Pedal neuroarthropathy in a nondiabetic patient as a result of long-term amiodarone use.

UNLABELLED: In this article, we describe a case of a man without diabetes with a long history of amiodarone use. He presented with a foot deformity and plantar ulceration. Examination showed him to have a symmetrical peripheral neuropathy and findings consistent with a Charcot foot. Extensive investigations failed to find other causes for his neuropathy, other than his amiodarone use. We believe that this is the first reported case of a neuropathic foot deformity and ulceration occurring with amiodarone use, and we feel that it is important to point out the association of this commonly used antiarrythmic drug with this form of neuropathic osteoarthropathy. LEVEL OF CLINICAL EVIDENCE: 4.

Alcohol-induced neuroarthropathy in the foot: a case series and review of literature.

Charcot arthropathy, also known as neuroarthropathy, is most commonly associated with diabetes mellitus, despite a variety of other etiologies. A limited number of case reports have been published on neuroarthropathies caused by other forms of neuropathy, including alcoholic peripheral neuropathy. We report 4 cases of neuroarthropathy associated with chronic alcoholism in nondiabetic individuals. Conservative management similar to that afforded diabetic patients was successfully employed in these cases. A review of the clinical presentation and the pathology of alcoholic neuropathy is included in this report. ACFAS Level of Clinical Evidence: 4.

Safety of fluoroquinolones in paediatrics.

In the last few years, there has been increasing pressure to use fluoroquinolones in paediatric patients, since these antibiotics offer the advantage of an oral treatment regimen on an out-patient basis. However, even although this class of antibiotics generally remains well-tolerated, the restriction of fluoroquinolone use in children on a compassionate basis, which derives from their potential to cause cartilage toxicity, limits the safety data in this population and suggests a cautious use. This review reports the data of the literature on the safety of fluoroquinolones in different districts, focusing on the side effects in children and drug interactions. Moreover, data available in the literature with regards to side effects in children are reported, with particular attention to their potential in arthropathy.

Selective ablation of rat knee joint innervation with injected immunotoxin: a potential new model for the study of neuropathic arthritis.

Neuropathic arthropathy is a severe chronic degenerative condition associated with decreased or absent sensory innervation of the involved joint. Existing animal models of neuropathic arthritis are limited by the technical difficulties of obtaining either highly selective or complete joint denervation in a minimally invasive fashion. We undertook experiments to determine the feasibility of using the newly described method of selective neuronal lesioning with injected immunotoxin as a means of creating a more tractable model of neuropathic arthritis. Retrograde tracing with fluorochrome revealed that the knee joint of the female Wistar rat is supplied by 581 +/- 31 (mean +/- SD) joint afferents. Immunohistochemistry confirmed that virtually all sensory neurons in the rat express the cell surface receptor Thy 1. Injection of rat knee joints with an immunotoxin targeted toward Thy 1 resulted in the selective ablation of an average of 88% of the joint afferents identified with fluorochrome that are normally found in the ipsilateral L3 and L4 ganglia.

Pefloxacin-induced arthropathy in an adolescent with brain abscess.

We present a case of pefloxacin-induced arthropathy in a 15-year-old patient with brain abscess. Six joints were involved, of which the right elbow joint was most severely affected. Magnetic resonance imaging of the right elbow revealed joint effusion, and bone scintigraphy showed increased tracer uptake which was still present in the follow-up bone scans.

A reappraisal of quinolone tolerability. The experience of their musculoskeletal adverse effects.

The experience of the rheumatological adverse effects of fluoroquinolones should be helpful for both toxicologists and epidemiologists. In the case of fluoroquinolone-related arthropathy, the paediatric clinical experience seems to support the possible use of newer derivatives like ciprofloxacin in children who really need it. This therapeutic attitude is still contradictory to the labelling of fluoroquinolones. Inversely, there has been an important time-lag between the first reports of fluoroquinolone-related tendinopathies and the official recognition of this unusual toxic phenomenon. This delay, along with the widespread use of fluoroquinolones, makes it difficult to return to more reasonable prescribing guidelines for these very useful and effective anti-microbial compounds. The reasons why potentially serious adverse effects of fluoroquinolones were not anticipated before their commercialisation may be related to the lack of adequate in vitro and in vivo models, and the unexpectedness of the events. When it occurs, fluoroquinolone-induced arthropathy is most frequently benign, and heals without sequelae. The prognosis is not so favourable in the case of fluoroquinolone-related tendinopathy, which carries an important risk of immediate or secondary tendon rupture. Increasingly, fluoroquinolones are being prescribed for benign infections of the urinary or bronchopulmonary tracts. Sometimes, they are even used for antimicrobial prophylaxis before surgical or endoscopic procedures. We believe that for any prescription, the risk/benefit ratio of the fluoroquinolones should be carefully considered, since better tolerated, less expensive drugs can usually be prescribed. Clear information dedicated both to physicians and patients regarding the cautions for use and possible adverse effects of fluoroquinolones would help reduce the risk and severity of adverse reactions. This is especially important for phototoxicity, tendinopathy and cardiovascular adverse effects. As underlined by Ball and Tillotson in this issue, the future clinical use of the fluoroquinolones will be determined by the balance between the antibacterial efficacy and adverse effects of these agents. The adverse reactions affecting the musculoskeletal system provide a good example of this dilemma. Given the absence of an adequate model of tendinopathy and the poor predictivity of animal manifestations in arthropathy and cartilage lesions in humans, careful monitoring of patients during phase II and III trials and, more importantly, long term pharmacovigilance during the postmarketing period, are still strongly warranted.

Charcot's arthropathy of the shoulder following intraarticular corticosteroid injections.

We describe a case of inflammatory and degenerative arthritis treated with intraarticular corticosteroid injections. This led to rapid subjective relief of symptoms, but inappropriate repeated injections led to the development of Charcot's arthropathy and rapid destruction of the shoulder joint.

[Aseptic osteonecrosis of the femoral head in cancer patients with neuropathies caused by vincristine and vinblastine]. / Osteonecrosi asettica della testa femorale in pazienti neoplastici con neuropatia da vincristina e vinblastina.

Aseptic osteonecrosis has been described in many and dissimilar pathologic conditions--most frequently as the aftermath of fractures or dislocations; in falciform anemia, obesity, alcoholism; in diseases requiring constant and heavy corticosteroid therapy, and also following renal transplantation. Many of these pathologies, especially alcoholism, diabetes, uremia, and collagen vascular diseases, have a common denominator: peripheral neuropathy, which is believed to be a pathogenetic factor supporting osteonecrosis. The authors analyze 3 cases of aseptic osteonecrosis of the femoral head in cancer patients treated with vincristine and/or vinblastine. Since in these subjects severe and persistent neuropathy preceded the onset of osteonecrosis, a possible relationship is postulated between the vincristine/vinblastine treatment and the onset of femoral head osteonecrosis, through the pathogenetic mechanism of peripheral neuropathy.