Efecto de la estimulación eléctrica transcutánea del músculo cuádriceps en la sintomatología de la artrosis de rodilla / Effect of transcutaneous electrical quadriceps muscle stimulation in knee osteoarthritis symptomatology

Objetivo. Determinar si el tratamiento rehabilitador de la artrosis de rodilla evolucionada a través de la estimulación eléctrica muscular (EMS) del cuádriceps, produciría una mejoría en la sintomatología de la artrosis de rodilla. Métodos. Veinte pacientes (> 40 años) con artrosis de rodilla sintomática, confirmada radiográficamente, se dividieron en dos grupos. A uno se le aplicó corriente activa (contracción activa del músculo cuádriceps) y al otro una corriente "inactiva" (leve analgesia o endorfínica). El dolor y la función física en los dos grupos se valoraron mediante la Escala Visual Analógica (EVA) del dolor, el Western Ontario and McMasters Universities (WOMAC) Osteoarthritis Index y el Índice de Lequesne, que valoran la gravedad de la artrosis. El análisis de los datos fue realizado usando el programa SPSS versión 11.5, llevando a cabo un análisis descriptivo e inductivo. Resultados. En el grupo de corriente activa que producía contracción del cuádriceps, se producía una mejoría tanto del dolor como de la rigidez y función física del paciente al terminar el tratamiento, manteniéndose la respuesta al menos un mes. Estos resultados se contraponían a los del grupo placebo donde no existía respuesta. Conclusión. En pacientes con artrosis de rodilla evolucionada, el tratamiento rehabilitador debería incluir la potenciación del cuádriceps, que en pacientes con grados muy avanzados de debilidad muscular podría realizarse a través de la electroestimulación

Objective. To determine whether the rehabilitation treatment in advanced knee osteoarthritis (OA) using electrical muscle stimulation (EMS) in muscle quadriceps could produce benefits in knee OA symptomatology. Methods. Twenty patients (> 40 years) with radiographically confirmed symptomatic knee OA, were divided in two groups. In one was applied an active electrical stimulus (active quadriceps contraction) and in the other a "inactive" stimulus (light analgesic or endorphin). Pain and physical function in the two groups were measure using the visual analogic scale (VAS), Western Ontario and McMasters Universities (WOMAC) Osteoarthritis Index and Lequesne Method, which measures the severity of knee OA. Statistical analyses were completed using SPSS version 11.5 performing a descriptive and inductive analysis. Results. Active group, which had quadriceps contraction (EMS), obtained benefits reducing pain and having a better flexibility and physically function scores at the end of treatment. This response was maintained unless for a month. Placebo group does not obtain any kind of benefits. Conclusion. Rehabilitation treatment in advanced knee OA should include quadriceps potentiation, which in patients with muscle quadriceps weakness could be obtained using electrical muscle stimulation (EMS) obtaining good results

Masa frontotemporal, afectación ocular y nasal / Frontotemporal mass, ocular and nasal involvement

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Tratamiento médico: fármacos de acción lenta, inmunosupresores y terapias combinadas en la artritis reumatoide / Medical therapy: slow acting drugs, immunosuppressive agents and combined therapies in rheumatoid arthritis

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[Asymmetric polyarthritis in Sézary's syndrome]. / Poliartritis asimétrica en el síndrome de Sézary.

We present the case of a patient with negative serology asymmetric polyarthritis and erythematous-squamous cutaneous lesions of two years evolution, initially attributed to psoriasis, which histopathology (hyperkeratosis, epidermic infiltration due to atypical CD4+ lymphocytes with formation of Pautrier's microabscesses) together with hematological findings (persistent lymphocytosis with cells with cerebriform nucleus, 97% CD4+) allowed the diagnosis of Sézary's syndrome. To our knowledge, this is the eight documented case of arthritis in Sézary's syndrome and the first one with asymmetric chronic polyarthritis.

[Osteoporosis as the first manifestation of minor beta-thalassemia]. / Osteoporosis como primera manifestación de la beta-talasemia minor.

We present the case of a 48-year-old premenopausal woman with right lumbosciatalgia secondary to osteoporosic vertebral collapses. Two of her three offsprings, a 31-year-old man and a 16-year-old woman, had chronic dorsolumbalgia, the study of which suggested the diagnosis of minor beta-thalassemia. As opposed to thalassemic osteoarthropathy, frequently observed in the forms of "major" and "minor" beta-thalassemia, rheumatic manifestations have almost never been described in the "minor" forms. We highlight the possibility of symptomatic osteoporosis as the first manifestation and we review the locomotive disorders associated to this hemoglobinopathy.

HLA and Behçet's disease in northern Spain: their lack of correlation with arthritis pattern.

