[Colonoscopic evaluation in patients with ankylosing spondylitis]. / Avaliação colonoscópica em pacientes com espondilite anquilosante.

INTRODUCTION: Patients with ankylosing spondylitis can have intestinal inflammatory lesions, thus the use of colonoscopy for such patients should be defined. OBJECTIVES: To assess the gross intestinal colonoscopic changes and microscopic histopathologic findings of patients with ankylosing spondylitis; to correlate the colonoscopic and histopathologic findings; and to study the relationship of the histopathologic findings with extra-articular manifestations of the disease, HLA-B27, BASFI and BASDAI. METHODS: This is a cross-sectional study of 22 patients with ankylosing spondylitis. The patients underwent clinical assessment, BASDAI and BASFI application, blood collection for HLA-B27 measurement, and colonoscopy with biopsy of four intestinal segments (terminal ileum, right and sigmoid colons, and rectum). RESULTS: Abnormal colonoscopic results were obtained in 13 (59.1%) patients, the major abnormality being intestinal polyps. The groups of normal and abnormal colonoscopic results (n=9 and n=13, respectively) were homogeneous regarding age, BASFI, BASDAI, and categorical variables, and the P-value showed no significant difference between groups. The histopathological findings revealed abnormal biopsies in 81%, 90.9%, 90.9% and 86.4% for terminal ileum, right colon, sigmoid colon, and rectum, respectively. The histopathologic results showed no statistically significant association with the extra-articular manifestations, BASFI, BASDAI and HLA-B27 positivity. CONCLUSIONS: The histological analysis of the four intestinal segments evidenced inflammatory lesions in patients with normal and abnormal colonoscopic results, independently of bowel symptomatology and therapy used in the treatment of the basal disease.

Association between juvenile idiopathic arthritis and osteogenesis imperfecta: case report.

The authors report a rare association case of juvenile idiopathic arthritis (JIA) and osteogenesis imperfecta (OI) in a 53 years-old female patient, present a literature review and discuss the radiological aspects of the temporo-mandibular joint involvement. To our knowledge, this is the first case report of JIA an OI association.

Reactive haemophagocytic syndrome in a systemic lupus erythematosus patient: case report.

The macrophagic syndrome or reactive haemophagocytic syndrome (RHS) is a complication resulting from systemic inflammatory diseases and may also be related to malign neoplasias, immunodeficiencies and to a variety of infections caused by virus, bacteria, and fungus. It is characterized by an excessive activation of macrophages and histiocytes along with intense hemophagocytosis in bone marrow and reticulum-endothelial system, causing the phagocytosis of erythrocytes, leukocytes, platelets, and their precursors. The clinical manifestations are fever, hepatosplenomegaly, lymphadenomegalies, neurological involvement, variable degrees of cytopenias, hyperferritinemia, liver disorders, intravascular coagulation, and multiple organs failure. We report a rare case of recurrent RHS complication in a systemic lupus erythematosus male patient after two years. Although extremely rare it has evolved with an improvement after a pulse methilprednisolone and cyclophosphamide therapy.

Bilateral osteochondrosis of lateral femoral condyles: case report and literature review.

Osteochondrosis is an injury on subchondral ossification with predominance of immature skeleton and whose etiology remains unknown. It may affect the femoral condyles (usually the medial condyle) and the involvement is mostly unilateral. The authors draw the attention to this usually late diagnosis due to its infrequent occurrence and report a child's rare case of bilateral osteochondrosis on lateral femoral condyles, stressing that just one similar case has been described in the orthopaedic literature up to the present time.

Use of 99mTc-anti-CD3 scintigraphy in the differential diagnosis of rheumatic diseases.

OBJECTIVES: The aim of this study was to assess the use of anti-CD3, labelled with technetium-99m scintigraphy, for evaluating the joints of patients with RA, juvenile idiopathic arthritis (JIA), OA and gouty arthritis, and to establish the diagnosis parameters for each disease. METHODS: We evaluated 2044 joints from 77 patients with rheumatic diseases. The clinical evaluation consisted of laboratory assays; examination for joint inflammation (pain and/or oedema); and for patients with RA, the disease activity score of 28 joints. To evaluate the sensitivity and specificity of 99mTc-anti-CD3 in detecting disease activity, patients received an injection of the radiopharmaceutical compound 99mTc-anti-CD3, and underwent a scintigraphy scan 1 h later. Scanning was repeated 3 h later. As a control, after 2 days, the patient was injected with 99mTc-non-specific human immunoglobulins, and scintigraphy scanning performed at 1 and 3 h after the injection. The intensity of uptake and the pattern of activity were defined, and Spearman's correlation and analysis of variance used for statistical evaluation. RESULTS: Diagnosis criteria were established for 99mTc-anti-CD3 uptake in different diseases. RA and JIA showed joint uptake with progressive increase in late images. Gouty arthritis showed joint uptake with decrease during the late images. Joint uptake was low or absent in patients with OA, although when present the joint uptake decreased during the examination. CONCLUSION: 99mTc-anti-CD3 scintigraphy is a useful method in the differential diagnosis of rheumatic diseases.

