ABSTRACT
Introducció. Losteomielitis crònica no bacteriana (OCNB)és una entitat poc freqüent en pediatria. Es tracta dunamalaltia inflamatòria no infecciosa de los que sol cursaramb remissions i exacerbacions espontànies. Té una etiologia desconeguda. Sol presentar-se com un dolor ossisubagut, acompanyat o no de clínica sistèmica, i és necessari descartar altres causes, com la neoplàstica o la infecciosa. Les proves dimatge donen suport al diagnòstic.Observació clínica. Es presenten dos casos de pacients ambdolor ossi insidiós a les extremitats inferiors de diversessetmanes devolució, amb alteració de la força i la mobilitat. Ambdós casos sassocien a anorèxia. Lanalítica presenta elevació dels paràmetres inflamatoris, VSG (velocitatde sedimentació globular) i PCR (proteïna C reactiva). Lagammagrafia òssia i la ressonància magnètica nuclear permeten fer el diagnòstic dOCNB. En ambdós casos es fatractament amb antiinflamatoris no esteroidals durant quatre setmanes, i es requereix laddició de bifosfonats a causaduna resposta parcial.Comentaris. LOCNB és una causa dinflamació òssia en elsinfants en què un diagnòstic precoç i la instauració duntractament efectiu permet evitar complicacions. És important tenir-la en compte en fer el diagnòstic diferencial deldolor ossi insidiós. Un coneixement millor en pot disminuirlinfradiagnòstic. (AU)
Introducción. La osteomielitis crónica no bacteriana (OCNB) esuna entidad poco frecuente en pediatría. Se trata de una enfermedad inflamatoria no infecciosa del hueso que suele cursar conremisiones y exacerbaciones espontáneas. Su etiología es desconocida. Suele presentarse como un dolor óseo subagudo, acompañado o no de clínica sistémica, y es necesario descartar otrascausas como la neoplásica o la infecciosa. Las pruebas de imagenapoyan el diagnóstico.Observación clínica. Se presentan dos casos de pacientes con doloróseo insidioso en extremidades inferiores de varias semanas de evolución con alteración de la fuerza y la movilidad. Ambos casosse asocian a anorexia. A nivel analítico presentan elevación de losparámetros inflamatorios, VSG (velocidad de sedimentación globular) y PCR (proteína C reactiva). La gammagrafía ósea y la resonancia magnética nuclear permiten realizar el diagnóstico de OCNB.En ambos casos se realiza tratamiento con antiinflamatorios noesteroideos durante cuatro semanas, requiriendo la adición de bifosfonatos debido a respuesta parcial.Comentarios. La OCNB es una causa de inflamación ósea en losniños en la que un diagnóstico precoz y la instauración de untratamiento efectivo permite evitar complicaciones. Es importantetenerla en cuenta al realizar el diagnóstico diferencial del doloróseo insidioso. Un mayor conocimiento puede disminuir su infradiagnóstico. (AU)
Introduction. Chronic non-bacterial osteomyelitis (CNBO) is a rarecondition in pediatrics. It is a non-infectious inflammatory diseaseof the bone that usually results in spontaneous remissions andexacerbations. Its etiology is unknown. It usually presents as subacute bone pain, with or without systemic signs and symptoms. Itis often necessary to rule out other causes such as neoplastic orinfectious. Imaging tests support the diagnosis.Clinical observation. We present two cases of patients with insidious bone pain in the lower extremities of several weeks of evolution with impaired strength and mobility. Both cases were associated with anorexia nervosa. Laboratory evaluation showed elevatedinflammatory parameters, erythrocyte sedimentation rate andC-reactive protein. Bone scintigraphy and nuclear magnetic resonance imaging allowed the diagnosis of CNBO. In both cases,treatment with nonsteroidal anti-inflammatory drugs was performed for 4 weeks, requiring the addition of bisphosphonates due topartial response.Comments. CNBO is a cause of bone inflammation in children inwhich early diagnosis and effective treatment can prevent complications. It is important to keep this entity in mind when makingthe differential diagnosis of insidious bone pain. Greater knowledgemay decrease its underdiagnosis. (AU)
Subject(s)