We have studied the characteristics of arthritis present in 32 patients with Behçet's disease (BD), and how this arthritis is related to the HLA markers class I. 84% of the patients presented arthritis, the most common being mono-arthritis as the initial presentation, and oligoarthritis in subsequent episodes. In 63% of the cases, the development was in episodes of acute/subacute arthritis. We found statistically significant association between antigens B-5 and B-51, and the group with BD, with a relative risk of 3.89 and 4.71 respectively. The attempt to relate markers B-5, B-51 and B-27 to the presence of arthritis as well as to its manifestation and further development was not conclusive.

Cutaneous polyarteritis nodosa and Crohn's disease.

We report a case of a 57-year-old woman who presented simultaneously cutaneous polyarteritis nodosa and Crohn's disease of the colon. Although similar pathogenic hypotheses have been reported, the association of both diseases is exceptional.

[Sternoclavicular staphylococcal arthritis in non-immunodepressed patients. Study of 4 cases]. / Artritis estafilocócica esternoclavicular en pacientes no inmunodeprimidos. Estudio de 4 casos.

We report four patients (3 males and one female) suffering a sternoclavicular staphylococcal arthritis in whom risk factors such as parenteral drug addiction, alcoholism, diabetes, or immunosuppression were not observed. The etiopathogenesis, clinical picture, and diagnosis of this uncommon septic arthritis in reviewed.

[Reiter's syndrome. A study of 25 cases]. / Síndrome de Reiter. Estudio de 25 casos.

The laboratory, radiological and clinical features of 25 cases of Reiter's syndrome were studied. Most of the subjects were between the 2nd and 4th decade of life (p less than 0.05). We observed a high incidence in females: 92% (p less than 0.01) and a high rate of alcoholism: 24%. Knees (72%) and ankles (44%) were the most afflicted joints. Urethritis (87.5%) and eye problems (87.5%), predominantly conjunctivitis (76%), were the more frequent extra-articular manifestation. HLA-B27 were positive in 81.8% (18/22). Sacroiliitis was confirmed radiologically in 8 patients (32%), being asymmetric in 6 of them. "Fluffy" periostitis (20%) was the more frequent peripheral articulation. The treatment used was indomethacin; we obtained good results in 20 subjects; the remaining 5 had to be treated with steroids to control ocular and joint symptoms. Two or more episodes occurred in a low rate of patients: 28%.

[Peripheral tuberculous arthritis in Galicia]. / Artritis tuberculosa periférica en Galicia.

We have evaluated the cases of tuberculous arthritis in peripheral joints (TAPJ) that had been diagnosed in our unit during the last twelve years. The diagnosis was made by synovial biopsy in 26 of 33 cases, and by synovial fluid culture in the remaining 7. TAPJ accounted for 2.4% of all forms of tuberculosis and for 6% of extrapulmonary cases diagnosed in our hospital during those years. In 54% of cases there were risk factors of tuberculous infection. The mean time from the onset of symptoms to the confirmation of the diagnosis was longer than one year. All cases had clinical features of monoarthritis, and the knee was the most commonly involved joint (42%). In the 16 investigated synovial fluids the mean cellular rate was 11060 cells/mm3. The most reliable diagnostic procedure was the histological confirmation with synovial biopsy, whereas the yield of synovial culture was 64% and that of staining techniques 40%. In 97% of cases the treatment was effective. Orthopedic surgery was required in 36% of cases, and 48% had sequelae.

[Sicca syndrome caused by large granulated lymphocytes in rheumatoid arthritis]. / Síndrome seco por linfocitos grandes granulados en la artritis reumatoide.

The proliferation of large granulated T lymphocytes (LGL) with neutropenia and splenomegaly can be observed in patients with rheumatoid arthritis (RA), in a similar way to Felty's syndrome. We report a female with long standing AR, xerophthalmia, xerostomia, neutropenia and LGL lymphocytosis. The phenotype of the latter was CD3+, CD8+, HNK1+. She was treated with methotrexate and corticosteroids. The genetic rearrangement study did not show monoclonality. Although LGL lymphocytosis can infiltrate several organs, salivary glands infiltration has not been reported. The development of a sicca syndrome can be a feature of LGL lymphocytosis and induce diagnostic mistakes in RA.

[Multiple aneurysms and cerebral vasculitis in systemic lupus erythematosus]. / Aneurismas múltiples y vasculitis cerebral en el lupus eritematoso sistémico.

A female in whom systemic lupus erythematosus had been diagnosed 5 years before suddenly developed headache and recurrent vomiting. Cranial computed tomography (CT) was consistent with subarachnoid hemorrhage, and cerebral arteriography disclosed cerebral aneurysms, multiple microaneurysms and cerebral vasculitis. After 7 days she developed left hemiparesis, and a cerebral infarct area was apparent in a new CT scan. Despite the poor prognosis of these lesions, the patient had a favorable outcome, without residual neurological deficit, after having been treated with intravenous corticosteroid boluses and oral cyclophosphamide.