[Faecal microbiota study reveals specific dysbiosis in spondyloarthritis according to subtype, disease activity and treatment]. / Estudio de microbiota fecal revela disbiosis específica en espondiloartritis, según subtipo, actividad de la enfermedad y tratamiento.

OBJECTIVE: To compare the diversity and composition of the gastrointestinal microbiome of patients with SpA. METHODS: MiSeq sequencing of the V3-V4 region of the 16S ribosomal RNA gene was performed on DNA isolated from stool. Patients with concurrent SpA and IBD were excluded. Differences were assessed for richness and diversity indices by QIIME 2™. Differences between means >0,2% with a p-value<0,05 were assumed significant. Institutional Ethics Committee endorsement. RESULTS: 69 individuals included, 49 with SpA (ankylosing spondylitis-AS 72,9%, psoriatic arthritis-PsA 18,8%, reactive arthritis-ReA 8,3%) 5 positive controls-dysbiosis and 15 controls-eubiosis. Conventional treatment in 42,9%, anti-IL-17 16,3% and anti-TNF 40,8%. By subtype, statistically significant differences in favour of AS were found for the diversity indices. AS vs PsA there was a difference in favour of AS for Clostridium clostridioforme (p=0,002), Gemmiger formicilis (p=0,009), Roseburia inulivorans (p=0,008) and Lachnospira pectinoschiza. AS vs ReA there was a difference in favour of AS for L. pectinoschiza (p=0,009), Ruminococcus callidus (p=0.006), Clostridium ruminantium (p=0.031); G. formicilis (p=0,034). Diversity and richness showed differences in patients with high activity for Simpson's and Pielou's indices. In high activity, lower enrichment of Bacteroides eggerthii (p= 0,0003), C. ruminantium (p= 0,026) and Alistipes putredinis (p=0,035) was found. The number of ASV was higher in the anti-IL-17 vs conventional group (p=0.025) and a trend between anti-IL-17 vs anti-TNF (p=0.09). In anti-TNF there was a lower proportion for C. clostridioforme (p=0.023), G. formicilis (p=0.030) and R. callidus (p= 0.003). In anti IL-17, Alistipes indistinctus (p= 0.012) was decreased. CONCLUSIONS: There are differences in microbial diversity for SpA subtypes. The level of disease activity is plausible to influence the composition of the faecal microbiota. Anti-TNFα treatment may influence the microbiome environment favouring restoration of the gut microbiota, while anti-IL-17 may maintain an inflammatory environment.

OBJETIVO: Comparar la diversidad y composición del microbioma gastrointestinal de pacientes con EspA. MÉTODOS: La secuenciación MiSeq de la región V3-V4 del gen ARN ribosomal 16, se realizó en ADN aislado de heces. Se excluyeron pacientes con EspA y EII simultánea. Se evaluaron diferencias para los índices de riqueza y diversidad por medio de QIIME 2™. Las diferencias entre medias> 0,2%, con un valor de p< 0,05, se asumieron significativas. Aval del Comité de Ética Institucional. RESULTADOS: 69 individuos incluidos, 49 con EspA (espondilitis anquilosante-EA 72,9%, artritis psoriásica-APs 18,8%, artritis reactiva-ARe 8,3%), cinco controles positivos-disbiosis y 15 controles-eubiosis. El tratamiento convencional en 42,9%, anti-IL-17 16,3%, y anti-TNF 40,8%. Por subtipo-EasP, se encontraron diferencias estadísticamente significativas a favor de EA para los índices de diversidad. Entre EA vs APs, hubo diferencia a favor de EA para Clostridium clostridioforme (p=0,002), Gemmiger formicilis (p=0,009), Roseburia inulivorans (p=0,008) y Lachnospira pectinoschiza. Entre EA vs ARe hubo diferencia a favor de EA para L. pectinoschiza (p=0,009), Ruminococcus callidus (p = 0,006), Clostridium ruminantium (p=0,031); G. formicilis (p=0,034). La diversidad y riqueza mostraron diferencias en pacientes con alta actividad para los índices de Simpson y Pielou. En alta actividad, se encontró menor enriquecimiento de Bacteroides eggerthii (p=0,0003), C. ruminantium (p= 0,026) y Alistipes putredinis (p= 0,035). El número de ASV fue superior en el grupo de anti IL-17 vs convencional (p=0.025), y una tendencia entre anti IL-17 vs anti-TNF (p=0,09). En anti TNF hubo menor proporción para C. clostridioforme (p=0,023), G. formicilis (p=0,030) y R. callidus (p= 0,003). Y en anti IL-17, Alistipes indistinctus (p= 0,012), estuvo disminuida. CONCLUSIONES: Existen diferencias en la diversidad microbiana para los subtipos de EspA. El nivel de actividad de la enfermedad es plausible para influir en la composición de microbiota fecal. El tratamiento con anti-TNFα, puede influenciar el ambiente del microbioma favoreciendo la restauración de la microbiota intestinal, mientras los anti IL-17 podrían mantener un ambiente inflamatorio.

