Chate Sivasomboon

Tuberculosis arthritis and tenosynovitis.

The incidence of extrapulmonary tuberculosis (TB) has been rising due to the increasing number of immunosuppressed patients. Musculoskeletal system accounts for 25% of extrapulmonary TB. Most of the musculoskeletal TB involves the spine. TB of peripheral joints and tendons occur infrequently, but if untreated, it can cause serious joint and tendon destruction as well as spread of the infection to the surrounding bursa, muscle, and other soft tissues. The diagnosis of TB of joints and tendons is difficult due to the nonspecific clinical manifestations and imaging features. Concurrent active pulmonary TB is present in <50% of the patients. A positive chest radiographic finding or a positive tuberculin test supports the diagnosis, but negative results do not exclude diagnosis. Although imaging features of TB of joints and tendons are nonspecific, certain findings such as relatively preserved joint space, juxta-articular osteoporosis, cold abscesses, para-articular soft tissue calcification, and rice bodies are suggestive of TB infection. Familiarity with these imaging features can help in making an early diagnosis and facilitating proper management.

Periodontal disease in Thai patients with rheumatoid arthritis

To evaluate the prevalence and severity of periodontal disease in patients with rheumatoid arthritis (RA) who attended a rheumatology clinic in a university hospital.

Deforming Arthropathy in Thai Patients With Systemic Lupus Erythematosus.

ObjectiveThe aim of this study was to determine the prevalence, spectrum, and clinical, radiological, and serologic findings as well as hand functions among Thai systemic lupus erythematosus (SLE) patients with deforming arthropathy. MethodsAll SLE patients attending the rheumatology clinic between January and December 2012 were interviewed, with their complete history and a physical examination being taken. Those with hand deformities were invited to join the study. ResultsForty (8.7%) of 458 SLE patients had deforming arthropathy, with 13 (2.8%) of them having erosive arthritis (EA group) and 27 nonerosive arthropathy (NEA group) (8 [1.8%] with Jaccoud arthropathy [JA subgroup] and 19 [4.1%] with mild deforming arthropathy [MDA subgroup]). Three of 13 EA patients (0.7% of all SLE patients) had high titer of rheumatoid factor (RF) and anti–cyclic citrullinated peptide (CCP) antibodies that might represent true overlapping between rheumatoid arthritis and SLE. There were no statistically significant differences in autoantibodies, RF, or anti-CCP between the EA and NEA groups or the JA and MDA subgroups, except for discoid rash that was seen more commonly in the MDA subgroup. Rheumatoid factor and anti-CCP were not present in the JA subgroup. Hand joint destruction and deformities were seen more commonly in the EA group and JA subgroup. The hand grip and palmar pinch strength decreased moderately, with hand functions quite well preserved in all groups. ConclusionsDeforming arthropathy was not uncommon in Thai SLE patients, but true overlapping between rheumatoid arthritis and SLE was rare. Despite significant hand joint deformities and moderately decreased hand grip and palmar pinch strength, preservation of hand functions was generally apparent.

Pitfalls in imaging of musculoskeletal infections.

In musculoskeletal infections, imaging helps in the diagnosis and identification of disease extent. Musculoskeletal infections have variable clinical presentations related to host immune responses and virulence of pathogens. Occasionally, infectious process may mimic other entities such as autoimmune inflammatory diseases, tumors, or traumatic injuries, both clinically and radiologically. Identification of the disease extent is sometimes difficult, particularly when infection occurs in the damaged tissue. The key imaging feature of infection is formation of abscesses. Familiarity of the imaging patterns of the infectious process leads to correct diagnosis and appropriate treatment.

Extravasation of the contrast media during voiding cystourethrography in a long-term spinal cord injury patient.

Objective:To present complications and pitfalls in voiding cystourethrography (VCUG) and introduce a guideline for performing VCUG in a long-term spinal cord injury (SCI) patient with neurogenic bladder dysfunction (NBD) and contracted bladder.Study design:A case report.Setting:Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand.Method:We describe a chronic C5 tetraplegic man with NBD and contracted bladder, who developed autonomic dysreflexia (AD), gross hematuria and extravasation of contrast median during VCUG.Result:A foley catheter was retained after VCUG. AD was resolved and urine cleared after a week of continuous bladder irrigation.Conclusion:VCUG should be performed with caution in a long-term SCI patient with NBD and contracted bladder. Forceful pushing of the contrast media by the hand-injection method caused abrupt distention of the contracted bladder, damaged bladder mucosa and aggrevated AD. We suggest a guideline as follows: report bladder capacity and AD, if present, in an X-ray requisition form; use the gravity-drip method, stop the drip and drain the contrast media if a sudden headache and rising of blood pressure (BP) develop; observe urine colour, and report if bleeding or AD occurs.

Prevalence and predictors of hand involvement in Thai patients with systemic sclerosis.

Data regarding the clinical and radiographic hand involvement in Asian patients with systemic sclerosis (SSc) are limited. Thus, we determined the prevalence of clinical and radiographic hand involvement in Thai SSc patients, comparing diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc). We also determined the factors associated with arthritis, contracture of fingers and digital ulcers.

AB0561 Prevalence and Clinical Manifestation of Deforming Arthropathy in Thai Patients with Systemic Lupus Erythematosus

Background Articular manifestation in systemic lupus erythematosus (SLE) is common and can range from arthralgia to chronic erosive deforming arthropathy. Objectives This study was performed to determine the prevalence, clinical features, and serological findings in Thai SLE patients with deforming arthropathy. Methods All SLE patients seen at the Rheumatology Clinic, Chiang Mai University Hospital, between January and December 2012, were included in this study. Their medical records were reviewed, together with a review of their history and physical examination, with special attention paid to the articular system. Those patients with evidence of hand arthropathy were invited to join the study. The arthropathy was classified according to van Vugts classification. Results Forty of 458 SLE patients (8.7%) had deforming arthropathy. Their mean ± SD age and disease duration were 34.5±14.7 years and 8.8±7.5 years, respectively. There were erosive arthritis with 13 (2.8%) cases, Jaccouds arthropathy with 8 (1.7%), and mild deforming arthropathy with 19 (4.1%). Of these 40 patients, 23 (57.5%) were diagnosed rheumatoid arthritis (RA) with a mean duration of 7.5±8.9 years before the SLE diagnosis was made. Discoid rashes were significantly more common in the mild deforming arthropathy group (63.2%) than in the erosive arthritis group (7.7%) and the Jaccouds arthropathy group (0.0%), p<0.01. Renal involvement was more common in the erosive arthritis group (69.2%) than in the Jaccouds arthropathy group (62.5%) and mild deforming arthropathy group (47.4%), but without statistical significance. There was no statistical significant difference in the mean accumulative number of the ACR criteria, or the disease activity determined by sum of the MEX-SLEDAI score among the three groups. Patients in the erosive arthritis group had significantly more joint deformities than those in the non-erosive ones. Rheumatoid factor (RF) and anti-CCP were present in 38.5% and 30.8% of patients, respectively, in the erosive arthritis group, and 26.3% and 26.3% of patients, respectively, in the mild deforming arthropathy group. There was no presence of RF or anti-CCP in the Jaccouds arthropathy group. Despite hand deformities, all group had maintained their hand functions, but with impaired grip and pinch strength. Conclusions Deforming arthropathy is not uncommon in Thai patients with SLE, and shares similar clinical features to those previously reported. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2936