Melania Martínez-Morillo

Artritis séptica de la articulación acromioclavicular: una localización atípica

Septic pyogenic arthritis of the acromioclavicular joint is a rare entity that occurs in immunosuppressed patients or those with discontinuity of defense barriers. There are only 15 cases described in the literature. The diagnosis is based on clinical features and the isolation of a microorganism in synovial fluid or blood cultures. The evidence of arthritis by imaging (MRI, ultrasound or scintigraphy) may be useful. Antibiotic treatment is the same as in septic arthritis in other locations. Staphylococcus aureus is the microorganism most frequently isolated. Our objective was to describe the clinical features, treatment and outcome of patients diagnosed with septic arthritis of the acromioclavicular joint at a Rheumatology Department. We developed a study with a retrospective design (1989-2012). The medical records of patients with septic arthritis were reviewed (101 patients). Those involving the acromioclavicular joint were selected (6 patients; 6%).

Granulomatosis con poliangeítis (Wegener). Descripción de 15 casos

BACKGROUND Granulomatosis with polyangiitis (GP) is a necrotizing vasculitis of unknown etiology that involves small and medium caliber vessels. It is associated with anti neutrophil cytoplasm antibodies (ANCA). It most often affects the respiratory tract and the kidneys and its most important pathologic feature is the presence of necrotizing granulomas. OBJECTIVES To detail the features of 15 patients with GP diagnosed in a university referral center. PATIENTS AND METHODS Retrospective study: between 1984 and 2009, 15 patients with GP were diagnosed in our center. Epidemiological, clinical, laboratory test as well as pathologic studies and treatment were retrospectively analyzed. Biopsy diagnosis of GP was considered as an inclusion criterion. RESULTS Fifteen patients were diagnosed: 12 men and 3 women. Mean age at diagnosis: 52.2 years (14-78). 12 patients had a history of smoking. A biopsy was diagnostic in all patients. ANCA were positive in 11 cases, 6 had a cytoplasmic c-ANCA pattern. All patients had pulmonary involvement and seven (40%) had renal involvement. All patients received intravenous glucocorticoids and cyclophosphamide as induction therapy. During the disease progression 5 patients died. CONCLUSIONS The clinical features of this series do not differ from those described by other authors. However, a history of smoking is more common than expected. Frequently used drugs were glucocorticoids and cyclophosphamide (oral and pulse therapy). The course was usually unfavorable, with outbreaks or complications due to immunosuppression, except for those with limited forms. Immunosuppressive therapy should be maintained indefinitely in most cases.

Autoimmunity and atrioventricular block of unknown etiology in adults: the role of anti-Ro/SSA antibodies.

To the Editor: Emerging evidence suggests that some autoantibodies may be involved in the pathogenesis of several heart rhythm disorders. This theory has been shown in a number of published series of patients with known autoimmune disease who often display electrocardiographic abnormalities, such

A comment on “From diagnosis to remission: place of MRI in eosinophilic fasciitis”

We read with interest the letter of Desvignes-Engelbert et al. [1] and we would like to comment on it. We recently reviewed 13 patients with eosinophilic fasciitis (EF). All were diagnosed on the basis of a fullthickness skin to muscle biopsy. We performed magnetic resonance imaging (MRI) in three patients who had a negative histological diagnosis. In all cases, the second guided biopsy was positive. Herein, we present the three cases, in which MRI was very useful.

Anti-Ro/SSA antibodies and cardiac rhythm disturbances: Present and future perspectives

Several case reports, small case series, and original research papers have recently suggested that the action of certain auto-antibodies related to connective tissue diseases may be responsible for significant cardiac rhythm disturbances in adults. The relationship between anti-Ro/SSA antibodies and congenital complete atrioventricular block is well recognized in the fetal heart. Herein we review the emerging evidences of the link to increased levels of anti-Ro/SSA antibodies with rhythm disorders of unknown origin in the adult. Confirmation of this distinct etiology may eventually be the basis for new therapies.

Osteoporosis premenopáusica: ¿cómo tratarla?

There is no agreement in defining osteoporosis in premenopausal women and diagnosis must be done carefully and not based on densitometric parameters. One must take into account the presence of other risk factors and history of fragility fractures, diseases or drugs that cause bone loss. Over 50% of premenopausal women with osteoporosis will have a secondary cause, with the remainder diagnosed with idiopathic osteoporosis. Therapeutic considerations are limited by a few studies in this group of patients, especially in regard to the risk of fractures. On the other hand, the FRAX index cannot be applied to premenopausal women. This article will review the measures to apply depending on the type of premenopausal osteoporosis, based on current scientific evidence.