Infectious arthritis and the temporomandibular joint. A review.

OBJECTIVE: Microorganisms can cause acute infectious arthritis, chronic infectious arthritis, or reactive inflammatory arthritis. The aim of this study is to perform a narrative review of the pathophysiology, etiology, and diagnostic features of infectious arthritis and TMJ infectious arthritis. METHODS: A search of the literature was performed using Medline, Scielo, Embase, and Google Scholar databases. The terms employed for the search were "Temporomandibular Joint Disorders" and "Infectious Arthritis"; or "Septic Arthritis"; or "Bacterial, Fungal, or Viral Arthritis." Over three hundred articles were screened for eligibility. RESULTS: The selected articles were utilized to perform a narrative review of the general aspects of infectious arthritis and infectious arthritis affecting the TMJ. CONCLUSION: Infectious arthritis is a rare, yet very morbid, form of arthritis. Understanding general aspects of joint infections and specific features of TMJ infectious arthritis is imperative for an adequate diagnosis.

Ampliação de uso do naproxeno para o tratamento da Artrite Reativa / Expansion of the use of naproxen for the treatment of Reactive Arthritis

INTRODUÇÃO: A artrite reativa (ARe) pertence ao grupo das espondiloartrites e é convencionalmente definida como uma artrite que surge após uma infecção extra-articular, geralmente geniturinária ou gastrointestinal. É uma doença relativamente rara que acomete tipicamente adultos jovens. O tratamento da ARe possui diferentes abordagens, e inclui o tratamento da infecção desencadeante e das manifestações musculoesqueléticas. O uso de anti-inflamatórios não esteroidais (AINE) constitui a abordagem inicial do tratamento da doença articular sintomática. De acordo com o Protocolo Clínico e Diretrizes Terapêuticas (PCDT) da Artrite Reativa de 2015, o único AINE disponibilizado para a doença no Sistema Único de Saúde (SUS) é o ibuprofeno. O naproxeno é um AINE não seletivo que possui tradição de uso e histórico de incorporações no SUS para condições musculoesqueléticas (espondilite anquilosante, artrite psoriásica, artrite reumatoide, osteoartrite de joelho e quadril), além de representar uma alternativa mais segura em relação aos eventos cardiovasculares quando comparado a outros AINE. PERGUNTA: O naproxeno é uma opção segura e eficaz para o tratamento da ARe? EVIDÊNCIAS CIENTÍFICAS: Foram realizadas buscas nas bases de dados Medline (via Pubmed) e Embase. Uma revisão sistemática (RS) de avaliação de AINE em espondiloartrites foi elegível. A RS incluiu cinco ensaios clínicos randomizados (ECR) de avaliação do naproxeno, sendo três em comparação a outros AINE (aceclofenaco, butacote, piroxicam) e dois em comparação a outros AINE (celecoxibe, etoricoxibe) e placebo. Os estudos que incluíram a comparação com placebo avaliaram desfechos de eficácia e segurança em pacientes com espondilite anquilosante. Os estudos evidenciaram benefício do naproxeno na melhora da dor, avaliação global do paciente, escore BASDAI e escore BASFI, sem aumento significativo dos eventos adversos, com exceção de um estudo que evidenciou maior taxa de eventos adversos (EA) gastrointestinais. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: a estimativa de custo global anual no cenário base foi de aproximadamente 27 mil reais, com impacto cumulativo em 5 anos de cerca de 138 mil reais. Na análise de sensibilidade, foram observados valores de 42 mil reais no cenário mais otimista, e acima de 516 mil reais no cenário mais pessimista, para o período de 5 anos. A variável de maior impacto nos resultados foi o custo unitário do medicamento. Análise comparativa com ibuprofeno evidencia custo incremental entre R$ 16,38 a R$ 28,35 por paciente tratado com naproxeno. CONSIDERAÇÕES: Não foram identificados estudos de avaliação do naproxeno em ARe e nenhum estudo comparou naproxeno com ibuprofeno, AINE já disponibilizado no SUS. A evidência disponível avalia a eficácia e a segurança do naproxeno em comparação a placebo, em pacientes com espondilite anquilosante, espondiloartrite que acomete preferencialmente a coluna vertebral. Os estudos evidenciam benefício do medicamento, sem