Clinico-radiological correlation of enthesitis in seronegative spondyloarthropathies (SNSA).

The goal of this work was to evaluate clinico-radiological correlation of enthesitis in SNSA patients, selected for presenting at least one radiological enthesopathy. Out of 50 patients with SNSA, 40 were selected for having had at least one radiological enthesitis. In a cross-sectional study, 32 males and 8 females, whose mean age was 40.4 years and mean disease duration 13 years, were evaluated. Nineteen patients had ankylosing spondylitis, 15 psoriatic arthritis and 6 Reiter's syndrome. Sites evaluated were pelvis and lower limbs. Radiological enthesopathies were identified by the presence of calcifications, new bone formation and/or erosions in tendinous and ligamentous insertion sites, and clinical enthesitis due to pain or tenderness and/or swelling at such locations. The site most commonly involved radiologically was the sciatic tuberosity in 33/40 cases, followed by the calcaneus with 12/40 on its inferior and 11/40 on its posterior aspect. Fifteen patients (37%) presented clinical manifestations at tendinous insertion sites, but clinico-radiological correlation was found in only 4 (22%). We conclude that clinical and radiological manifestations correlate poorly in SNSA enthesitis, perhaps due to the wide diversity of developmental stages of the disease.

Clinic and functional evaluation of total hip and knee prostheses in patients with juvenile chronic arthritis: a 20-year experience / Avaliaçäo clínico-funcional de próteses de quadril e joelho em pacientes com artrite crônica juvenil: uma experiência de 20 anos

Foram revistos os resultados de implante de prótese total de quadril e de joelho em pacientes com artrite crônica juvenil e acompanhados em nosso Serviço nos últimos 20 anos. Os 40 casos avaliados (34 com artrite reumatóide juvenil e seis com espondilite anquilosante juvenil) receberam 71 próteses (61 de quadril e dez de joelho): quatro dos 34 casos de artrite reumatóide juvenil receberam três ou mais próteses articulares. No grupo de 61 próteses de quadril (23 bilaterais), a idade média à cirurgia foi de 24 anos, com 85 por cento dos pacientes abaixo de 31 anos. O acompanhamento pós-operatório médio foi de 60 meses. Os resultados foram excelentes em 46 próteses de quadril (75 por cento) e bons ou pobres em 15 (25 por cento). Das 61 próteses de quadril observou-se infecçäo em dois casos (3 por cento), falência mecânica devida a soltura em sete casos (11 por cento) e ossificaçäo heterotópica em 25 casos (45 por cento). Houve necessidade de revisÝo cirúrgica em sete próteses. Em um período pós-operatório médio de 47 meses, todos os seis casos de artrite reumatóide juvenil recebendo prótese total de joelho (bilaterais) apresentaram-se sem complicaçöes clínicas, com resultados bons a excelentes em 80 por cento dos casos. Pacientes que receberam múltiplas próteses devido a grave incapacitaçäo funcional (grau IV) obtiveram melhora significante. Conclui-se que artroplastia total de quadril e joelho é uma valiosa modalidade terapêutica para reabilitaçäo de casos de artrite crônica juvenil

Artroplastias de caderas y rodillas en artritis cronica juvenil / Hip and knee arthroplasties in juvenile chronic arthitis: our twenty-year experience

Se revisaron los resultados clinico-funcionales de las protesis totales de caderas y rodillas realizadas en pacientes con Artritis Cronica Juvenil (ACJ) seguidos en nuestro servicio durante 20 años. Se evaluaron 40 pacientes que recibieron un total de 71 protesis (61 caderas y 10 rodillas); 4 de 34 pacientes con ARJ, recibieron 3 o mas reemplazos articulares. Se realizaron 61 artroplastias totales de caderas (23 bilateral); la edad promedio a la cirugia fue de 24 años; el 85 por ciento de los pacientes era menor de 35 años. El tiempo promedio de seguimiento postoperatorio fue de 60 meses. Los resultados fueron a excelentes en 46 protesis (75 por ciento) y regular a pobre en 15 (25 por ciento). De estas 61 protesis se observo infeccion en 2 casos (3 por ciento), fallo mecanico debido a aflojamiento en 7 (11 por ciento) y osificacion heterotopica en 25 (41 por ciento). Siete protesis debieron ser revisadas quirurgicamente. Los 6 pacientes con ARJ que recibieron un total de 10 protesis de rodilla (4 bilaterales), permanecieron libres de complicaciones clinicas, alcanzando resultados bueno a excelente en el 80 por ciento de los casos. Los cuatro pacientes que fueron sometidos a reemplazos multiples por severa discapacidad funcional (grado IV ACR) mejoraron significativamente posterior a la cirugia funcional no clinica. Las atropatias totales de caderas y rodillas constituyen un recurso terapeutico a tener en cuenta en la rehabilitacion de pacientes con ADJ con severo compromiso funcional

