¿Cuál es la evolución de las artritis indiferenciadas? / What is the outcome of undifferentiated arthritis?

No disponible

[Amyloidosis complicating spondyloarthropathies: Study of 15 cases]. / Amiloidosis secundaria a espondiloartritis: estudio de 15 casos.

BACKGROUND AND OBJECTIVE: Secondary amyloidosis (AA) is a rare complication of rheumatic diseases. OBJECTIVE: The aim of this study was to determine the frequency of symptomatic amyloidosis AA in patients with spondyloarthropathy. PATIENTS AND METHOD: Retrospective study (1984-2013). We reviewed the medical records of patients with spondyloarthropathy who had a histological diagnosis of amyloidosis AA (15 patients). RESULTS: We identified 1.125 patients with spondyloarthropathies. Fifteen (1.3%) patients with amyloidosis AA were recruited. It was suspected in 14 patients (93.3%) because of nephrotic syndrome in most of them: 14 were symptomatic (93.3%): 5 (33.3%) ankylosing spondylitis (AS), 5 (33.3%) spondylitis associated with inflammatory bowel diseases (IBD), 4 (26.7%) psoriatic arthritis, and one (6.7%) reactive arthritis. The mean disease duration was 23.9 years. Mortality after one and 5 years of follow-up was 30 and 50% respectively. CONCLUSIONS: The frequency of clinical amyloidosis AA in our patients was 1.3%. There was a marked male predominance, with AS or IBD. Clinical amyloidosis was diagnosed at a relatively late stage in spondyloarthropathy.

The SAPHO syndrome: a clinical and imaging study.

The purpose of this study is to describe the clinical and radiological manifestations of patients with the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Retrospective study (1984-2007) was performed in a single center. All patients with the SAPHO syndrome were included. Fifty-two patients were included: 26 male, mean age at diagnosis is 42±12 years. Ostearticular involvement was present before cutaneous involvement in 59.6% of patients and concomitantly in 23.5%. Anterior chest pain was the commonest clinical manifestation, it was present in 38 patients (73%), followed by peripheral arthritis in 17 patients (32%), and sacroliliac pain in 14 patients (26.9%). Cutaneous involvement was present in 33 patients (63.5%). HLA B27 antigen was present in eight patients (17.7%). Bone scintigraphy showed an increased uptake in 42 patients (93.3%). The location of the uptake was mainly in sternoclavicular and manubriosternal joints. CT scan was performed in all "hot joints" showing sclerosis, erosions, hyperostosis, and soft tissue involvement. Refractory patients were treated mainly with pamidronate. Although SAPHO syndrome is an entity that share features that fit into a variety of established disease categories, the present study has a homogenous clinical and radiological pattern that gives support to believe that the SAPHO syndrome is an isolated clinical entity.

[Ostearticular tuberculosis. Study of 53 cases]. / Tuberculosis osteoarticular: estudio de 53 casos.

BACKGROUND AND OBJECTIVE: To analyze the characteristics of bone and joint tuberculosis in a Spanish university hospital. PATIENTS AND METHOD: Retrospective study (1984-2006) in a university hospital. All patients had microbiologically and/or histologically proved osteoarticular tuberculosis. Patients with clinical and radiological criteriae, positive tuberculin test responding to antituberculous treatment were not excluded despite negative cultures. RESULTS: We attended 53 patients with osteoarticular tuberculosis (35 males/18 females; mean age: 52 years). Bone tuberculosis involved axial skeleton in 37 patients (71%), peripheral distribution in 12 (21%) and both locations in 4 (8%). Mean time to diagnosis was 8 months. Most common involved joints were knee and ankle. An extraarticular involvement was found in 12 patients (22%) and multifocal bone infection in 6 (11%). Risk factors were present in 22 patients (42%), and 15% were immigrants. The diagnosis was established by a positive culture in 40 cases (75%), and 33 (62%) had suggestive histology. Complications of tuberculosis included medullar compression (9.4%), abscess (12%) and fistulae (9.4%). Spine involvement required surgical intervention in 27% and peripheral involvement in 56%. Curation was achieved in 33 patients (62.3%), curation with secuelae in 19 cases (35.9%) and no consolidation of arthrodesis in one case. CONCLUSIONS: Bone and joint tuberculosis is still common in our area and should be particularly considered in immigrants. Diagnosis delay is remarkable. Complications are present in one third of patients. Surgical treatment is often required.