comprometimento significativo da segurança. Apesar da escassez de evidências do uso de naproxeno em ARe, seu uso baseia-se na experiência clínica e na evidência de benefício em outras condições musculoesqueléticas, particularmente em outras formas de espondiloatrite. O medicamento possui tradição de uso e histórico de incorporações no SUS para condições semelhantes. RECOMENDAÇÃO PRELIMINAR: Diante do exposto, a Conitec, em sua 88ª reunião ordinária, realizada no dia 08 de julho de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar favorável à incorporação do naproxeno como opção terapêutica da ARe no Sistema Único de Saúde. CONSULTA PÚBLICA: A Consulta Pública nº 43/2020 foi realizada entre os dias 20/08/2020 a 08/09/2020. Foram recebidas 89 contribuições no total, das quais 5 (5,6%) foram pelo formulário para contribuições técnico-científicas e 84 (94,4%) pelo formulário para contribuições sobre experiência ou opinião de pacientes, familiares, amigos ou cuidadores de pacientes, profissionais de saúde ou pessoas interessadas no tema. Das 5 contribuições de cunho técnico-científico, uma era relacionada a outro tema de consulta pública, sendo consideradas na análise somente quatro contribuições. Em relação à recomendação preliminar da Conitec, que foi favorável à ampliação do uso do naproxeno, dois participantes submeteram a contribuição com opinião favorável a recomendação preliminar da comissão. As outras duas contribuições discordaram da recomendação preliminar da Conitec. Foram recebidas 84 contribuições de experiência e opinião, no entanto 37 contribuições possuíam comentários relacionadas a outro tema de consulta pública, não sendo consideradas na análise. Em relação à recomendação preliminar da Conitec, 18 participantes (38%) submeteram a contribuição com opinião favorável a recomendação preliminar da comissão, uma contribuição não concordou e não discordou da recomendação e 28 participantes (59%) discordaram da recomendação preliminar da Conitec. Houve onze relatos sobre a recomendação preliminar, no entanto, nove deles relatavam discordância com relação a não incorporação de uma tecnologia, não sendo o caso da tecnologia avaliada neste relatório. RECOMENDAÇÃO FINAL: Os membros do Plenário presentes na 91ª Reunião Ordinária da Conitec, no dia 07 de outubro de 2020, deliberaram, por unanimidade, recomendar a ampliação de uso do naproxeno para o tratamento de pacientes com Artrite Reativa. Na apreciação da CP, os membros do Plenário entenderam que a maioria das contribuições relatavam discordância em relação a não incorporação de uma tecnologia, não sendo o caso da tecnologia avaliada neste relatório, sendo assim mantiveram a recomendação preliminar. Foi assinado o Registro de Deliberação nº 558/2020. DECISÃO: Ampliar o uso do naproxeno para o tratamento de pacientes com artrite reativa, no âmbito do Sistema Único de Saúde - SUS, conforme Portaria n° 48, publicada no Diário Oficial da União n° 217, seção 1, página 144, em 13 de novembro de 2020.

Disseminated tuberculosis associated with reactive arthritis of Poncet in an immunocompetent patient

Abstract Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.

Disseminated tuberculosis associated with reactive arthritis of Poncet in an immunocompetent patient.

Cutaneous tuberculosis is a rare extrapulmonary manifestation of tuberculosis which, like disseminated tuberculosis, commonly occurs in immunocompromised patients. Poncet reactive arthritis is a seronegative arthritis affecting patients with extrapulmonary tuberculosis, which is uncommon even in endemic countries. We report a previously healthy 23-year-old male patient with watery diarrhea associated with erythematous ulcers on the lower limbs and oligoarthritis of the hands. Histopathological examination of the skin showed epithelioid granulomatous process with palisade granulomas and central caseous necrosis. AFB screening by Ziehl-Neelsen staining showed intact bacilli, the culture was positive for Mycobacterium tuberculosis, and colonoscopy revealed multiple shallow ulcers. Disseminated tuberculosis associated with reactive Poncet arthritis was diagnosed, with an improvement of the clinical and skin condition after appropriate treatment.

