Background Inflammatory activity may be quantified using Spectral Doppler (sD), which detects power Doppler (PD) signal through the internal resistance index (RI) in microcirculation1,2. Objectives Assess the RI in the nail bed in longitudinal (LRI) and transverse (TRI) planes; correlate with the presence of PD in the ungueal bed (NPD), change in standard trilaminar appearance of the nail (NGS), measure of the ungueal bed (mNGS) and clinical measurements. Methods In this cross-sectional study, 28 patients with psoriatic arthritis (PsA) diagnostic using the CASPAR classification criteria were included, as well as 7 patients control (71.42% healthy and 28.57% with osteoarthritis). They were submitted to an examination through an Esaote Ultrasound machine (Brazil, São Paulo), with 6–18 MHz broadband multifrequency linear transducer and Doppler frequency ranging from 7.1 to 14.3 MHz. The RI was considered changed when measuring ≤0.851. In the statistical study, the program SPSS Statistics 17.0. Spearman's correlation was used to analyze the non-parametric variables and the Pearson's correlation for the analysis of parametric variables. T-test was used for the comparison analysis between the PsA groups and the control. Results A total of 133 ungueal beds were assessed in patients and control individuals with the following variables: PsA (45.5% men and 54.5% women), race (96.42% Caucasian and 3.57% Asiatic) while controls variables were: 42.9% men, 57.1% women, race (85.71% Caucasians and 14.28% African); the procedure took place in the Instituto de Pesquisa Clínica of Campinas – IPECC and Pontifícia Universidade Catόlica of Campinas. The following average outcomes were observed in the controls: age 37.14±21.59 years; the general visual analog scale for pain (GVASp) 0.00±0.00 cm; LRI 0.86±0.41; TRI 0.70±0.16; NPD 1.0±0.00; mNGS 1.75±0.35 mm; NGS 0.00±0.00. Patients with PsA: 53.57% with no use of medication; 25% using methotrexate (15.71mg ±1.74), 14.28% using anti-TNF and 7.14% acitretin; average outcomes were: disease time 10.05±10.49 years; age 45.3±14.61 years; Psoriasis Area Severity Index (PASI) 6.03±12.27; medication time of use: 11.46±22.00 months; GVASp 1.78±3.42 cm; LRI 0.50±0.13; TRI 0.48±0.09, NPD 0.88±0.31; mNGS 1.73±0.68 mm; NGS 0.48±0.50. Significant correlations LRI with TRI r=0.333 (p=0.013); mNGS with NGS r=0.472 (p=0.023); LRI with drug time of use r=0.578 (p=0.002) and NGS with disease time r=0.551 (p=0.002). The LRI with NPD showed negative and very low correlation: -0.213 (p=0.038). The TRI with NPD, did not show any correlation (p=0.139). In the comparison between the groups in relation to the RIs: p<0.001 for the PsA group and p=0.002 for the TRI control (Test value = 0.85). Conclusions The sD may help confirm quantitatively ungueal inflammatory activity in PsA patients in future studies. References Terslev L, Torp-Pedersen S, Qvistgaard E, von der Recke P, Bliddal H. Doppler ultrasound findings in healthy wrists and finger joints. Ann Rheum Dis 2004; 63:644–648. Gutierrez M, Fi...

Paracoccidioidomycosis is a fungal infection endemic to South America. The infection is usually asymptomatic and mostly affects the upper and lower respiratory tracts with clinical-radiological dissociation. Joint involvement is rare with no specific pattern or radiological injury. We report a case of paracoccidioidomycosis in which the patient's initial symptoms were hoarseness and arthritis. After an ultrasound examination, we performed the differential diagnosis of other noninfectious arthropathies and analysis of the material collected, which revealed infection with the fungus Paracoccidioides brasiliensis.

No abstract

BACKGROUNDAcute diffuse glomerulonephritis is one of the most prevalent causes of glomerulonephritis worldwide. Children of preschool age are the most affected age group, being rare in adults over 40 years old. Treatment is symptomatic and the prognosis is favorable in most cases. CASE REPORTFemale patient, 42 years old, in 2019 started with a recurrent urinary infection. During the investigation, the presence of proteinuria was evidenced, an ANA was requested, which was reactive and a renal biopsy was indicated, but not performed at the time due to loss of follow-up. In January 2020, she developed malar rash, photosensitivity, alopecia, inflammatory rhythm arthralgia in metacarpophalangeal and proximal interphalangeal joints. After an irregular external follow-up period and with a report of shortterm use of hydroxychloroquine and methotrexate, in August 2021 she was referred to our service. When the diagnostic hypothesis of systemic lupus erythematosus (SLE) was raised, tests were requested for diagnostic investigation, with fine speckled nuclear ANA 1:160, C3 hypocomplementemia, reagent anticardiolipin IgM and 24-h proteinuria of 957 mg. Due to the diagnosis of SLE with persistent proteinuria without loss of renal function, it was decided to perform a renal biopsy to better elucidate the condition before instituting immunosuppression. The biopsy showed 23 glomeruli with mild to moderate hypercellularity, with reduced capillary lumen and occasional neutrophils in these areas, 2 of them with a focus of fibrinoid necrosis. The immunohistochemistry showed as alteration the presence of complement, positive C3 fraction 3+/3+ with coarse granular pattern, of global and diffuse distribution in capillary loops. The morphological findings associated with the immunofluorescence exam correspond to acute diffuse intracapillary glomerulopathy (post-streptococcal glomerulonephritis). Since the patient meets the criteria for SLE, with proteinuria, but with renal biopsy not suggestive of lupus nephritis, but of another pathology (ADGN), it was decided to introduce methotrexate 12.5 mg/week, prednisone 20 mg/day due to cutaneous activity and articulate. The patient evolved with resolution of proteinuria and normalization of C3 with the instituted treatment. CONCLUSIONThe presence of proteinuria in SLE patients should draw our attention to one of the most serious complications of this disease, which is lupus nephritis. However, its differential diagnosis is extensive and renal biopsy should be performed whenever possible, since other diagnoses may not require immunosuppression.

Amyloidosis can mimic or occur concomitantly with several rheumatological diseases, and it is necessary to pay attention to this pathology as a differential diagnosis of immune-mediated diseases.