Humans , Female , Child, Preschool , Child , Osteomyelitis/diagnostic imaging , Osteomyelitis/therapy , Chronic Pain , Osteitis/diagnostic imaging , Osteitis/diagnosis , Osteitis/therapy , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Diphosphonates/therapeutic useSubject(s)
Humans , Male , Adult , Sarcoidosis , Finger Injuries , Treatment Outcome , Inpatients , Physical Examination , Rheumatology , Rheumatic Diseases , GhanaSubject(s)
Osteoarthritis , Sarcoidosis , Humans , Sarcoidosis/diagnosis , Sarcoidosis/diagnostic imagingABSTRACT
MASEI is the main validated ultrasound score for the evaluation of enthesis. The lack of studies facing the agreement to achieve for the interpretation of the MAdrid Sonographic Enthesis Index (MASEI) among researchers from different centers in multicenter studies is of concern. The aim of this multicenter was to evaluate the interobserver reliability of MASEI. An experienced ultrasonographer-rheumatologist performed ultrasound scans of the areas included in MASEI index in three patients with Ankylosing Spondylitis and Psoriatic Arthritis. Videos were captured. The videos were then evaluated by 24 rheumatologists of the ultrasound working group of the Catalan Society of Rheumatology (EcoCAT). A face-to-face training meeting was held. Ten days after the workshop, the study participants evaluated the videos. A reliability assessment was performed. The ICC for the MASEI scores after the workshop was of 0.97 (95% CI 89-99). Reliability did not vary statistically with examiner experience. Globally, no problems of reliability by structures were seen, and all the ICCs were above 0.90 and improved slightly after the educational program. However, the correlation observed between examiners at plantar aponeursis and triceps tendon was weak. The small variability observed in the results of the index validation in our study, suggests that the MASEI index is reproducible by different observers when those are well trained and show awesome results of the enthesis when examined by ultrasound.
Subject(s)
Musculoskeletal System/diagnostic imaging , Spondylarthropathies/diagnostic imaging , Ultrasonography/methods , Adult , Aged , Female , Humans , Male , Observer Variation , Reproducibility of Results , Rheumatology/education , Rheumatology/methods , Severity of Illness IndexABSTRACT
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Subject(s)
Humans , Male , Adult , Familial Mediterranean Fever/complications , Familial Mediterranean Fever/drug therapy , Familial Mediterranean Fever/genetics , Spondylitis, Ankylosing/complications , Spondylitis, Ankylosing/genetics , Spondylitis, Ankylosing , Ibuprofen/therapeutic use , Thoracentesis/methods , Familial Mediterranean Fever/physiopathology , Familial Mediterranean Fever , Spondylitis, Ankylosing/drug therapy , Radiography, Thoracic/methods , Magnetic Resonance Imaging , Tomography, Emission-Computed/methods , Pericardial EffusionABSTRACT
No disponible
Subject(s)
Humans , Osteitis Deformans/diagnosis , Osteitis Deformans/therapy , Biomarkers/analysis , Diagnostic Imaging/methods , Diphosphonates/therapeutic use , Calcitonin/therapeutic useABSTRACT
BACKGROUND AND OBJECTIVE: We intended to describe the clinical characteristics, treatment and evolution of 26 patients with adult onset Still's disease. PATIENTS AND METHOD: This was a retrospective study (1984-2004). The clinical records of patients with adult onset Still's disease were reviewed. RESULTS: Twenty six patients were included. Most frequent clinical characteristics were: fever (100%), arthritis (81%), rash (92%) sore throat (92%) and lymphadenopathy (42%). Aspirin controlled the disease in 27% of patients, prednisone was needed in 70% and methotrexate was added in 50% cases. A monocyclic course was seen in 54% and polycyclic in 46% patients. CONCLUSIONS: The clinical characteristics were similar to previous series. A febrile polyarthritis was the most frequent presentation form. A polycyclic course was found in 58% of cases and it seems to be associated with poor prognosis and need for aggressive treatment.