Bone mineral density at 45 years of age, before menopause.

OBJECTIVE: The objectives of this study were to investigate variations in bone mineral density values in 45-year-old women from a community sample in the City of Rio de Janeiro, in the same-name Brazilian state, and to compare them with US norms and international standards. DESIGN: In this cohort study, the age of 45 years is significant for the design, since clinical observation in this community indicates that it is approximately 5 years before menopause can be confirmed, thus preceding the typical postmenopause acceleration of the rate of bone loss. Nine hundred fifty-nine such women volunteered to participate in the investigation, conducted in 2 Rio de Janeiro teaching hospitals. Informed of procedures, potential risks, and benefits, they were screened for the inclusion criteria: (a) being 45-years-old: (b) being healthy (without obvious or diagnosed systemic disease, metabolic disease, endocrine disease, liver disease, cardiac disease, infectious disease, pulmonary disease, neurologic disease, dermatologic disease, inflammatory bowel disease, kidney disease, hereditary, or congenital conditions); (c) having regular and intact menstrual cycles; (d) having had normal healthy development to date; (e) having had high protein intake from birth to date; (f) having at least completed high school; (g) living in a dwelling equipped with running water, electricity, and public sewer; (h) being nonsmoking and non-drug abusing. Racial distinction was not among the inclusion criteria. After further informed consent, the 146 women who met all inclusion criteria had bone mineral density quantified--using the dual energy x-ray absorptionmetry method--and compared with US-born density norms for L2-L4 and the neck of the femur for young adults and the sample age group, which are endorsed by the World Health Organization and by the International Osteoporosis Foundation. RESULTS: About three-quarters of the sample had normal bone mineral density values, 22.61% had osteopenia, and 2.73% had osteoporosis. CONCLUSION: These findings, obtained from women whose regular and intact menstrual cycles demonstrated premenopausal hormonal levels, seem to attest to the importance of genetic predisposition, yet they warrant the authors' recommendation that interventions be instituted before age 45, specifically aimed at increasing the chances of all women, especially those genetically predisposed, of avoiding osteoporosis and its deleterious consequences.

Determinants of risk for venous and arterial thrombosis in primary antiphospholipid syndrome and in antiphospholipid syndrome with systemic lupus erythematosus.

OBJECTIVE: Antiphospholipid syndrome (APS) is characterized by thrombosis (venous and arterial) and pregnancy loss in conjunction with the lupus anticoagulant, IgG or IgM anticardiolipin, or IgG or IgM anti-beta2-glycoprotein I. In most series, only a minority of patients with antiphospholipid antibodies develop a clinical manifestation. METHODS: A cross-sectional study of consecutive patients in the Hopkins Lupus Center was performed. Interviews were done and records were reviewed for the following variables: gender, ethnicity, hypertension, triglycerides, cholesterol, smoking, diabetes mellitus, homocysteine, cancer, hepatitis C, hormone replacement therapy/oral contraceptives, hereditary thrombophilia, anticardiolipin antibodies IgG, IgM and IgA, and lupus anticoagulant (LAC). Our aim was to identify risk factors associated with thrombosis and pregnancy loss in patients with antiphospholipid antibodies. RESULTS: A total of 122 patients (84% female, 74% Caucasian) were studied. Patients were divided into 3 groups: primary APS, APS associated with systemic lupus erythematosus, and patients with systemic lupus erythematosus (SLE) with antiphospholipid antibodies but no thrombosis or pregnancy loss. Venous thrombosis was associated with high triglycerides (p=0.001), hereditary thrombophilia (p=0.02), anticardiolipin antibodies IgG>40 (p=0.04), and LAC (p=0.012). Hypertriglyceridemia was associated with a 6.4-fold increase, hereditary thrombophilia with a 7.3-fold increase, and anticardiolipin IgG>40 GPL with a 2.8-fold increase in the risk of venous thrombosis. Arterial thrombosis was associated with hypertension (p=0.008) and elevated homocysteine (p=0.044). Hypertension was associated with a 2.4-fold increase in the risk of arterial thrombosis. No correlations were found for pregnancy loss. CONCLUSION: The frequency of thrombosis and pregnancy loss is greater in APS associated with SLE than in primary APS. Risk factors differ for venous and arterial thrombosis in APS. Treatment of hypertension may be the most important intervention to reduce arterial thrombosis. Elevated triglycerides are a major associate of venous thrombosis, but the benefit of treatment is not known. Hereditary thrombophilia is an associate of venous but not arterial thrombosis, making it cost-effective to investigate only in venous thrombosis.