Thoracic outlet syndrome (TOS) mimicking Takayasu's arteritis--case report.

Thoracic outlet syndrome (TOS) is defined as a set of symptoms caused by the compression of the brachial plexus and subclavian vessels in the thoracic outlet region. Anomalies in musculoskeletal structures may be responsible for TOS, including prolonged transverse process of the seventh cervical vertebra, cervical rib, and first anomalous rib and clavicle fractures. The authors describe a case of a young woman with pain in the left forearm, accompanied by intermittent claudication, weigh loss, myalgias and ischemic lesions in the fingers, with no pulses and no measurable blood pressure in the left arm, who was initially diagnosed as Takayasu arteritis. The chest radiography showed accessory cervical ribs and the dynamic vascular image tests (Doppler ultra-sound and angiography) showed bilateral compression of the subclavian artery, confirming the diagnosis of TOS.

Baixa dose de methotrexate comparado a placebo em osteoartrite de joelho / Low-dose methotrexate compared to placebo in the treatment of knee osteoarthritis

OBJETIVO: avaliar a eficácia de baixa dose de metotrexato (MTX) em osteoartrite (OA) de joelho. MÉTODOS : 58 pacientes foram separados em dois grupos em um estudo prospectivo, duplo-cego, placebo-controlado, randomizado, com duração de 4 meses. O grupo 1 recebeu metotrexato na dose de 7,5 mg por semana e o grupo 2 recebeu placebo. Foram utilizados como medidas de avaliação primária o Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), o Índice Algofuncional de Lequesne e a Escala Visual Analógica (EVA) para dor. A quantidade consumida de comprimidos de paracetamol para analgesia serviu como medida de avaliação secundária. RESULTADOS : a média de idade dos pacientes foi de 61,8 anos no grupo 1 e de 60,4 anos no grupo 2 (p = 0,43). Houve predomínio de mulheres em ambos os grupos com 93,1 por cento no grupo 1 e 72,4 por cento no grupo 2 (p = 0,08). Não houve diferença estatisticamente significante entre os grupos com relação ao WOMAC (p = 0,94), Lequesne (p = 0,87) e EVA (p = 0,89). Também não houve diferença estatística significante entre os grupos (0,09) quanto ao consumo de paracetamol, mas houve tendência a consumo maior de analgésico no grupo placebo. CONCLUSÃO : metotrexato não trouxe alívio sintomático nem reduziu limitação funcional quando comparado ao placebo em osteoartrite de joelho. Metotrexato mostrou uma tendência a menor consumo de analgésicos em osteoartrite de joelho.

OBJECTIVE: to evaluate the efficacy of low-dose methotrexate in the treatment of knee osteoarthritis. METHODS: 58 patients were separated into two groups in a prospective, double-blinded, placebo-controlled, randomized 4 months study. Group 1 received a 7,5 mg weekly dose of methotrexate whilst group 2 received placebo. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequèsne Algofunctional Index and the Visual Analogue Scale (VAS) for pain were utilized as measurement of primary evaluation. The quantity of paracetamol used for analgesia served as a secondary evaluation. RESULTS: the patient's average age was of 60.4 years in the group 2 and 61.8 years in group 1 (p = 0.43). In both groups, women predominated, comprising 93.1 percent in group 1 and 72.4 percent in group 2 (p = 0.08). There were no statistically significant difference between both groups regarding WOMAC (p = 0.94), Lequèsne (p = 0.87) and VAS (p = 0.89. Likewise, in the paracetamol consumption there was not statistically significant difference between both groups. However, there was tendency to increased consumption in the placebo group. CONCLUSION: methotrexate provided neither symptomatic relief nor did it reduce the functional limitation when compared to placebo in knee osteoarthritis. Methotrexate showed a tendency to decrease the consumption of paracetamol in knee osteoarthritis.