Intrathecally injected tramadol reduces articular incapacitation and edema in a rat model of lipopolysaccharide (LPS)-induced reactive arthritis.

AIMS: Intrathecal injection of morphine presents analgesic and antiedematogenic effects in rats. However, it is unknown whether tramadol, which possess a mixed mechanism of action, can also produce analgesic and antiedematogenic effects similarly. MAIN METHODS: Male Wistar rats received carrageenan and LPS in the right knee joint. Tramadol (10 µg) was injected intrathecally 20 min before articular LPS injection. Incapacitation and articular edema were measured 5 h after LPS stimulation. Synovial fluid was collected for leukocyte counting and western blot analysis. Whole joint and lumbar spinal cord were also collected for histology and immunohistochemistry, respectively. Intrathecal pretreatments groups were with the NKCC1 blocker bumetanide, TRPV1 agonist resiniferatoxin, µ-opioid receptor antagonist CTOP and serotonergic neurotoxin 5,7-DHT, all previously to tramadol. KEY FINDINGS: Tramadol treatment caused the reduction of incapacitation and edema. It also reduced c-Fos protein expression in the spinal cord dorsal horn and slightly reduced TNF-α levels in synovial fluid, but neither reduced cell migration nor tissue damage. Bumetanide and resiniferatoxin prevented the analgesic and antiedematogenic effects of tramadol. CTOP prevented the analgesic and the antiedematogenic effects, but 5,7-DHT prevented only tramadol-induced analgesia. SIGNIFICANCE: Spinal NKCC1 cotransporter and peptidergic peripheral afferents seem to be important for the analgesic and antiedematogenic effects of tramadol, as well as µ-opioid receptor. However, the monoamine uptake inhibition effect of tramadol seems to be important only to the analgesic effect.

Artritis reactiva post-estreptocócica. Una revisión de literatura / Post-streptococcal reactive arthritis. A literature review

Introducción: existe un debate en la actualidad acerca de si la artritis reactiva post-estreptocócica es una entidad separada o una condición en el espectro de la fiebre reumática aguda. Objetivo: revisar la literatura existente sobre el tema artritis reactiva post-estreptocócica. Desarrollo : se realizó una búsqueda bibliográfica en Medline, Pubmed, Scielo y Dialnet, buscando como palabras clave: artritis y artritis reactiva post-estreptocócica. Además de la búsqueda computadorizada se realizó una búsqueda manual. Dichas bases de datos recogen las publicaciones más importantes en el campo científico de la medicina. La búsqueda se realizó en abril del 2018, y comprendió desde el año 1989 hasta la actualidad. Utilizamos el programa Reference Manager, versión 12, para crear una base de datos con las publicaciones, categorizarlas y filtrarlas de acuerdo a su relevancia para nuestro estudio. Se recabaron un total de 45 documentos en total, de los cuales fueron descartados unos 30, debido a su nivel de generalización y escasa especificidad en el tema abordado. Conclusiones: los signos clásicos de tumefacción, eritema, calor y dolor están presentes, siendo el dolor el más importante, está presente en reposo y aumenta con los movimientos. Como en la FR, la artritis postestreptocócica es una artritis reactiva caracterizada por una infección faríngeaestreptocócica, un intervalo libre y una posterior inflamación aséptica en una o más articulaciones(AU)

Introduction: there is currently debate about whether post-streptococcal reactive arthritis is a separate entity or condition in the spectrum of acute rheumatic fever. Objective: to review the existing literature on the topic post-streptococcal reactive arthritis. Development: a bibliographic search was carried out in Medline, Pubmed, Scielo and Dialnet, searching as keywords: arthritis and post-streptococcal reactive arthritis. In addition to the computerized search, a manual search was carried out. These databases collect the most important publications in the scientific field of medicine. The search was conducted in April 2018, and ran from 1989 to the present. We use the Reference Manager program, version 12, to create a database with publications, categorize them and filter them according to their relevance to our study. A total of 45 documents were collected, of which about 30 were discarded, due to their level of generalization and lack of specificity in the topic addressed. Conclusions: the classic signs of swelling, erythema, heat and pain are present, with pain being the most important, it is present at rest and increases with movements. As in RF, post-streptococcal arthritis is a reactive arthritis characterized by a pharyngeal-streptococcal infection, a free interval and subsequent aseptic inflammation in one or more joints(AU)

IL-12/23p40 overproduction by dendritic cells leads to an increased Th1 and Th17 polarization in a model of Yersinia enterocolitica-induced reactive arthritis in TNFRp55-/- mice.