Tuberculosis osteoarticular: estudio de 53 casos / Ostearticular tuberculosis. Study of 53 cases

Fundamento y objetivo: Analizar las características de la tuberculosis osteoarticular en un hospital universitario. Pacientes y método: Se ha realizado un estudio retrospectivo (1984-2006) de los pacientes con tuberculosis osteoarticular atendidos en el Hospital Universitario Germans Trias i Pujol de Badalona (Barcelona). Se incluyó a todos los pacientes con diagnóstico microbiológico y/o histológico, y también a los que tenían criterios clínicos y radiológicos indicativos, prueba de la tuberculina positiva (derivado proteico purificado) y respuesta favorable al tratamiento antituberculoso. Resultados: Se recogieron 53 casos de tuberculosis osteoarticular (35 eran varones). La edad media de los pacientes era de 52 años. La localización de la infección tuberculosa fue: esqueleto axial en 37 casos (71%), periférica en 12 (21%) y mixta en 4 (8%). El tiempo medio transcurrido hasta el diagnóstico fue de 8 meses. Las articulaciones más afectadas fueron la rodilla y el tobillo. Se halló simultáneamente otra localización extraarticular activa en 12 pacientes (22%) e infección ósea multifocal en 6 (11%). En 22 casos (42%) se observó algún factor de riesgo. El 15% eran inmigrantes. El diagnóstico se estableció por el resultado positivo del cultivo en 40 casos (75%) y 33 (62%) tuvieron histología compatible. Las complicaciones más frecuentes fueron la compresión medular (9,4%) y la formación de abscesos (12%) y fístulas (9,4%). Se intervino quirúrgicamente al 27% de los pacientes con afectación vertebral y al 56% de aquéllos con formas periféricas. Se obtuvo curación en 33 casos (62,3%), curación con secuelas en 19 (35,9%) y mala consolidación de la artrodesis en uno. Conclusiones: La tuberculosis osteoarticular es una infección prevalente en nuestro entorno y debe tenerse especialmente en cuenta en la población inmigrante. La demora hasta el diagnóstico es importante y sus complicaciones condicionan que más de la tercera parte de los pacientes precise tratamiento quirúrgico

Background and objective: To analyze the characteristics of bone and joint tuberculosis in a Spanish university hospital. Patients and method: Retrospective study (1984-2006) in a university hospital. All patients had microbiologically and/or histologically proved osteoarticular tuberculosis. Patients with clinical and radiological criteriae, positive tuberculin test responding to antituberculous treatment were not excluded despite negative cultures. Results: We attended 53 patients with osteoarticular tuberculosis (35 males/18 females; mean age: 52 years). Bone tuberculosis involved axial skeleton in 37 patients (71%), peripheral distribution in 12 (21%) and both locations in 4 (8%). Mean time to diagnosis was 8 months. Most common involved joints were knee and ankle. An extraarticular involvement was found in 12 patients (22%) and multifocal bone infection in 6 (11%). Risk factors were present in 22 patients (42%), and 15% were immigrants. The diagnosis was established by a positive culture in 40 cases (75%), and 33 (62%) had suggestive histology. Complications of tuberculosis included medullar compression (9.4%), abscess (12%) and fistulae (9.4%). Spine involvement required surgical intervention in 27% and peripheral involvement in 56%. Curation was achieved in 33 patients (62.3%), curation with secuelae in 19 cases (35.9%) and no consolidation of arthrodesis in one case. Conclusions: Bone and joint tuberculosis is still common in our area and should be particularly considered in immigrants. Diagnosis delay is remarkable. Complications are present in one third of patients. Surgical treatment is often required

[Osteoporosis as a first manifestation of systemic mastocytosis. Study of 6 cases]. / Osteoporosis como primera manifestación de una mastocitosis sistémica. Estudio de 6 casos.

