years; 46% had rheumatoid factor (RF)- positive polyarticular JIA, 40% had RF-negative polyarticular JIA, 15% had disease of systemic onset and 3% had oligoarthritis. Active disease was found in 29 patients and 33 were in remission with medication. Of the total of 124 ears evaluated according to the Jerger classification for tympanometry, abnormal findings were observed in 78 that were type As and in 1 that was type Ad, whereas there were 45 type A ears. Hearing loss was disclosed by speech audiometry, rather than by pure tone audiometry. The TOAE were absent in 4% of those assessed and the stapedius reflex was absent in less than 10%. Factors that had a positive correlation with hearing impairment were RF-positive polyarticular JIA, disease duration, degree of disability and the erythrocyte sedimentation rate level (P<.000). Conclusion: The presence of an abnormal tympanogram suggested early involvement in the structure of the tympanic-ossicular complex; however, 3.4 years later, no hearing loss had been reported

Tjalma syndrome (pseudo-pseudo Meigs') as initial manifestation of juvenile-onset systemic lupus erythematosus. / Síndrome de Tjalma (pseudo-pseudo Meigs) como manifestación inicial de lupus eritematoso sistémico de inicio juvenil.

Tjalma syndrome or pseudo-pseudo Meigs' syndrome is a clinical condition characterized by pleural effusion, ascites and elevated CA-125 with no associated benign or malignant ovarian tumor in a patient with systemic lupus erythematosus (SLE). Tjalma described the first case of a patient with SLE, pleural effusion, ascites and elevated CA-125. We report the first case in a 14-year old patient who presented with ascites and pleural effusion refractory to treatment and elevated CA-125, in the absence of an ovarian tumor, that warranted aggressive management.

Frequency of auditory involvement and of associated factors in patients with juvenile idiopathic arthritis. / Frecuencia de la afección auditiva y los factores asociados en pacientes con artritis idiopática juvenil.

INTRODUCTION: Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease characterized by the presence of arthritis in children under 16 years of age for more than 6 weeks in the absence of any other known cause. The extra-articular manifestations, especially in the audiovestibular system, are related to the involvement of the joints of the ossicular chain as a result of the inflammatory process in the synovium. Previous clinical studies in pediatric patients have shown conductive or sensorineural hearing loss. OBJECTIVE: The aim of this study was to assess the frequency of hearing impairment and of associated factors in patients with JIA. METHODOLOGY: A prospective, analytical study was conducted from January 2013 to August 2014 in 62 patients with JIA aged between 5 and 15 years. The study was approved by the local ethics committee and parents signed their informed consent. All subjects underwent audiological examination involving otomicroscopy, audiometry, tympanometry, stapedius reflex and test for transient otoacoustic emissions (TOAE); rheumatologic evaluation included joint examination and the application of a measure of functional ability (disability) using the Childhood Health Assessment Questionnaire (CHAQ). Measures of central tendency and of dispersion were used (chi-square for associations and P<.05 for statistical significance). RESULTS: Sixty-two patients were included: 56 girls and 6 boys, mean age 11.9 years and mean disease duration of 3.4 years; 46% had rheumatoid factor (RF)- positive polyarticular JIA, 40% had RF-negative polyarticular JIA, 15% had disease of systemic onset and 3% had oligoarthritis. Active disease was found in 29 patients and 33 were in remission with medication. Of the total of 124 ears evaluated according to the Jerger classification for tympanometry, abnormal findings were observed in 78 that were type As and in 1 that was type Ad, whereas there were 45 type A ears. Hearing loss was disclosed by speech audiometry, rather than by pure tone audiometry. The TOAE were absent in 4% of those assessed and the stapedius reflex was absent in less than 10%. Factors that had a positive correlation with hearing impairment were RF-positive polyarticular JIA, disease duration, degree of disability and the erythrocyte sedimentation rate level (P<.000). CONCLUSION: The presence of an abnormal tympanogram suggested early involvement in the structure of the tympanic-ossicular complex; however, 3.4 years later, no hearing loss had been reported.

Xantomas y macrotrombocitopenia: sitosterolemia es la respuesta / Xanthomas and macrothrombocytopenia: sitosterolaemia is the answer

No disponible

Síndrome de activación de macrófago como manifestación inicial de lupus eritematoso sistémico severo de inicio juvenil. Respuesta favorable a ciclofosfamida / Macrophage activation syndrome as the initial manifestation of severe juvenile onset systemic lupus erythematosus. Favorable response to cyclophosphamide

El síndrome de activación de macrófago es una complicación inusual pero potencialmente fatal de pacientes con enfermedades reumáticas autoinmunes. Esta es una entidad clínico-patológica caracterizada por la activación de histiocitos con hemofagocitosis prominente en la médula ósea y otros sistemas reticuloendoteliales. En pacientes con lupus, puede simular una exacerbación de la enfermedad o infección. Presentamos el caso de una paciente de 7 años de edad en la que el diagnóstico de lupus eritematoso sistémico y síndrome de activación de macrófago fue simultáneo con respuesta al uso de ciclofosfamida (AU)