Dendritic cells (DCs) play critical functions in the initiation of immune responses. Understanding their role in reactive arthritis (ReA) will help delineate the pathogenesis of this arthropathy. In early studies, we detected IL-12/23p40 deregulation in Yersinia entercolitica (Ye)-induced ReA in TNFRp55-deficient (TNFRp55-/-) mice. In this study, we assessed the contribution of DCs in this overproduction. First, greater levels of IL-12/23p40, IFN-γand IL-17A were confirmed in supernatants of lipopolysaccharide (LPS)-stimulated TNFRp55-/-splenocytes obtained on arthritis onset (day 14 after Ye infection). Later, DCs were identified as a precise source of IL-12/23p40 since increased frequency of splenic IL-12/23p40+DCs was detected in TNFRp55-/- mice. After robust in vivo amplification of DCs by injection of Fms-like tyrosine kinase 3-Ligand (Flt3L)-transfected BL16 melanoma, DCs were purified. These cells recapitulated the higher production of IL-12/23p40 under TNFRp55deficiency. In agreement with these results, TNFRp55-/- DCs promoted Th1 and Th17 programs by co-culture with WT CD4+lymphocytes. A mechanistic study demonstrated that JNK and p38 MAPK pathways are involved in IL-12/23p40 overproduction in purified TNFRp55-/- DCs as well as in the JAWS II cell line. This deregulation was once again attributed to TNFRp55 deficiency since CAY10500, a specific inhibitor of this pathway, compromised TNF-mediated IL-12/23p40 control in LPS-stimulated WT DCs. Simultaneously, this inhibition reduced IL-10 production, suggesting its role mediating IL-12/23p40 regulation by TNFRp55 pathway. These results provide experimental data on the existence of a TNFRp55-mediated anti-inflammatory circuit in DCs. Moreover, these cells may be considered as a novel target in the treatment of ReA.

Reactive arthritis: update 2018.

At this time, reactive arthritis (ReA) is considered to be part of the spectrum of the spondyloarthritis, previously known as Reiter's syndrome, and refers to an infection induced systemic illness, characterized by a sterile synovitis occurring in a genetically predisposed individual, secondary to an infection localized in a distant organ/system, but also accompanied with multiple extra articular manifestations.

Potential risk factors for reactive arthritis and persistence of symptoms at 2 years: a case-control study with longitudinal follow-up.

The objective of the study is to determine the risk factors for the development of reactive arthritis (ReA) and examine the factors associated with the persistence of symptoms. Patients with a new diagnosis of ReA and controls with a gastrointestinal (GI), urogenital, or sexually transmitted infection in the 3-6 months prior to study entry were prospectively enrolled in Guatemala City. ReA patients fulfilled the Assessment in Spondyloarthritis International Society criteria for peripheral spondyloarthropathy (SpA). Patients underwent history, examination, Achilles tendon ultrasound, and blood draw. Human leukocyte antigen (HLA) type and serum biomarkers were measured. t tests and nonparametric equivalents were used to examine the association of clinical, laboratory, and imaging factors with ReA. Patients were contacted 2 years later to assess for persistence of symptoms. Study subjects included patients with ReA (N = 32) and controls (N = 32). ReA patients were most frequently infected in April whereas controls were most frequently infected in August. Two ReA patients and two controls were HLA-B27-positive. Serum cathepsin K and C-reactive protein were higher in ReA patients compared to controls (p = 0.03 for both), while total cholesterol and low-density lipoprotein were lower (p = 0.008 and 0.045, respectively). Among those with ReA, 15 (47%) patients had continued symptoms at 2 years. These patients had a lower matrix metalloproteinase-3 level at diagnosis than patients for whom ReA resolved (p = 0.004). HLA-B27 was not associated with development of ReA in Guatemala; however, the month of infection was associated with ReA. The most striking finding was the persistence of arthritis at 2 years in nearly half of the patients.

Activation of iNKT Cells Prevents Salmonella-Enterocolitis and Salmonella-Induced Reactive Arthritis by Downregulating IL-17-Producing γδT Cells.

