Measuring inflammation in rheumatoid arthritis with a new clinical and ultrasound index: development and initial validation.

With the aim to develop and validate a clinical + ultrasound (US) inflammation score in rheumatoid arthritis (RA) for use in clinical practice, a mixed-method study was conducted. The theoretical development of the index was achieved with qualitative methodology (discussion group and Delphi survey). Subsequently, a cross-sectional study was carried out to analyse issues related to scoring and validation of the new index. RA patients underwent clinical [28 swollen and tender joints count, patient and physician global assessment (PhGA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)], and US assessments [synovitis or tenosynovitis by grey-scale (GS) and power Doppler (PD) of 42 structures]. An index was created based on statistical models and expert interaction. Construct validity was tested by correlation with DAS28, SDAI, CDAI, and PhGA. Reliability was evaluated in a subgroup of patients with the intraclass correlation coefficient (ICC). US assessment, CRP, and swollen joints were the items that passed the prioritization phase (Delphi study). For the cross-sectional study, 281 patients were randomly divided into design (n = 141) and validation samples (n = 140). The combination of US sites chosen (7 bilaterally) detected the maximum proportion of synovitis and PD present. Three scoring methods were tested: semiquantitative (0-3 GS + 0-3 PD), dichotomous (0/1 GS + 0/1 PD), and qualitative (0/1 based on algorithm). All showed strong correlation with activity measures (ρ ≥ 0.60), and reliability (ICC 0.89-0.93). The index with best parameters of validity, feasibility, and reliability was the qualitative. The final index chosen was the sum of swollen joint count, US qualitative score, and CRP. The UltraSound Activity score is a valid and reliable measure of inflammation in RA equal to the sum of 28 SJC, a simplified (0/1) US assessment of 11 structures and CRP. It is necessary further investigation to demonstrate additional value over existing indices.

Osteomielitis vertebral hematógena. Experiencia en un hospital comarcal / Haematogenous vertebral osteomyelitis. Experience of a primary care hospital

Objetivo Describir las características generales de una serie de enfermos con osteomielitis vertebral hematógena (OVH) desde la perspectiva de un hospital comarcal y comparar nuestros resultados con los de otras series nacionales y extranjeras. Pacientes y métodos Análisis retrospectivo de las historias clínicas de los pacientes con OVH diagnosticados en el Hospital de Viladecans en el período comprendido entre 1993 y 2008. Se han incluido sólo los pacientes con demostración microbiológica de infección y adquiridos por vía hemática. Resultados Veintiséis pacientes cumplían los criterios de inclusión, nueve mujeres y diecisiete varones, con una edad media de 61 años (límites 36–83). La mayoría de éstos tenían algún factor predisponente de base, predominando la diabetes mellitus, y estaban causados por gérmenes piógenos (77%). La presentación clínica habitual fue el dolor vertebral de características inflamatorias, observado en 23 enfermos (88,4%). La artritis séptica de articulaciones periféricas fue la forma de inicio en dos pacientes (7,6%) y el abdomen agudo en un paciente. La fiebre se detectó en 22 casos (84,6%). La mortalidad fue nula, aunque las complicaciones y secuelas resultaron frecuentes y a menudo graves. Conclusiones Las características clínicas generales de nuestra serie no difieren esencialmente de otras, tanto nacionales como extranjeras, aunque como hecho diferencial hemos detectado una incidencia predominante de etiología estreptocócica sobre la estafilocócica habitual. Es reseñable la nula mortalidad observada. Aunque se trata de una enfermedad infrecuente, parece que está aumentando su incidencia, lo que unido a su potencial capacidad para ocasionar complicaciones y secuelas graves obliga a sensibilizar al colectivo médico a fin de conseguir un diagnóstico más precoz y mejorar con ello el pronóstico (AU)

Objectives To describe a series of patients with haematogenous vertebral osteomyelitis (HVO) in a primary care hospital. The results were compared with other Spanish and foreign series. Patients and methods The files of patients with HVO diagnosed in the Viladecans hospital from 1993 through 2008, were retrospectively reviewed. Only patients with microbiological demonstration of infection were included. Patients with HVO after surgical procedures were excluded. Results Twenty six patients had inclusion criteria, 9 females and 17 males, with a mean age of 61 years (range 36–83). The most patients had any predisposing factor, generally diabetes mellitus. Pyogenic microorganisms were the most frequent aetiological agents (77%). Back pain was by far the most common presenting symptom (88,4%), followed by peripheral septic arthritis in two patients (7,6%), and acute abdominal pain in one. Fever was found in 22 cases (84,6%). None of our patients died, but the sequelae were non rare. Conclusion We did not find difference between our series and others. It is noteworthy that the streptococcal species represents the most frequently isolated organism, followed by Staphylococcus aureus, more common in other series. Remarkably, none of our patients died. HVO is a infrequent disease. However, evidence suggest that the incidence is increasing. Early diagnosis can avoid potential serious sequelae (AU)

[Haematogenous vertebral osteomyelitis. Experience of a primary care hospital]. / Osteomielitis vertebral hematógena. Experiencia en un hospital comarcal.

OBJECTIVES: To describe a series of patients with haematogenous vertebral osteomyelitis (HVO) in a primary care hospital. The results were compared with other Spanish and foreign series. PATIENTS AND METHODS: The files of patients with HVO diagnosed in the Viladecans hospital from 1993 through 2008, were retrospectively reviewed. Only patients with microbiological demonstration of infection were included. Patients with HVO after surgical procedures were excluded. RESULTS: Twenty six patients had inclusion criteria, 9 females and 17 males, with a mean age of 61 years (range 36-83). The most patients had any predisposing factor, generally diabetes mellitus. Pyogenic microorganisms were the most frequent aetiological agents (77%). Back pain was by far the most common presenting symptom (88,4%), followed by peripheral septic arthritis in two patients (7,6%), and acute abdominal pain in one. Fever was found in 22 cases (84,6%). None of our patients died, but the sequelae were non rare. CONCLUSION: We did not find difference between our series and others. It is noteworthy that the streptococcal species represents the most frequently isolated organism, followed by Staphylococcus aureus, more common in other series. Remarkably, none of our patients died. HVO is a infrequent disease. However, evidence suggest that the incidence is increasing. Early diagnosis can avoid potential serious sequelae.