Muehrcke lines associated to active rheumatoid arthritis.

Careful examination of the fingernails and toenails can help to detect underlying systemic diseases. Physicians should look for shape, growth, or color changes in the nails; the transverse nail discolorations include different diagnostic possibilities such as Muehrcke lines and Mees lines. Leukonychia striata or Muehrcke lines are transverse nail bands of discoloration that are unspecific, and there are around 70 different causes that include cancer treatment and less commonly rheumatic diseases. In this case, we report the unusual presentation of Muehrcke lines associated with active rheumatoid arthritis.

Inter- and intra-observer agreement of high-resolution ultrasonography and power Doppler in assessment of joint inflammation and bone erosions in patients with rheumatoid arthritis.

To assess the inter- and intra-observer reproducibility of musculoskeletal ultrasonography among rheumatologist in detecting inflammatory and morphostructural changes in small joints of the hands in patients with rheumatoid arthritis (RA). Five members of the "Escuela de Ecografía del Colegio Mexicano de Reumatología" tested their inter- and intra-observer reliabilities in the assessment of basic sonographic findings of joint inflammation and bone erosion. Their results were compared to those obtained by a group of international experts from European League Against Rheumatism. A clinical rheumatologist evaluated eight RA patients. Five Siemens Acuson Antares ultrasound machines (7-13 MHz linear probes) were used. The OMERACT preliminary definitions of joint effusion, synovial hypertrophy, bone erosions and tenosynovitis were adopted. Inter-observer and intra-observer agreement was calculated by overall agreement and kappa statistics. Mean kappa value for joint effusion was good, 0.654 (85%); synovial hypertrophy, 0.550 (77.2%); power Doppler signal, 0.550 (82.5%); bone erosions, 0.549 (81%); and tenosynovitis, 0.500 (91.5%). Mean and overall intra-observer agreement for semiquantitative score was good for joint effusion, 0.630 (77.2%) and bone erosions, 0.605 (56.25%); and moderate to synovial hypertrophy, 0.476 (65%) and power Doppler signal, 0.471 (80%). Mean kappa value for joint effusion was 0.381 (95%), synovial hypertrophy, 0.447 (72%); power Doppler signal, 0.496 (81%); bone erosions, 0.294 (81%); and tenosynovitis, 0.030 (66%). Mean and overall inter-observer agreement for semiquantitative score was poor for joint effusion, 0.325 (57%) and bone erosions, 0.360 (43%); and moderate to synovial hypertrophy, 0.431 (55%) and power Doppler signal, 0.496 (81%). Intra-observer variability reached the highest levels of agreement. Factors related to the experience of the rheumatologist, the time spent in each examination and knowledge of the software ultrasound equipment could influence the lower level of inter-observer agreement in this study.

Poiquilodermatomiositis / No disponible

No disponible

Methylprednisolone versus triamcinolone in painful shoulder using ultrasound-guided injection.

There is little evidence about the comparative efficacy of corticosteroids in the treatment of painful shoulder. The main aim was to compare the efficacy of methylprednisolone (MTP) versus triamcinolone (TMC) in the treatment of painful shoulder using an ultrasound-guided injection. Patients with painful shoulder due to subacromial bursitis and partial or full-thickness rotator cuff tears demonstrated by musculoskeletal ultrasound received a guided-injection of MTP acetate 40 mg (12 patients) or TMC acetonide 40 mg (12 patients). Range of motion and pain visual analogue scale were registered at 10 and 30 min, 1 and 2 weeks postinjection. Two weeks postinjection, both groups reported a mean improvement in range of motion (33%) and relief of pain (61%). Relief of pain of 50% or more was observed in 92% of patients in MTP group and 50% of TMC group (p = 0.02). Two months postinjection, 50% of the patients in MTP group and 25% in TMC group reported total relief of pain (p = 0.3). Patients with painful shoulder receiving an ultrasound-guided injection of MTP or TMC have a rapid and sustained overall response. Relief of pain tends to be more rapid with MTP than TMC.

Osteomielitis de rótula y artritis séptica de rodilla por Pseudomonas aeruginosa / Pseudomonas aeruginosa-associated osteomyelitis of the patella and septic arthritis of the knee

Introducción. La osteomielitis de rótula es una infección poco frecuente que afecta principalmente a los niños. En la mayoría de los casos la causa es Staphylococcus aureus. El diagnóstico se sospecha si hay dolor e hinchazón perirrotuliano, celulitis, bursitis prerrotuliana (séptica o no), o artritis séptica que no responde al tratamiento estándar. Caso clínico. Paciente diabético tipo 1 de 14 años de edad con dolor e inflamación de la rodilla izquierda por una herida superficial con un objeto metálico punzante sin respuesta a antibióticos orales y antiinflamatorios. Se confirmó infección de articulación y de rótula por gammagrafía y ultrasonido músculo-esquelético, así como por estudio histológico del tejido sinovial obtenido por cirugía. El cultivo reveló Pseudomonas aeruginosa. El tratamiento con ceftazidima seguido de ciprofloxacina fue efectivo con resolución del proceso infeccioso. Conclusión. Se requiere de un alto nivel de sospecha y de un abordaje exhaustivo para el diagnóstico de osteomielitis de rótula, asociado o no a artritis séptica.