Reactive arthritis (ReA) is an inflammatory condition of the joints that arises following an infection. Salmonella enterocolitis is one of the most common infections leading to ReA. Although the pathogenesis remains unclear, it is known that IL-17 plays a pivotal role in the development of ReA. IL-17-producers cells are mainly Th17, iNKT, and γδT lymphocytes. It is known that iNKT cells regulate the development of Th17 lineage. Whether iNKT cells also regulate γδT lymphocytes differentiation is unknown. We found that iNKT cells play a protective role in ReA. BALB/c Jα18-/- mice suffered a severe Salmonella enterocolitis, a 3.5-fold increase in IL-17 expression and aggravated inflammation of the synovial membrane. On the other hand, activation of iNKT cells with α-GalCer abrogated IL-17 response to Salmonella enterocolitis and prevented intestinal and joint tissue damage. Moreover, the anti-inflammatory effect of α-GalCer was related to a drop in the proportion of IL-17-producing γδT lymphocytes (IL17-γδTcells) rather than to a decrease in Th17 cells. In summary, we here show that iNKT cells play a protective role against Salmonella-enterocolitis and Salmonella-induced ReA by downregulating IL17-γδTcells.

Poncet's disease after the intravesical instillation of Bacillus Calmette-Guérin (BCG): a case report.

BACKGROUND: Poncet's disease is a rare syndrome characterized by articular impairment in a form of rare tuberculid. One of the theories of its cause involves an autoimmune response induced by the intravesical administration of the Calmette-Guerin Bacillus or the treatment of bladder carcinoma. Furthermore, there may be an appearance of oligoarticular or polyarticular arthritis, beginning 1-3 months after the start of therapy. Few physicians know the disease and the literature related to that syndrome is scarce and restricted to case reports, which contributes to its under diagnosis. CASE PRESENTATION: Female patient, 64 years old, Caucasian, in whom was noticed firstly dark urine, without haematuria or dysuria. Later felt also colic pain in the hypogastric region. Microscopically, the conclusive diagnosis was a high grade non-invasive papillary urothelial carcinoma. Thereupon, the treatment of the tumour began with transurethral resection technique and intravesical instillation of Calmette-Guérin Bacillus as adjuvant treatment. Eight months after the beginning of treatment, the lingering presence of the carcinoma was identified. Nevertheless, arthritis was identified through radiographs, after an increase in the clavicle capitation, right knee and left ankle in bone scintigraphy. Coinciding with the joint manifestations, the patient developed fever and purulent urethral discharge (culture was negative). Therefore, trying to investigate the cause of the arthritis, Purified Protein Derivate was taken, with reactive results. An increase of acute phase reactants was found, with other tests resulting normal: blood chemistry, Complete Blood Count, immunology and serology. Human Leukocyte Antigen typing by polymerase chain reaction revealed the presence of A24/AX, B44, B27, BW4/BW4, DQ7 and DQ5. Consequently, Poncet's disease was the diagnostic conclusion. The treatment with intravesical Calmette-Guérin Bacillus was immediately discontinued. The patient received corticosteroids associated with etoricoxib and isoniazid for 4 months, achieving disappearance of the inflammatory joint signs in 3 months. After 6 months, no joint pain recurrence or other manifestations suggesting active disease had been seen. CONCLUSIONS: Therefore, such diagnosis should be considered when confronted with an osteoarticular clinical picture in patients treated with intravesical Calmette-Guérin Bacillus, especially patients with HLA-B27 (+) and B7 (+), as Poncet's disease is a reactive arthritis.

Association of human leukocyte A, B, and DR antigens in Colombian patients with diagnosis of spondyloarthritis.