BACKGROUND AND OBJECTIVE: We describe 6 cases of secondary osteoporosis due to systemic mastocytosis diagnosed in the last 6 years. RESULTS: Three females and 3 males, age range: 47-66 years, diagnosed with osteoporosis were subsequently diagnosed with systemic mastocytosis. Diagnosis delay: 0.5-17 years. Cutaneous involvement was present in 3 patients, hematologic involvement in 2 patients and gastrointestinal involvement in 2 patients. Histamine levels in urine were elevated in all cases. Four patients had fractures. Treatment with bisphosphonates was started. After 3 years the values of bone mineral density (BMD) improved in the 5 patients evaluated. Two patients had new vertebral fractures and started teriparatide. CONCLUSIONS: Osteoporosis is an unfrequent initial manifestation of systemic mastocytosis. These patients have a high risk of fractures. Our results suggest that although bisphosphonates improve the bone mineral density the risk of fractures persists.

Osteoporosis como primera manifestación de una mastocitosis sistémica. Estudio de 6 casos / Osteoporosis as a first manifestation of systemic mastocytosis. Study of 6 cases

Fundamento y objetivo: Se describen 6 casos de osteoporosis como primera manifestación de una mastocitosis sistémica diagnosticados en un período de 6 años. Resultados: Se incluyó a 3 mujeres y 3 varones con edades entre 47 y 66 años. El intervalo entre el diagnóstico de osteoporosis y el de mastocitosis sistémica osciló entre 0,5 y 17 años; 3 presentaban afección cutánea; 2, hematológica y 2, gastrointestinal, y los valores de histaminuria estaban elevados en los 6 casos; 4 pacientes tenían fracturas. Se inició tratamiento con bisfosfonatos. A los 3 años, el valor de densidad mineral ósea (DMO) lumbar mejoró en los 5 pacientes evaluados. A pesar del aumento de DMO, 2 de ellos tuvieron nuevas fracturas vertebrales, por lo que se inició tratamiento con teriparatida. Conclusiones: La osteoporosis como primera manifestación de una mastocitosis sistémica es muy poco frecuente. Suelen ser osteoporosis graves. Aunque los fármacos antirresortivos mejoran la masa ósea en estos pacientes, continúa habiendo riesgo de fracturas

Background and objective: We describe 6 cases of secondary osteoporosis due to systemic mastocytosis diagnosed in the last 6 years. Results: Three females and 3 males, age range: 47-66 years, diagnosed with osteoporosis were subsequently diagnosed with systemic mastocytosis. Diagnosis delay: 0.5-17 years. Cutaneous involvement was present in 3 patients, hematologic involvement in 2 patients and gastrointestinal involvement in 2 patients. Histamine levels in urine were elevated in all cases. Four patients had fractures. Treatment with bisphosphonates was started. After 3 years the values of bone mineral density (BMD) improved in the 5 patients evaluated. Two patients had new vertebral fractures and started teriparatide. Conclusions: Osteoporosis is an unfrequent initial manifestation of systemic mastocytosis. These patients have a high risk of fractures. Our results suggest that although bisphosphonates improve the bone mineral density the risk of fractures persists

Reversal of HIV-1-associated osteoporosis with once-weekly alendronate.

HIV-1-infected patients with osteoporosis were randomly assigned to alendronate 70 mg once-weekly plus dietary counselling (n = 11) or diet counselling alone (n = 14). At week 96, 27% of patients on alendronate versus 96% of controls presented with osteoporosis. Spine bone mineral density (BMD) increases were detected at week 48, and progressed thereafter. Improvements in trochanter BMD were obtained after 2 years. Once-weekly oral alendronate may be an effective and safe treatment for HIV-1-associated osteoporosis.

Value of Disease Activity Score 28 (DAS28) and DAS28-3 compared to American College of Rheumatology-defined remission in rheumatoid arthritis.