Espondilodiscitis sin endocarditis causada por Streptococcus mitis

La espondilodiscitis es la infección del disco intervertebral y as vértebras. Su incidencia ha aumentado en los últimos años. l microorganismo responsable de la mayoría de casos en adulos es Staphylococcus aureus. Las especies de estreptococos han enido poca relevancia, hasta el momento, como agentes causaes de osteomielitis vertebral. Sin embargo, recientemente se ha roducido un aumento del número de casos causados por estos icroorganismos1. A continuación presentamos el caso de un aciente con espondilodiscitis causada por Streptococcus mitis. Varón de 49 años, exfumador, sin otros antecedentes patoógicos de interés. Consultaba por lumbalgia de características nflamatorias de 4 semanas de evolución, con irradiación hacia a extremidad inferior izquierda. No explicaba fiebre ni síndrome óxico asociado. Tampoco lesiones cutáneas ni consumo de producos lácteos artesanales. No había tenido manipulación dentaria en os últimos 2 años. En los estudios de laboratorio destacaba hemorama sin leucocitosis, ni alteraciones de la fórmula leucocitaria, ero con elevación de reactantes de fase aguda (VSG 80 mm, PCR 2 mg/l). Las serologías para VIH y Brucella fueron negativas, así omo la prueba cutánea de la tuberculina. La radiografía de columna umbar mostraba una discreta irregularidad en el platillo vertebral nferior de L5. Se realizó una resonancia magnética de columna umbosacra que puso de manifiesto signos compatibles con esponilodiscitis L5-S1. Los hemocultivos cursados fueron negativos. Se racticó ecocardiograma transtorácico sin signos de endocarditis. inalmente, se practicó biopsia y punción-aspiración con aguja fina e la lesión discal, guiadas por tomografía computarizada (TC). En l cultivo bacteriológico crecieron colonias de Streptococcus mitis ensible a todos los grupos de antimicrobianos excepto a la peniilina. Se realizaron, además, nuevos hemocultivos a las 4 h de la iopsia vertebral, en los cuales se aisló también Streptococcus mitis. e administró tratamiento con ceftriaxona vía endovenosa durante semanas y, posteriormente, 3 semanas más con levofloxacino vía ral. El paciente presentó buena evolución, con resolución de la línica y normalización de los reactantes de fase aguda. En la bibliografía médica anglosajona hay descritos 7 casos e espondilodiscitis causada por Streptococcus mitis1–3 (PubMed: pondylodiscitis and Streptococcus mitis 1969-2015). El Streptooccus mitis pertenece al grupo de los Streptococcus viridans sp, orma parte de la flora comensal de la boca y los senos paranasa-

Mujer con lupus eritematoso sistémico y poliadenopatías

We present the case of a 51 year old woman with a history of several years of non organ specific Systemic Lupus Erythematosus, who presented a toxic syndrome and adenopathy and cranial nerve affection. We carried out the differential diagnosis. We then described the case resolution and progression.

Polimialgia reumática con derrame pleuropericárdico: una asociación infrecuente

We have carefully read the article by Sánchez Ruiz-Granados et al. Published in your journal and which touched upon a case of Polymyalgia Rheumatica (PMR) and a pleuropericardial effusion.1 It described the case of an 80-year-old male with joint pain on the scapular and pelvic girdles, with constitutional signs, who presented a pleuropericardial effusion and an elevation of acute phase reactants. Among other diagnosis, elderly onset rheumatoid arthritis (EORA) was ruled out due to the affection of the scapular and pelvic girdles and rheumatoid factor negativity. This conclusion led to our unease and we would like to comment on a series of facts. PMR is an inflammatory disease of elderly patients characterized by pain and morning stiffness in the cervical region as well as the scapular and pelvic girdles and elevated erythrocyte sedimentation rate. Immunological testing is typically negative and X-rays show no alterations. Due to the absence of specific tests, its excellent response to steroids is considered part of the diagnosis.2 Recent echographic and magnetic resonance tests have shown the almost constant presence of extra-articular inflammation in the form of subacromial bursitis or bicipital tendinitis, leading to the inclusion of these alterations in the new diagnostic criteria for PMR.3 As may be understood, the diagnostic difficulty for PMR is inherent in its definition and the absence of specific testing. Therefore, in the differential diagnosis the clinician must take into account other rheumatic and non-rheumatic diseases that may simulate PMR.4–6 Among non-rheumatic causes one finds some infections and tumors that in the case at hand were reasonably ruled out. However, among the rheumatic causes, EORA stands out and we consider that it cannot be ruled out. EORA differs from rheumatoid arthritis of younger patients because it affects women with less frequency, has a more acute onset of disease, is more commonly accompanied by constitutional symptoms and, frequently, affects large joints, especially the shoulders, simulating PMR, with less affection of metacarpophalangeal joints. It presents with high erythrocyte sedimentation rate and the percentage of patients with positive rheumatoid factor is reduced in relation to younger patients. Due to these characteristics, its onset may be undistinguishable from PMR.7,8 In the case at hand, although the patient has PMR criteria, the presence of a pleuropericardial effusion leads to doubts on the

Nephrotic syndrome in a patient with Pfeifer-Weber-Christian disease.

Joint Bone Spine - In Press.Proof corrected by the author Available online since jeudi 25 decembre 2014