Josep Valverde

Group B streptococcus (Streptococcus agalactiae) pyogenic arthritis in nonpregnant adults.

We analyzed the cases of pyogenic arthritis from group B streptococcus (GBS), or Streptococcus agalactiae, in nonpregnant adults diagnosed in the Hospital Universitari de Bellvitge, a 1,000-bed tertiary care teaching hospital in Barcelona, Spain, during a 10-year period, and we reviewed the available literature to summarize the experience with this infectious entity. From the database of our institution, which does not attend pediatric, obstetric, or burn patients, we collected all microbiologically proven cases of infectious arthritis seen from January 1992 to December 2001. We excluded patients with infection limited to spine; patients with prosthetic joint infection; patients undergoing articular surgery during the year before diagnosis; and those with tuberculous, brucellar, or fungal arthritis. Of a total of 112 patients identified, GBS was the causative organism in 11 (10%) cases. We reviewed the literature using a MEDLINE search (1972–2001), and found 64 additional cases.Of the 75 patients, 34 (45%) were men and 41 (55%) women, with ages ranging from 20 to 87 years (mean age, 57.9 ± 14.9 yr); 37 patients (49%) were over 60 years. Sixty-eight percent (51/75) of the patients presented with monoarthritis, while in 32% (24/75) more than 1 joint was involved. The most common location was the knee (36%), followed by the shoulder (25%). In 66% (43/65) of cases, bacteremia was documented. In 64% (47/74) of patients, a systemic predisposing factor for infection was noted; the most common conditions were diabetes mellitus, malignancies, and chronic liver diseases. In 31% (23/75) of patients, a concomitant infectious process due to the same microorganism was found, mainly vertebral osteomyelitis and urinary tract infection. Penicillin was the main antibiotic used after bacterial identification; surgical drainage was performed in 36% (27/75) of cases. The overall mortality rate was 9% (7/75).GBS is now a significant causative agent of pyogenic arthritis in nonpregnant adults. In this population, joint infection by GBS is a disease that mainly affects aged patients with underlying medical illnesses; polyarticular involvement, bacteremia, and the presence of a concomitant infectious process are frequent conditions. The case-fatality rate is substantial.

High HDL-cholesterol in women with rheumatoid arthritis on low-dose glucocorticoid therapy

Background  Dyslipidaemia has been described in non‐treated rheumatoid arthritis (RA), and improves after therapy with disease modifying anti‐rheumatic drugs or glucocorticoids; however, it has generally been perceived that glucocorticoids adversely affect lipid metabolism. The association of low dose glucocorticoid therapy with plasma lipid levels was evaluated in female RA patients.

Nutritional status in patients with rheumatoid arthritis

BACKGROUND Some chronic diseases have been associated to an impairment of nutritional status. OBJECTIVE To analyze nutritional status and its relation to dietary intake, disease activity and treatment in rheumatoid arthritis. PATIENTS AND METHODS We have included 93 patients (43 men and 50 women) and 93 age- and sex-matched healthy controls. The assessment of nutritional status included anthropometric (body mass index, tricipital skin fold and midarm muscular circumference) and biochemical (serum albumin, prealbumin and retinol binding protein) parameters. Dietary intake was calculated from a food frequency questionnaire. As a measure of disease activity, we used the Health Assessment Questionnaire, Ritchie index, tender and swollen joint count and C-reactive protein. Statistical analysis was performed in the whole series and in every functional class. RESULTS In the whole series, midarm muscular circumference and serum albumin were significantly lower in patients than in controls. All anthropometric parameters and serum albumin were significantly lower in patients in functional class IV than in their respective controls. The dietary intake of energy, carbohydrates, vegetal proteins and lipids was higher in patients than in controls. Midarm muscular circumference and serum albumin had a significant inverse relation with disease activity parameters; body mass index, midarm muscular circumference and serum albumin correlated inversely with the cumulative dose of glucocorticoids. CONCLUSIONS Patients with rheumatoid arthritis in functional class IV have an impairment of nutritional status without a deficient dietary intake. The differences found in other functional classes are explained by rheumatoid arthritis itself. Nutritional parameters are related to disease activity and glucocorticoid treatment.

Conventional Lipid Profile and Lipoprotein(a) Concentrations in Treated Patients with Rheumatoid Arthritis

Objective. Patients with rheumatoid arthritis (RA) have an increased cardiovascular risk not completely explained by traditional cardiovascular risk factors. If the proatherogenic lipid profile observed in active and untreated RA improves by effectively treating RA without the use of a lipid-lowering agent, other nonconventional cardiovascular lipid risk factors may be implicated. We evaluated conventional lipid risk factors and lipoprotein(a) in treated patients with RA. Methods. This cross-sectional study was conducted in 122 patients with RA. Lipid profiles of patients were compared with a control group, consisting of a population-based study cohort (DRECE study), matched for sex, age, menopausal status, and body mass index. Excess lipoprotein(a) was defined by a serum concentration > 0.3 g/l. Results. High-density lipoprotein cholesterol (HDL-c) concentrations were higher in pre- and postmenopausal women with RA than in controls (p = 0.023 and p ≤ 0.001, respectively). All RA patients had significantly lower levels of apolipoprotein B and apolipoprotein B/apolipoprotein A-I ratio, and postmenopausal women with RA also had significantly lower low-density lipoprotein cholesterol and total cholesterol levels than their respective controls. No differences were observed in serum levels of apolipoprotein A-I and triglyceride. All RA patients had higher lipoprotein(a) values than controls. Fourteen men (56%) and 10 (53%) and 42 (54%) pre- and postmenopausal women with RA, respectively, had hyperlipoproteinemia(a). Conclusion. RA patients undergoing antirheumatic therapy display a nonatherogenic conventional lipid profile, i.e., high HDL-c, low apolipoprotein B concentrations, and low apolipoprotein B/apolipoprotein A-I ratio. This may be counteracted by the high prevalence of hyperlipoproteinemia(a) observed in these patients.

Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures.

Objective: To analyse whether bone mineral density (BMD) assessment is required in postmenopausal women presenting with low trauma vertebral fracture. Methods: Women with vertebral fracture diagnosed over a 10 year period were recruited from our database. The following were excluded: (a) patients with high energy trauma; (b) patients with malignancies; (c) patients with a metabolic bone disease other than osteoporosis. All postmenopausal women were included in whom BMD had been evaluated at both the lumbar spine and femoral neck by dual energy x ray absorptiometry during the six months after the diagnosis. Patients with a potential cause of osteoporosis other than age and menopause were not considered. A total of 215 patients were identified. Results: The mean (SD) age of the patients was 65.9 (6.9) years. BMD at the lumbar spine was 0.725 (0.128) g/cm2 and the T score was −2.94 (1.22); BMD at the femoral neck was 0.598 (0.095) g/cm2 and the T score was −2.22 (0.89). The BMD of the patients was significantly lower than that of the general population at both the lumbar spine and femoral neck. When the lowest value of the two analysed zones was considered, six patients (3%) showed a normal BMD, 51 (23.5%) osteopenia, and 158 (73.5%) osteoporosis. The prevalence of osteoporosis at the femoral neck increased with age; it was 25% in patients under 60, 35% in patients aged 60–70, and 60% in patients over 70. Conclusion: These results indicate that bone densitometry is not required in postmenopausal women with clinically diagnosed vertebral fractures if it is performed only to confirm the existence of a low BMD.

Estudio densitométrico en mujeres posmenopáusicas con artritis reumatoide tratadas con dosis bajas de glucocorticoides

Fundamento : Evaluar el estado de la densidadmineral osea (DMO) en un grupo demujeres posmenopausicas afectadas de artritisreumatoide (AR) tratadas con dosisbajas de glucocorticoides. Pacientes Y Metodo : Se incluyeron 111 pacientes.La edad media (DE) fue de 63,8(8,8) anos, la duracion media del periodoposmenopausico de 16,4 (10,1) anos y laduracion media de la enfermedad de 12,5(8,2) anos. Resultados : Se observo una reduccion significativade la DMO, respecto de la poblaciongeneral, tanto en la columna lumbar(p Conclusiones : El estudio confirma, en poblacionespanola, que las mujeres posmenopausicascon AR tratadas con dosis bajasde glucocorticoides presentan una menorDMO que la poblacion general. La prevalenciade la osteoporosis se considera elevada. Background : To study bone mineral density(BMD) in a group of postmenopausal womenwith rheumatoid arthritis (RA) treatedwith low doses of corticosteroids. Patients and Methods : One hundred and elevenpatients were included. Mean age (SD)was 63.8 (8.8) years, mean duration ofpostmenopausal period was 16.4 (10.1) yearsand the mean disease duration was12.5 (8.2) years. Results : A significant reduction of lumbarBMD (p Conclusions : The study supports, in theSpanish population, that postmenopausalwomen with RA treated with low doses ofcorticosteroids, have low BMD. We considerthat the prevalence of osteoporosis in these patients is high.

Évaluation de l’état nutritionnel chez les patients atteints de polyarthrite rhumatoïde

Resume Certaines maladies chroniques s’accompagnent d’une alteration de l’etat nutritionnel. Objectif. Analyser l’etat nutritionnel et ses relations avec les apports alimentaires, l’activite et le traitement de la polyarthrite rhumatoide. Patients et methodes. Nous avons etudie 93 patients (43 hommes et 50 femmes) et 93 temoins, apparies pour l’âge et le sexe. L’evaluation de l’etat nutritionnel a ete faite a l’aide de parametres anthropometriques (indice de masse corporelle, pli cutane tricipital et circonference musculaire brachiale) et biochimiques (albumine, prealbumine et retinol binding protein seriques). Les apports dietetiques ont ete calcules a partir d’un questionnaire de frequence des prises alimentaires. L’activite de la polyarthrite rhumatoide a ete evaluee a partir du Health Assessment Questionnaire, de l’indice de Ritchie, du nombre d’articulations douloureuses, du nombre d’articulations gonflees et de la mesure de la proteine C-reactive. L’analyse statistique a ete effectuee sur l’ensemble des malades et dans chaque classe fonctionnelle. Resultats. Chez l’ensemble des patients, la circonference musculaire brachiale et l’albuminemie etaient significativement diminuees par rapport aux temoins. Tous les parametres anthropometriques ainsi que l’albuminemie etaient significativement diminues chez les patients appartenant a la classe fonctionnelle IV, et ce par rapport a leurs temoins respectifs. Les apports alimentaires en calories, en hydrates de carbone, en proteines vegetales et en lipides etaient plus eleves chez les patients que chez les temoins. La circonference musculaire brachiale et l’albuminemie etaient inversement correlees aux parametres de l’activite de la polyarthrite. De plus, l’indice de masse corporelle, la circonference musculaire brachiale et l’albuminemie etaient inversement correles a la dose totale cumulee de glucocorticoides. Conclusion. Les sujets atteints d’une polyarthrite rhumatoide de classe IV ont une alteration de leur etat nutritionnel qui n’est pas liee a une carence des apports alimentaires. Les differences observees dans les autres classes fonctionnelles sont expliquees par la polyarthrite rhumatoide elle-meme. Les parametres de l’etat nutritionnel sont correles avec l’activite de la maladie et la corticotherapie.