There is substantial evidence that non-B27 major histocompatibility complex (MHC) genes are associated with spondyloarthritis (SpA). Studies in Mexican and Tunisian populations demonstrated the association of SpA and human leukocyte antigen (HLA) B15. The purpose of this study was to evaluate the association of HLA-A, B, and DR antigens in a group of Colombian patients with a diagnosis of SpA. A total of 189 patients and 100 healthy subjects were included in the present study. All subjects underwent a complete characterization of HLA alleles A, B, and DR. Of the 189 studied patients, 35 were reactive arthritis (ReA), 87 were ankylosing spondylitis (AS), and 67 undifferentiated SpA (uSpA). According to the Assessment of Spondyloarthritis International Society (ASAS) criteria, 167 were axial SpA (axSpA) and 171 were peripheral SpA (pSpA). 63.8% were men, with a mean age of 35.9 ± 12.7 years. 40.7% (77/189) of patients were HLA-B27 positive of which 52.9% had AS and 42.5% axSpA. 23.2% (44/189) of patients were HLA-B15 positive: 23.8% were uSpA, 12.57% were axSpA, and 11.7% were pSpA. In addition, HLA-DRB1*01 was associated with AS (58.6%) and axSpA (42.5%). Also, HLA-DRB1*04 was present in 62 patients with AS (71.2%) and in 26 with axSpA (15.5%). In this population, we found a strong association between the presence of HLA-B27 and the diagnosis of axSpA and AS, but the HLA-B15 is also significantly associated with all subtypes of the disease, predominantly with pSpA. Additionally, HLA-DR1 and DR4 were associated in a cohort of patients with SpA from Colombia.

Acute myopericarditis as primary manifestation of urogenital reactive arthritis by Staphylococcus haemolyticus metilcilino resistant / Miopericarditis aguda como manifestación primaria de artritis reactiva urogenital por Staphylococcus haemolyticus resistente a meticilina

Reactive arthritis describes the relationship between the host and the environment. This leads to urogenital or gastrointestinal infections. It clinically presents with inflammatory lumbosacral pain, asymmetric oligoarthritis and enthesitis of the Achilles tendon and plantar fascia. Among the extra-articular manifestations are acute anterior uveitis, skin lesions, genital lesions, and oral ulcers, with the rarest being cardiovascular. A case is presented of a patient with a urogenital infection and cardiovascular manifestations, interpreted and managed as acute coronary syndrome. After further studies an acute myopericarditis was considered as a primary manifestation of reactive arthritis.

La artritis reactiva describe la interrelación entre el hospedero y el medio ambiente. Aparece después de infecciones urogenitales o digestivas. Clínicamente presenta dolor lumbosacro inflamatorio, oligoartritis asimétrica y entesitis del tendón de Aquiles y la fascia plantar. Entre las manifestaciones extraarticulares, se encuentran la uveítis anterior aguda, lesiones en piel, lesiones genitales y úlceras orales. Las más infrecuentes son las cardiovasculares. Describimos el caso de un paciente con infección urogenital y manifestaciones cardiovasculares interpretadas y manejadas como síndrome coronario agudo, pero que a la luz de estudios posteriores se consideró finalmente una miopericarditis aguda como manifestación primaria de una artritis reactiva.

Prevalence of Post-Chikungunya Infection Chronic Inflammatory Arthritis: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine the percentage of patients who would develop chronic inflammatory rheumatism (CIR) following chikungunya (CHIK) virus disease. METHODS: We conducted a systematic review of the literature in 3 databases (PubMed, Science Citation Index, and Scopus) to identify studies assessing the proportion of patients who progress to CHIK-CIR. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence intervals (95% CIs). A 2-tailed alpha level of 5% was used for hypothesis testing. Measures of heterogeneity, including Cochran's Q statistic, the I2 index, and the tau-squared test, were calculated and reported. Subgroup analyses were conducted by type of study and country, by studies evaluating chronic arthritis, and by studies with ≥200 patients and followup ≥18 months. Publication bias was assessed using a funnel-plot. RESULTS: Up to June 15, 2015, our literature search yielded 578 citations. The pooled prevalence of CHIK-CIR in 18 selected studies among 5,702 patients was 40.22% (95% CI 31.11-49.34; τ2 = 0.0838). From studies derived from India, prevalence was 27.27% (95% CI 15.66-38.88; τ2 = 0.0411), while from France, prevalence was 50.25% (95% CI 25.38-75.12; τ2 = 0.1797). The prevalence of CHIK chronic arthritis was 13.66% (95% CI 9.31-18.00; τ2 = 0.0060). Considering just those studies with ≥200 patients assessed, prevalence was 34.14% (95% CI 23.99-44.29; τ2 = 0.0525). In studies with a followup ≥18 months, prevalence was 32.13% (95% CI 22.21-42.04; τ2 = 0.0453). CONCLUSION: According to our results in the most conservative scenario, approximately 25% of CHIK cases would develop CHIK-CIR (34% if we just consider the most representative studies), and 14% would develop chronic arthritis.