Artroplastias de caderas y rodillas en artritis cronica juvenil / Hip and knee arthroplasties in juvenile chronic arthitis: our twenty-year experience

Se revisaron los resultados clinico-funcionales de las protesis totales de caderas y rodillas realizadas en pacientes con Artritis Cronica Juvenil (ACJ) seguidos en nuestro servicio durante 20 años. Se evaluaron 40 pacientes que recibieron un total de 71 protesis (61 caderas y 10 rodillas); 4 de 34 pacientes con ARJ, recibieron 3 o mas reemplazos articulares. Se realizaron 61 artroplastias totales de caderas (23 bilateral); la edad promedio a la cirugia fue de 24 años; el 85 por ciento de los pacientes era menor de 35 años. El tiempo promedio de seguimiento postoperatorio fue de 60 meses. Los resultados fueron a excelentes en 46 protesis (75 por ciento) y regular a pobre en 15 (25 por ciento). De estas 61 protesis se observo infeccion en 2 casos (3 por ciento), fallo mecanico debido a aflojamiento en 7 (11 por ciento) y osificacion heterotopica en 25 (41 por ciento). Siete protesis debieron ser revisadas quirurgicamente. Los 6 pacientes con ARJ que recibieron un total de 10 protesis de rodilla (4 bilaterales), permanecieron libres de complicaciones clinicas, alcanzando resultados bueno a excelente en el 80 por ciento de los casos. Los cuatro pacientes que fueron sometidos a reemplazos multiples por severa discapacidad funcional (grado IV ACR) mejoraron significativamente posterior a la cirugia funcional no clinica. Las atropatias totales de caderas y rodillas constituyen un recurso terapeutico a tener en cuenta en la rehabilitacion de pacientes con ADJ con severo compromiso funcional

Protrusio acetabuli in seronegative spondyloarthropathy.

Protrusio acetabuli (PA) is a complication of many disorders involving the hip joint. Its frequency and clinical features in seronegative sponyloarthropathy (SNSA) are unknown. The prevalence and characteristics of PA were studied in 50 adults and 25 children with SNSA (40 ankylosing spondylitis, 24 psoriatic arthropathy, and 11 Reiter's syndrome). PA was considered present when the acetabular line medially exceeded the ilioischial line by 3 mm or more in men, 6 mm or more in women, more than 1 mm in boys, and more than 3 mm in girls. PA prevalence was 25% in the total group (19 of 75 patients), 22% in adults, and 32% in children. There were no significant differences in seronegative disease type; PA was present with similar frequency between genders and did not correlate with disease duration, clinical severity of hip involvement, or previous medication. Radiological damage was similar in adults and children and did not differ in those with and without PA. Similarly, functional capacity did not differ between groups. It is concluded that PA is a frequent complication in SNSA; however, its presence does not seem to modify the functional prognosis of these patients.

Effect of low doses of deflazacort vs prednisone on bone mineral content in premenopausal rheumatoid arthritis.

Longterm administration of steroid drugs, particularly prednisone, is known to induce osteoporosis, as well as bone growth inhibition and delayed fracture union. Recently deflazacort, an oxazoline prednisone derivative, has been developed to reduce such deleterious effects. We carried out a comparative study in premenopausal patients with rheumatoid arthritis (RA). Sixteen cases whose mean age was 36.5 years and mean disease duration 29 months, all fulfilling ARA criteria, were evaluated in a randomized, double blind trial. Visually identical deflazacort or prednisone capsules were given and patients were instructed to maintain an adequate calcium intake. Laboratory tests focussed on bone mineral density in lumbar spine, femoral neck and Ward's triangle and whole body mineral content. Differences between baseline and 12-month values were processed statistically. Persistent synovitis control proved similar for both drugs and features suggestive of Cushing's syndrome were only found in the prednisone group. The difference in whole body bone mineral content between the deflazacort and prednisone groups just failed to reach statistical significance. In the deflazacort group, the difference between the nonsignificant bone mineral density increase at the femoral neck and the significant decrease in the prednisone group proved statistically significant. Ward's triangle was the most sensitive area to bone mineral density changes in patients receiving prednisone, with a highly significant intergroup difference (p < 0.01). We believe this is the first study on corticosteroid induced osteoporosis, as evaluated by whole body mineral content measurements in premenopausal patients with short term RA, showing that deflazacort is a promising alternative in cases severe enough to require steroid therapy.