RESUMO
It is becoming increasingly desirable to diagnose ankylosing spondyloarthropathy (AS) at its pre-radiographic stage (prior to the presence of sacro-iliitis on radiographs). MRI plays a key role for early diagnosis of AS, as illustrated by recently proposed international diagnostic criteria (ASAS). MRI of the SI joints is most helpful for early diagnosis; sequences using fat suppression and/or Gadolinium administration are necessary for the detection of inflammatory changes. However, the rate of false positive and false negative results of MR imaging of the SI joints, especially early in the course of the disease, is unknown and requires prudent interpretation of imaging findings. In patients with normal MRI examination of the SI joints and/or if symptoms are limited to the spine, MRI of the lumbar spine with STIR and/or Gadolinium administration may be helpful; again the positive and negative predictive values are unknown, especially early in the course of the disease. The demonstration of inflammatory changes on MRI, at the axial level, could be an indication for anti-TNF treatment, outside of WMA (national and international recommendations). The role of Doppler US, especially for peripheral entheses, remains hypothetical for early diagnosis. The role of MRI for structural evaluation is also being assessed even though radiographs remain the standard of reference. To date, no treatment, conventional or other, has been shown to have a structural effect (aside from limitations related to the methodology of available studies).
Assuntos
Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Articulações/patologia , Imageamento por Ressonância Magnética/métodos , Espondilite Anquilosante/diagnóstico , Ultrassonografia/métodos , Adulto , Antirreumáticos/uso terapêutico , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Progressão da Doença , Diagnóstico Precoce , Gadolínio DTPA , Humanos , Vértebras Lombares/patologia , Masculino , Articulação Sacroilíaca/patologia , Sensibilidade e Especificidade , Espondilite Anquilosante/classificação , Vértebras Torácicas/patologia , Fator de Necrose Tumoral alfa/antagonistas & inibidoresAssuntos
Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Espondilite Anquilosante/tratamento farmacológico , Tuberculose Renal/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Contraindicações , Humanos , Infliximab , Masculino , Espondilite Anquilosante/complicações , Fatores de Tempo , Tuberculose Renal/complicações , Tuberculose Renal/tratamento farmacológico , Suspensão de TratamentoRESUMO
Concern has arisen regarding a possible increase in the risk of malignant diseases such as lymphoproliferative disorders in a patient taking TNF-alpha antagonists for the treatment of chronic inflammatory diseases. The evidence of a causal link remains unclear. We report a case of 60-year-old male patient who developed acute myeloid leukemia during infliximab therapy for ankylo-sing spondylitis.