OBJECTIVE: To assess the criteria for remission based on Disease Activity Score 28 (DAS28) and DAS28-3 (excluding patients' evaluation of disease activity) compared to American College of Rheumatology (ACR) preliminary criteria in established rheumatoid arthritis (RA), and to examine the value of each ACR criterion individually. METHODS: The EMECAR study was designed to assess the burden of comorbidity and inflammatory activity for RA in Spain. A random sample of 788 patients with RA from 34 Spanish centers was selected. Remission was defined by preliminary ACR criteria applied specifically and the clinical activity assessed by the DAS28 and the DAS28-3. A receiver operating characteristics curve analysis was performed to identify cutoff values with the highest usefulness in defining remission on both DAS indices. RESULTS: Thirty-two patients (4.1%) were in ACR-defined remission, 62 (7.9%) if fatigue was excluded from the criteria. The frequency of any single criterion that patients in remission fulfilled: no fatigue and joint pain by anamnesis in 31 patients (96.9%); morning stiffness < 15 min in 26 (81.3%); no swelling in joints in 21 (65.6%); normal erythrocyte sedimentation rate (ESR) in 29 (90.6%); and no joint tenderness in 21 (65.6%) patients. The positive predictive value for remission of each criterion: normal ESR 6.5%; morning stiffness < 15 min 8.4%; no fatigue 8.7%; no joint tenderness 13%; no swelling in joints 15.8%; and no joint pain by anamnesis 27.7%. The DAS28 cutoff values with higher discriminatory power for remission were 3.14 (sensitivity 87%; specificity 67%) when all the ACR criteria were used, and 2.81 (sensitivity 84%; specificity 81%) when fatigue was omitted. The equivalent cutoffs for the DAS28-3 were 3.52 (sensitivity 84%; specificity 66%) and 2.95 (sensitivity 82%; specificity 83%), respectively. CONCLUSION: DAS28 and DAS28-3 are good tools to define remission in established RA. No joint pain by anamnesis is the criterion with the highest value in defining remission, while normal ESR, an absence of morning stiffness, and fatigue are the least effective.

Increased risk of tuberculosis in patients with rheumatoid arthritis.

OBJECTIVE: To quantify the risk of tuberculosis (TB) in an unselected sample of patients with rheumatoid arthritis (RA) compared to the risk in the general population. METHODS: The incidence of TB in the general population of Spain was obtained from the National Network of Epidemiological Surveillance reports. The incidence of TB was ascertained from a cohort of 788 patients with RA selected randomly from the registries of 34 participating centers throughout Spain. A patient was considered a TB case only if information about disease symptoms, microorganism identification, and TB treatment were confirmed in the clinical records. The relative risk of TB in RA was calculated by dividing the standardized mean incidence of TB from 1990 to 2000 in the RA cohort by the mean incidence of TB in Spain during the same years. RESULTS: The mean incidence of TB in the general population of Spain from 1990 to 2000 was 23 cases per 100,000. Seven cases of TB were identified in the RA cohort, yielding a mean annual incidence (1990-2000) of 134/100,000 patients. The incidence risk ratio of pulmonary TB in patients with RA compared to the general population is 3.68 (95% CI 2.36-5.92). CONCLUSION: We found a 4-fold increased risk of TB infection in patients diagnosed with RA. These results might help to interpret the magnitude of the problem attributable to the introduction of new therapies in RA.

Patterns of disease modifying antirheumatic drug use in a Spanish cohort of patients with rheumatoid arthritis.

OBJECTIVE: To determine the adequacy of disease modifying antirheumatic drug (DMARD) prescription to disease activity in patients with rheumatoid arthritis (RA) and to assess whether the reasons for DMARD discontinuation agree with published evidence. METHODS: Cross-sectional analysis of the baseline year of a RA cohort (n = 788) randomly selected from the clinical registries of 34 centers. Data about current and previous DMARD use was collected from medical records and confirmed by the patient. Disease activity score (DAS), Health Assessment Questionnaire (HAQ) and Larsen scores, and other clinical data were obtained during the study visit. RESULTS: At baseline visit, 607 patients (77%) were receiving one or more DMARD. Mean DAS, HAQ, and Larsen scores (+/- SD) were: 3.40 +/- 1.22, 1.6 +/- 0.4, and 54.68 +/- 26.37, respectively. Methotrexate (MTX) was the most frequently prescribed DMARD and parenteral gold salts (GS) showed the highest rate of discontinuation. MTX was used as single therapy in a significantly higher proportion (64.3%) than other DMARD (< 50%) and treatment discontinuation due to inefficacy was significantly less frequent (25.5%) than with other DMARD (> 40%). However, the DAS28 was significantly worse in the group treated with MTX in single therapy than in the group treated with GS alone (4.13 vs 3.43; p = 0.032). CONCLUSION: Despite the high use of DMARD among Spanish patients with RA, a significant number of them still have poor control of the disease. In addition, our data show a different perception of ineffectiveness depending on the DMARD used. A non-systematic use of objective quantitative tools for assessment of RA activity and some non-evidence based decisions on the management of DMARD may account for these findings.

