Objective To evaluate facet joint degeneration following surgical treatment in patients with lumbar disc herniation, seeking to correlate it with possible determining factors. Methods Cross-sectional observational study, which analyzed medical records, radiographs and magnetic resonance images of 287 patients with lumbar disc herniation treated surgically at the Spine Surgery Service of the Hospital Ortopédico de Passo Fundo. Information about age and sex was collected. In the imaging exams, the following variables were evaluated: facet joint angulation and its tropism, measured by the Karacan method, sacral slope and lumbar lordosis, measured by the Cobb method, arthrosis of the interfacetary joints, measured by the Weishaupt classification, and intervertebral disc degeneration, measured by the Pfirrmann classification. Results A statistically significant relationship was observed between facet joint degeneration and age (p = 0.002), and also between facet joint degeneration and sacral slope (p = 0.038). No correlation was found between facet joint degeneration and lumbar lordosis (p = 0.934). It was found that the most degenerated facet joints were those that had the greatest facet joint asymmetry (tropism). However, the mean degree of facet tropism did not increase homogeneously with the progression of the joint degeneration score (p = 0.380). Conclusion It was verified that there are, in fact, a multiplicity of factors related to the degree of facet joint degeneration in the low lumbar spine. Additional studies, correlated with the asymmetry of the facet joints, would be important to elucidate better preventive management of this degeneration, aiming to avert secondary low back pain and sciatica with advancing age. Level of evidence II; Retrospective study.

BACKGROUNDMyositis ossificans is an uncommon form of metaplasia in which bone tissue forms in muscle after an injury to the muscle fibers, most commonly due traumatic injury-be it by repetitive minor trauma or one significant single event. This is a case report of a patient with myositis ossificans of femoral and hip muscles due to injury related to tonic-clonic seizures. CASE REPORTA 33-year-old female, with epilepsy associated with autoimmune limbic encephalitis since 2006, presented to the Rheumatology Clinic with chronic pain of both knee and hip joints bilaterally since the seizures began. The patient had begun previous treatment with a rheumatologist in another institution with loss of follow-up, presenting no response to treatment with alendronate. On physical examination, she presented with significantly limited range of motion of the hips, as well as swelling and pain during mobilization of both knees and hips; and also crackles during mobilization of the knees. X-rays showed heterotopic calcifications in both hips, as well as ossification of heterotopic calcification in the medial facet of both knees in the general topography of the medial collateral ligaments. Further investigation showed negative ANA, anti-DNA antibody and rheumatoid factor, as well as normal complement levels. The patient is currently undergoing treatment with risedronate, and awaiting computed tomography scans to be evaluated by an orthopedic surgeon; however, due to the severity of her neurologic symptoms and difficulty in controlling seizures, the risk of trauma to the already injured muscles persists. CONCLUSIONMyositis ossificans is a heterogeneous group of diseases that vary between post-traumatic and inflammatory injuries to genetic disorders; trauma being the most commonly associated etiology to the development of heterotopic ossification in muscles. It is believed that hematomas formed in muscle fibers related to injury are the main factor associated with the inflammatory cascade that leads to the formation of osteoblast in muscle and in turn ossification of said muscle. Treatment usually consists in controlling the risk factors (ongoing trauma) and avoiding formation or enlargement of muscle hematoma in acute cases; however, the use of bisphosphonates as an adjunct treatment, has been reported to be beneficial in some cases. In chronic cases, such as this one, surgical removal of these ossifications can be considered to improve range of motion of the joints and to better control pain.

BACKGROUNDGranulomatosis with polyangiitis (GPA) is a necrotizing vasculitis that predominantly affects small-sized arteries. The most affected organs include the upper respiratory tract (sinusitis, rhinorrhea, otitis media), lower respiratory tract (alveolar hemorrhage and pulmonary nodules) and kidneys (glomerulonephritis). It is strongly associated with antineutrophil cytoplasmic antibody (ANCA) and antiproteinase-3 (PR3) positivity. Central nervous system involvement may occur, but pituitary involvement is rare. This is a case report of panhypopituitarism due to granulomatous hypophysitis in a patient diagnosed with GPA. CASE REPORTA 40-year-old man, with a previous history of panhypopituitarism due to granulomatous hypophysitis without defined etiology. He reported sinusitis with purulent rhinorrhea, recurrent otitis media, chronic headaches, and reduced visual acuity. Magnetic resonance imaging of sella turcica showed areas of low signal intensity on T2 and pituitary stalk thickening. Chest computed tomography showed two granulomatous lesions measuring 1.6 and 0.9 cm. ANCA and PR3 were positive, all screenings for infectious diseases were negative; renal function and urinalysis were normal. Histology of pulmonary nodule obtained by excisional biopsy showed neutrophilic vasculitis with areas of necrosis and granulomas, compatible with GPA, further sample analysis was negative for fungi and mycobacteria. The patient was treated with pulse therapy (1 g methylprednisone) for 3 days, followed by prednisone 40 mg/day and monthly cycles of IV cyclophosphamide. Currently, the patient is being monitored by the rheumatology team. CONCLUSIONGPA is a small-size arteries vasculitis associated with ANCA positivity and presents a variability in relation to organ involvement as well as disease severity. The main sites affected are the upper respiratory tract, lungs and kidneys, but other organs can be affected, such as skin, eyes, heart, gastrointestinal tract, urinary tract and liver. The central nervous system may be involved, mainly in the form of mononeuritis multiplex, sensory alterations, cranial nerve alterations and tumors. Granulomatous hypophysitis due to GPA is rare, less than 100 cases have been described in the literature. Treatment consists of two phases, induction with glucocorticoids associated with rituximab or cyclophosphamide, aiming at disease remission followed by maintenance. Rituximab, azathioprine, methotrexate, and mycophenolate are options for maintenance therapy.

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Objetivo: O objetivo deste artigo foi verificar a relação entre depressão e demência e a associação com fatores sociais e demográficos em adultos e idosos frequentadores de um Centro de Referência e Atenção ao Idoso.Método: As variáveis utilizadas foram obtidas por meio de questionário estruturado contendo dados sociais e demográficos e instrumentos validados e de livre acesso: Escala de Depressão Geriátrica, Mini-Exame do Estado Mental, Teste do Desenho do Relógio, Teste de Fluência Verbal Semântica dos Animais e o Alzheimer’s Disease Assessment Scale (ADAS-Cog).Resultados: Os resultados evidenciaram prevalências de 6% (n=10) para depressão e 12,6% (n=21) para demência. Em relação a demência, nos participantes classificados com cognição prejudicada a média de idade foi maior, a média de anos de estudo foi inferior e o tempo que viveu no meio rural foi superior, comparado com aqueles sem cognição prejudicada, respectivamente. A depressão foi associada com demência no modelo univariável e após ajuste para idade e tempo que viveu no meio rural.Conclusões: Observa-se associação significativa entre depressão e demência e baixa prevalência desses dois desfechos de saúde mental, podendo ser influenciada pelas atividades físicas, sociais, culturais e educacionais realizadas pelo Centro de Referência e Atenção ao Idoso.