No abstract

US of "no rhupus" SLE and RA patients is different, especially in wrists. In SLE patients the clinical variable most associated with US findings was "puffy hands."

Background To the best of our knowledge, no previous reports have addressed concomitantly quantitative and semi-quantitative sonographic measurements obtained from several peripheral joints of healthy people, and compared them among different age groups. Objectives To describe quantitative and semi-quantitative ultrasound measurements in healthy joints and compare them among different age groups. Methods Bilateral ultrasound measurement of small, medium and large joints were performed in 130 healthy adult volunteers, stratified into five age groups (A: 18-29, B: 30-39,C: 40-49, D: 50-59, E: 60-80 years), totalizing 46 joint recesses per patient. Sonographic measurements were correlated with age group and demographic variables: age, BMI, gender, skin color, smoking history and physical activity. My Lab 60 XVision machine (Esaote, Biomedica - Genova, Italy) with a linear probe (6-18 MHz) was used. Quantitative measurements of synovial recess (QSR) (mm) and semi-quantitative measures of synovial hypertrophy (SSH), Power Doppler (SPD) and bone erosion (SBE) (score 0-3), were performed. Articular cartilage (AC) at dorsal 2nd and 3rd metacarpophalangeal (MCP) were also evaluated (score 0-4). Results 5,980 joint recesses were studied in 130 healthy adults; mean age 44.84, 76,9% women, 62,3% white. The mean (±SD) of QSR (mm) was: radiocarpal 2.0 (0.62); distal radioulnar 1.48 (0.37); ulnocarpal 1.39 (0.56); dorsal 2nd MCP 1.04 (0.54); palmar 2nd MCP 0.93 (0.66); dorsal 3rd MCP 0.81 (0.60); palmar 3rd MCP 0.83 (0.67); dorsal 2nd proximal interphalangeal joint of the hand (PIP) 0.47 (0.27); palmar 2nd PIP 0.85 (0.31); dorsal 3rd PIP 0.47 (0.35); palmar 3rd PIP 0.86 (0.35); coronoid fossa 1.07 (1.11); olecranean fossa 1.25 (1.16); glenohumeral (GH) axillary recess 2.46 (0.60); posterior GH recess 2.45 (0.52); hip 6.35 (1,25); knee 2.13 (1.47); talocrural (TC) 2.21 (1.09); talonavicular (TN) 2.61 (1.11); subtalar (ST) 2.16 (1.15), dorsal 1st metatarsophalangeal (MTP) joint 2.16 (0.83); dorsal 2nd MTP 2.32 (0.86); dorsal 5th MTP 0.73 (0.68). The largest QSR measurements (p<0.02) were observed in age groups D and E at the recesses: dorsal 2nd and 3rd PIP, dorsal 2nd and 3rd MCP, dorsal 5th MTP, palmar 2nd and 3rd MCP, olecranean fossa, TC and ST. The worst SSH scores (p<0.02) were observed at age groups D and E in the recesses: palmar 2nd and 3rd MCP, palmar 2nd and 3rd PIP, dorsal 2nd and 3rd PIP, dorsal 3rd MCP, 5th dorsal MTP, TN and ST. The worst SPD scores (p<0.016) were observed in age group E at the dorsal 3rd PIP and 3rd MCP. The worst SBE scores (p<0.041) were observed in age group E at the recesses: radiocarpal, ulnocarpal and posterior GH. Minor AC changes (score 1) (p<0.001) were observed in age groups D and E at the dorsal 2nd and 3rd MCP. There were few occasional correlations among ultrasound measurements and demographic variables. Inter-observer reliability (r) for the quantitative and semi-quantitative measurements ranged from 0.563 to 0.872 and 0.341 to 0.823, respectively. Conclusions Articular sonograph...

CONTEXT: Anti-glomerular basement membrane (anti-GBM) antibody syndrome is characterized by deposition of anti-GBM antibodies on affected tissues, associated with glomerulonephritis and/or pulmonary involvement. This syndrome has been described in association with other autoimmune disorders, but as far as we know, it has not been described in association with dermatomyositis and psoriasis.CASE REPORT: A 51-year-old man with a history of dermatomyositis and vulgar psoriasis presented with a condition of sensitive-motor polyneuropathy of the hands and feet, weight loss of 4 kg, malaise and fever. On admission, he had been making chronic use of cyclosporin and antihypertensive drugs for three months because of mild arterial hypertension. Laboratory tests showed anemia and leukocytosis, elevated serum urea and creatinine and urine presenting proteinuria, hematuria, leukocyturia and granular casts. The 24-hour proteinuria was 2.3 g. Renal biopsy showed crescentic necrotizing glomerulonephritis with linear immunoglobulin G (IgG) deposits on the glomerular basement membrane by means of direct immunofluorescence, which were suggestive of anti-GBM antibodies. The patient was then treated initially with methylprednisolone and with monthly cyclophosphamide in the form of pulse therapy. RESUMOCONTEXTO: A síndrome do anticorpo anti-membrana basal glomerular (anti-MBG) é caracterizada pela deposição de anticorpos anti-MBG em tecidos afetados, associada à glomerulonefrite e/ou ao envolvimento pulmonar. Essa síndrome já foi descrita em associação a outras doenças autoimunes, mas até onde conhecemos, não há relatos de sua associação com dermatomiosite e psoríase. RELATO DE CASO:Um homem de 51 anos com antecedentes de dermatomiosite e psoríase vulgar apresentou quadro de polineuropatia sensitivomotora de mãos e pés, perda de 4 kg, adinamia e febre. À admissão estava em uso crônico de ciclosporina e de anti-hipertensivos há três meses devido a hipertensão arterial leve. Exames laboratoriais mostraram anemia e leucocitose, creatinina e ureia séricas elevadas e urina com proteinúria, hematúria, leucocitúria e cilindros granulosos. A proteinúria de 24 horas foi de 2,3 g. A biópsia renal revelou uma glomerulonefrite crescêntica necrotizante com depósitos lineares de imunoglobulina G (IgG) na MBG à imunofluorescência, sugestivos de anticorpos anti-MBG. O paciente foi então tratado inicialmente com metilprednisolona e com ciclofosfamida mensalmente na forma de pulsoterapia.

OBJECTIVE:This study compares the clinical, ultrasonography, radiography, and laboratory outcomes of painless and painful chronic synovitis in patients with established rheumatoid arthritis.METHODS:This cross-sectional study involved 60 patients with rheumatoid arthritis and synovitis in the metacarpophalangeal joints; 30 of the patients did not experience pain, and 30 had experienced pain for at least 6 months prior to the study. The radiocarpal, distal radioulnar, and metacarpophalangeal joints were evaluated using the ultrasound gray scale, power Doppler, and radiography. Past and present clinical and laboratory findings were also evaluated.RESULTS:There were no statistically significant differences between the groups for most of the outcomes. The group with pain scored worse on the disease activity indices (e.g., DAS 28 and SDAI), function questionnaires (HAQ and Cochin), and pinch strength test. A logistic regression analysis revealed that the use of an immunobiological agent was associated with a 3-fold greater chance of belonging to the group that experienced pain. The painless group had worse erosion scores in the second and fifth metacarpophalangeal with odd ratios (ORs) of 6.5 and 3.5, respectively. The painless group had more cartilage with grade 4 damage in the third metacarpophalangeal.CONCLUSIONS:The rheumatoid arthritis patients with both painless and painful synovitis exhibited similar disease histories and radiographic and ultrasound findings. However, the ultrasonography evaluation revealed worse scores in the second and fifth metacarpophalangeal of the synovitis patients who did not experience pain.