Sucralfate therapy in NSAID bleeding gastropathy.

BACKGROUND AND AIMS: A randomized, double-blind, placebo-controlled, multicenter study was conducted to assess the efficacy of 2 g sucralfate suspension in treating gastric mucosal lesions caused by long-term treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: Only patients given NSAIDs continuously for at least 2 months with positive fecal occult blood (FOB) and endoscopically confirmed mild to moderate mucosal lesions (Lanza scale, grades 2-4) were included. After 1-week run-in phase, patients were stratified into 2 groups according to gastropathy-related symptoms during the preceding 7 days (symptomatic vs. asymptomatic) and randomized to 2 g (10 mL) of sucralfate suspension or placebo twice a day over a 6-week period. NSAIDs were given according to each patient's dosage schedule and always after meals. RESULTS: Twenty-five patients received sucralfate and 25 received placebo. At the end of the study, 68% (17/25) of patients given sucralfate had no lesions (Lanza grade 0) on endoscopy compared with 35% (8/23) in controls (P = 0.042). The Lanza grades in patients given sucralfate were significantly improved compared with the placebo patients (P = 0.022). CONCLUSIONS: In this target population selected according to positive FOB test and endoscopic evidence of mucosal injury, chronic administration of sucralfate significantly decreased NSAID-induced gastric erosions.

[Paget's disease of bone: study of 314 patients]. / Enfermedad ósea de Paget: estudio de 314 pacientes.

BACKGROUND: To describe the clinical and laboratory features of Paget's disease of bone at the time of diagnosis. PATIENTS AND METHOD: This multicenter and retrospective study included 314 patients. Diagnosis was performed by means of characteristic radiological findings and typical bone scintigraphy. The variables analyzed included: epidemiological variables, cause of diagnosis, bone involvement, disease extension (Coutris index), complications, alkaline phosphate (AP) levels and disease activity (Renier index). RESULTS: There were 159 (50.5%) males and the mean age was 64.9 years (SD 12.6). Diagnosis was casual in 228 (72.6%) patients. Polyostotic involvement was detected in 201 (63.9%) patients. More common locations were pelvis, skull and lumbar spine. Sacrum was more frequently involved in men than in women (p < 0.05), whereas skull involvement was more common in women (p < 0.05). The number of bones involved was 3.1 SD 3 and the percentage of skeletal involvement was 8.7 % (SD 6.5). One hundred ninety eigth (63%) patients had complications. The disease was active in 242 (77%) patients with a mean AP value of 377 IU/L (SD 493); the activity of the disease measured by the Renier index was 34 (SD 46); the activity was greater in the skull and the humerus. CONCLUSIONS: Paget's disease of bone is usually asymptomatic. Polyostotic involvement and activity are common at the time of diagnosis. Knowledge of the extension and activity by means of a mathematical model may aid to make therapeutical decisions.

Enfermedad ósea de Paget: estudio de 314 pacientes / Paget's disease of bone: study of 314 patients