The macrophage activation syndrome is a rare but potentially fatal complication of patients with autoimmune rheumatic diseases. This is a clinicopathological entity characterized by activation of histiocytes with prominent hemophagocytosis in the bone marrow and other reticuloendothelial systems. In patients with lupus it may mimic an exacerbation of the disease or infection. We report the case of a 7-year-old girl in whom the diagnosis of lupus erythematosus and macrophage activation syndrome was simultaneously made with response to the use of cyclophosphamide (AU)

Presentación de un caso: teratoma sacrococcígeo / A Case presentation: Sacrocoxigeal teratoma

La palabra teratoma fue utilizada por primera vez por Virchow en 1869 para referirse a los crecimientos sacrococcígeos y es el tumor más frecuente en el período perinatal y presentan baja mortalidad en el período neonatal se revisa la literatura en lo concerniente a teratoma coccígeo. Se realiza la presentación de un caso en neonato masculino, con peso de 3000 g, nacido por vía vaginal en villa Pongui, distrito Kimongo, extrahospitalario, en un puesto médico rural. Ingresa a los 5 días de nacido por tumor en región sacro-coccígea. La clínica y los complementarios permitieron el diagnóstico de teratoma sacrococcígeo benigno. Se realizó por primera vez en el Hospital de Dolisie, República del Congo la exéresis del tumor en dos tiempos, dado su gran tamaño. La evolución del niño fue favorable y no existió recidiva a los 12 meses(AU)

The term teratoma was first time used in 1869 by Virchow to refer to sacrococcygeal growths. It is the most frequent tumor in perinatal period; however it presents a low mortality rate at birth, medical literature is reviewed concerning coccygeal teratoma. The bibliography concerning coxigeal teratoma is revised. A case is presented of a male neonate, weight 3000 g, natural birth, in Pongui Village, Kimongo District, extrahospitalary, at a rural medical post. He is admitted after six days of been born, due to a tumor in the sacrocoxigeal region. The clinical study and the complementary tests allowed diagnosing a benign sacrocoxigeal teratoma. It was for the first time performed in the Congo Republic Dolisie Hospital, the removal of a tumor in two periods, due to its big size. The child´s evolution was favorable and it did not exist redisive after 12 months(AU)

Presentación de un caso: teratoma sacrococcígeo / A Case presentation: Sacrocoxigeal teratoma

Introducción: la palabra teratoma fue utilizada por primera vez por Virchow en 1869 para referirse a los crecimientos sacrococcígeos y es el tumor más frecuente en el período perinatal y presentan baja mortalidad en el período neonatal se revisa la literatura en lo concerniente a teratoma coccígeo. Presentación del caso: se realiza la presentación de un caso en neonato masculino, con peso de 3000 g, nacido por vía vaginal en villa Pongui, distrito Kimongo, extrahospitalario, en un puesto médico rural. Ingresa a los 5 días de nacido por tumor en región sacro-coccígea. La clínica y los complementarios permitieron el diagnóstico de teratoma sacrococcígeo benigno. Conclusiones: se realizó por primera vez en el Hospital de Dolisie, República del Congo la exéresis del tumor en dos tiempos, dado su gran tamaño. La evolución del niño fue favorable y no existió recidiva a los 12 meses.

Introduction: the term teratoma was first time used in 1869 by Virchow to refer to sacrococcygeal growths. It is the most frequent tumor in perinatal period; however it presents a low mortality rate at birth, medical literature is reviewed concerning coccygeal teratoma. Case report: the bibliography concerning coxigeal teratoma is revised. A case is presented of a male neonate, weight 3000 g, natural birth, in Pongui Village, Kimongo District, extrahospitalary, at a rural medical post. He is admitted after six days of been born, due to a tumor in the sacrocoxigeal region. The clinical study and the complementary tests allowed diagnosing a benign sacrocoxigeal teratoma. Conclusions: It was for the first time performed in the Congo Republic Dolisie Hospital, the removal of a tumor in two periods, due to its big size. The child´s evolution was favorable and it did not exist redisive after 12 months.

Human papillomavirus-related cancers among people living with AIDS in Puerto Rico.

The objective of this study was to estimate the incidence of cancer and human papillomavirus (HPV)-related cancers and the risk of death (by cancer status) among people living with AIDS (PLWA) in Puerto Rico. We used data from the Puerto Rico AIDS Surveillance Program and Central Cancer Registry (1985-2005). Cancers with highest incidence were cervix (299.6/100,000) for women and oral cavity/oropharynx for men (150.0/100,000); the greatest excess of cancer incidence for men (standardized incidence ratio, 86.8) and women (standardized incidence ratio, 52.8) was for anal cancer. PLWA who developed a cancer had decreased survival and increased risk of death compared with those who did not have cancer. Cancer control strategies for PLWA will be essential for improving their disease survival.