Introduction. Osteomyelitis of the patella is an infrequent infection that predominantly affects children. The most frequent microorganism is Staphylococcus aureus. Diagnosis should be considered in patients with pain and swelling around the patella, cellulitis, prepatellar bursitis (septic or not), and in patients with septic arthritis with no response to the standard treatment. Case report. We report the case of a 14-year-old male patient with type 1 diabetes mellitus with pain and swelling of the left knee after being injured with a sharp metallic object. No response was obtained with oral antibiotics and anti-inflammatory drugs. Surgery, gammagraphy, and musculoskeletal ultrasound, together with the histology, confirmed septic arthritis of the knee and osteomyelitis of the patella due to Pseudomonas aeruginosa. Treatment with ceftazidime and subsequent ciprofloxacin resulted in total remission of symptoms. Conclusion. A high level of suspicion and an exhaustive approach are required for definitive diagnosis of osteomyelitis of the patella, associated or not with septic arthritis.

Acute hepatitis associated to leflunomide in a patient with rheumatoid arthritis

No disponible

Agudeza diagnóstica del examen físico de rodilla en la artritis reumatoide: estudio clínico y sonográfico del derrame articular y quiste de Baker / Diagnostic accuracy of physical examination of the knee in rheumatoid arthritis: clinical and ultrasonographic study of joint effusion and Baker’s cyst

Introducción: En pacientes con artritis reumatoide (AR),el dolor en las rodillas puede ser inflamatorio, mecánico oextraarticular. La exploración física (EF) no siempredetecta el derrame articular o el quiste de Baker (QB) enlas rodillas de estos pacientes.Objetivo: Determinar la agudeza diagnóstica de la EF enel diagnóstico de derrame articular y QB en pacientes conAR evaluados con ultrasonografía osteomuscular(USME), la técnica de imagen de referencia.Material y método: Se utilizaron 3 equipos de ultrasonidomarca Toshiba Tosbee, Toshiba Capasee y SiemensSonoline, con transductores lineares de 7,5 MHz paradetectar derrame y QB en rodillas de pacientes con ARvalorados previamente por clínica por un reumatólogo,quien dictaminó si los había. Se registraron edad, sexo,duración de la AR, factor reumatoide, tratamiento, clasefuncional de AR (CFAR) y diagnóstico clínico previo alUSME.Resultados: Se evaluó a 40 pacientes (80 rodillas) conAR, el 80% eran mujeres, la edad promedio fue 61,3 ±15 años y la duración de la enfermedad, 9,5 ± 11,3 años;el factor reumatoide fue positivo en el 80% de los casos;CFAR I (3 pacientes), CFAR II (27), CFAR III (8),CFAR IV (2); el 55% de los pacientes recibíanmetotrexato. Hubo dolor referido por el paciente en 26rodillas (32,5%). Se comunicó derrame por USME en49 rodillas (61,2%) y QB en 14 (17,5%); derrame porEF en 35 rodillas (43,7%) y corroborado por USME en31 rodillas (38,75%), QB por clínica en 12 rodillas(15%) y corroborado por USME en 6 rodillas (7,5%).La sensibilidad de la EF para la detección de derrame fue 0,63 y la especificidad, 0,87; para la detección de QBfueron 0,43 y 0,91, respectivamente.Conclusiones: La EF mostró una agudeza diagnósticaaceptable para el clínico. El uso complementario de laUSME en la EF de los pacientes con AR puede ser unfactor decisivo en la conducta terapéutica y diagnóstica enpacientes con AR y afección de rodillas(AU)

Introduction: In patients with rheumatoid arthritis (RA),knee pain can be inflammatory, mechanical or extraarticular.The physical examination (PE) doesn’t alwaysdetect the presence of knee joint effusion or Baker’s cyst(BC) in the knees of these patients.Objective: To determine the diagnostic accuracy of PE inthe diagnosis of effusion and BC in patients with RAevaluated with musculoskeletal ultrasound (MSUS),using this technique as the gold standard for comparison.Material and method: Three different models ofultrasound machines with a 7.5 MHz linear probe wereused (Toshiba Tosbee, Toshiba Capasee and SiemensSonoline). A rheumatologist evaluated the presence orabsence of knee joint effusion or BC in patients. Weregistered age, gender, time of evolution of RA,rheumatoid factor, treatment, functional class of RA(FCRA) and previous clinical diagnosis to the MSUSstudy.Results: 40 patients (80 knees) with RA were evaluated.Eighty percent were women, mean age 61.3 ± 15 years.Time since onset of RA was 9.5 ± 11.3 years, rheumatoidfactor was positive in 80%, FCRA I (3 patients), FCRA II (27), FCRA III (8), FCRA IV (2). Fifty five percent ofthe patients received methotrexate. Patients reffered painin 26 knees (32.5%). Joint effusion was reported by theclinician in 35 knees (43.7%) and corroborated by MSUSin 31 knees (38.75%), BC was reported by the clinician in12 knees (15%) and corroborated by MSUS in 6 knees(7.5%). The sensitivity of the PE for detection of jointeffusion was 0.63 and specificity of 0.87, for the detectionof BC was 0.43 and 0.91, respectively.Conclusions: The PE showed acceptable diagnosticaccuracy for the clinician. The complementary use of theMSUS can change the therapeutic and diagnosticapproach in patients with RA(AU)