FUNDAMENTO: Describir las características clínicas y analíticas de los pacientes con enfermedad ósea de Paget en el momento del diagnóstico. PACIENTES Y MÉTODO: Estudio multicéntrico y retrospectivo que ha incluido a 314 pacientes. El diagnóstico se realizó mediante gammagrafía con polifosfato de 99Tc y radiografía simple. Se analizaron los datos epidemiológicos, motivo del diagnóstico, huesos afectados, grado de extensión mediante el índice de Coutris, complicaciones durante la evolución y actividad de la enfermedad con el índice de Renier. Los resultados se han analizado con el paquete estadístico SPSS.RESULTADOS: Ciento cincuenta y nueve (50,5 per cent) eran varones y la media (DE) de edad de 64,9 (12,6) años; en 288 (72,6 per cent) el diagnóstico fue casual y 201 (63,9 per cent) presentaron una enfermedad poliostótica; las localizaciones más frecuentes fueron el hueso coxal, cráneo y columna lumbar. La afectación del sacro fue más frecuente en el varón que en la mujer (p < 0,05), mientras que para el cráneo ocurría lo contrario (p < 0,05). El número medio de huesos afectados fue de 3,1 (3) y el porcentaje de esqueleto involucrado fue de 8,7 (6,5 per cent). Las vértebras, el sacro y el cráneo fueron los huesos que estaban más extensamente afectados en el momento del diagnóstico. Ciento noventa y ocho pacientes (63 per cent) presentaron complicaciones durante la evolución. En 242 casos (77 per cent) la enfermedad estaba activa con una fosfatasa alcalina (FA) de 377 (493) UI/l. Los pacientes con afectación craneal tenían un valor de FA mayor que aquellos en que no existía (701 [753] frente a 237 [201] UI/l; p < 0,001); la actividad de la enfermedad según el índice de actividad de Renier fue de 34 (46); el cráneo y el húmero fueron los huesos donde la actividad del hueso patético fue mayor. CONCLUSIONES: Aunque con frecuencia la enfermedad de Paget es asintomática, en el momento del diagnóstico se presenta en muchas ocasiones de forma poliostótica y activa. El conocimiento de la extensión y la actividad de la enfermedad mediante una simple fórmula matemática son útiles para tomar una decisión terapéutica (AU)

Una estimación de la laxitud articular en la consulta externa / An estimation of join hipermobility in the out-patients clinic

Objetivo: Determinar la prevalencia de la laxitud articular en la consulta externa de reumatología de un hospital universitario y en un centro de asistencia primaria española.Material y métodos: Se examinaron consecutivamente a 280 pacientes (193 mujeres, 87 varones), con una edad media de 44,7 ñ 11,2 años, atendidos en un centro de asistencia primaria, así como a 317 pacientes (233 mujeres y 84 varones), con una edad media de 40,5 ñ 16,8 años, que acudían como primera visita a un centro hospitalario. Se utilizaron los criterios de Beighton para evaluar la laxitud articular.Resultados: Un 15 por ciento de los pacientes que acudían al centro de asistencia primaria tenían laxitud articular, así como un 25 por ciento de los que acudieron a la consulta externa de reumatología del hospital. La laxitud articular fue más frecuente en ambos grupos en el sexo femenino. Conclusión: La prevalencia estimada de laxitud articular en un centro de asistencia primaria es del 15 por ciento, y en las consultas externas de reumatología de un hospital universitario es del 25 por ciento (AU)

¿Hemipelvis pagética? / Pagetic hemipelvis?

No disponible

Clorambucilo en el tratamiento de la amiloidosis secundaria / Chlorambucyl treatment in secondary amyloidosis

No disponible

Un sistema de codificación en reumatología. Experiencia de 15 años / A rheumatology codification system. A 15 years experience

Objetivo: Describir qué enfermedades se diagnostican en la consulta externa de reumatología y qué tipo de pacientes se ven en primeras y segundas visitas. Material y métodos: Lugar: Hospital Universitari Germans Trias i Pujol. Área de referencia de 750.000 habitantes. Sistema de codificación: versión modificada de la nomenclatura y clasificación del American College of Rheumatology. Pacientes: análisis de todos los enfermos visitados en consulta externa en el período 1984-1998. Se compararon los códigos diagnósticos de las primeras visitas con los de las segundas del año 1995; así como los códigos del período 1984-1995 con los del período 1984-1998. Resultados: En el período 1984-1998 se han introducido 13.833 códigos de 8.590 pacientes. Un 28 por ciento son códigos de enfermedades inflamatorias y 72 por ciento de no inflamatorias. En el análisis del año 1995 se analizaron 2.967 visitas: 914 primeras y 2.053 visitas de revisión. Un 31,5 por ciento de los códigos de las primeras visitas correspondían a enfermedades inflamatorias, mientras que las visitas de revisión representaban un 45 por ciento. Conclusiones: Las enfermedades diagnosticadas con mayor frecuencia en una consulta externa de reumatología son: trastornos extraarticulares (categoría IX), trastornos óseos y cartilaginosos (categoría VIII), artrosis (categoría III) y enfermedades metabolicoendocrinas (categoría V). Sin embargo, destacan cada vez más las conectivopatías. Existe una tendencia a controlar las enfermedades inflamatorias y se tiende a dar de alta a pacientes con trastornos de las enfermedades extraarticulares y artrosis (AU)