Macrophage activation syndrome as the initial manifestation of severe juvenile onset systemic lupus erythematosus. Favorable response to cyclophosphamide.

The macrophage activation syndrome is a rare but potentially fatal complication of patients with autoimmune rheumatic diseases. This is a clinicopathological entity characterized by activation of histiocytes with prominent hemophagocytosis in the bone marrow and other reticuloendothelial systems. In patients with lupus it may mimic an exacerbation of the disease or infection. We report the case of a 7-year-old girl in whom the diagnosis of lupus erythematosus and macrophage activation syndrome was simultaneously made with response to the use of cyclophosphamide.

Risk of cancer among Hispanics with AIDS compared with the general population in Puerto Rico: 1987-2003.

BACKGROUND: The risk of cancer among Hispanics with Acquired Immune Deficiency Syndrome (AIDS) in the United States and Puerto Rico (PR) has not been well described. The purpose of this study was to determine the risk of AIDS related and non-AIDS related cancers among Hispanics with AIDS in PR. METHODS: A probabilistic record linkage of the PR AIDS Surveillance Program and PR Central Cancer Registry databases was conducted. AIDS cases were grouped according to year of AIDS onset and antiretroviral therapy availability: 1987-1989 (limited availability), 1990-1995 (mono and dual therapy), and 1996-2003 (highly active antiretroviral therapy: HAART). Cancer risk was described using the standardized incidence ratios (SIR). RESULTS: A total of 612 cancers were identified after 3 months of AIDS diagnosis: 409 (66.7%) AIDS related and 203 (33.1%) non-AIDS related. Although a decreasing trend in the risk of AIDS and non-AIDS related cancers was observed, the risk for both remained higher in the AIDS group compared to the general population in PR. Non-AIDS related cancers with higher risk during the HAART availability were: oropharyngeal, anal, liver, larynx, eye and orbit, Hodgkin lymphoma, and vaginal. CONCLUSION: Hispanics with AIDS in PR consistently showed a greater risk of AIDS and non-AIDS related cancers compared to the general population in PR and that has not changed over time.

Eficacia y seguridad del ozono intraarticular en artrosis de rodilla refractaria al tratamiento / Efficacy and safety of intraarticular ozone in osteoarthritis of the knee refractory to treatment

El ozono, es una variedad triatómica del oxígeno (O3), que se aplica al organismo humano con fines terapéuticos, sobre todo en enfermedades crónicas con poco beneficio de la medicina alopática, tal es el caso de enfermedades reumáticas como la osteoartritis (OA). Se evalúan 100 pacientes con diagnóstico de OA primaria de rodillas grado III, con pobre respuesta clínica a los antiinflamatorios no esteroideos (AINES), a quienes se aplica ozono intraarticular de rodillas, en dosis de 5 cc a 15 ug/ml las primeras 5 sesiones y de 5 cc a 20 ug/ml las restantes 3 sesiones, con una frecuencia de 2 infiltraciones semanales. Utilizando el cuestionario WOMAC-escala de Likert en la evaluación del dolor, rigidez articular, dificultad funcional, expresados según puntaje acumulado, observamos una disminución progresiva en forma significativa del puntaje a los 7, 14 y 28 días de tratamiento, al término del cual el porcentaje de mejoría en los 3 parámetros clínicos evaluados fue del 52%. Los efectos adversos no fueron de consideración, salvo el dolor agudo y transitorio de rodillas durante el momento de la administración del ozono. La administración de AINES concomitantes se redujo en forma importante. Se concluye que el ozono intraarticular es una terapia efectiva en el tratamiento de OA de rodillas grado III resistentes al tratamiento con AINES.

Ozone is a triatomic variety of oxygen, applied to the human organism with therapeutic aims, mainly in chronic diseases that have little benefit with allopatic medicine, like the rheumatic disease osteoarthritis. 100 patients with diagnosis of primary knee osteoarthritis grade III were evaluated, all of them with poor clinical response to non-steroidal antiinflammatory. They received intra-articular ozone in knees, in 5 first applications of 5 cc at a doses of 15 ug/ml, with 3 remaining sessions of 5cc at a doses of 20 ug/ml, 2 weekly applications. Using the questionnaire WOMAC with Likert score, there was a progressive and significant lowering of global scores at 7, 14 and 28 days of treatment, at the end the proportional improvement in the three clinical parameters evaluated was 52%. Adverse effects were minimal, with acute and transitory pain in knees at the moment of application of ozone. Concomitant administration of NSAIDs was importantly reduced. We concluded that intraarticular ozone is an effective therapy in the treatment of grade III knee osteoarthritis resistant to treatment with NSAIDs.