No abstract

ObjectivesTo describe the main characteristics of patients with Behçet's disease (BD) who presented with thrombosis included in the Spanish BD Registry Group (REGEB) and try to identify the prognostic factors associated with re-thrombosis in this cohort.MethodsUp to December 2014, 541 BD patients from 20 Spanish hospitals had been included in the REGEB. We selected those patients who presented thrombotic manifestations. Descriptive analysis was performed and factors related with thrombosis recurrence were identified. This project was performed, on behalf of Systemic Autoimmune Diseases Group (GEAS) of the Spanish Society of Internal Medicine (SEMI). This registry started in 2009, with a multicenter, consecutive, and retrospective design.ResultsAmong 541 BD patients, 85 (16%) had thrombosis. Sixty (70.6%) were men and the mean age of onset of the disease was 27.4 years (11) and median follow-up time was 160 months (range 0-418). Most patients (88.2%) were Caucasian. In 28 (32.9%) cases, HLA B51 was detected. In 36 (42.3%) patients, thrombosis was one of the presenting manifestation of BD and it concurred with other symptoms of BD in 71 (84%). Deep venous thrombosis in the legs (n=49) wasthe most frequent thrombosis followed by cerebral venous sinus thrombosis (n=10). Considering therapy, 68 (80%) patients received anticoagulation, 45 (52.9%) corticosteroids, 25 (29.4%) immunosuppressants and 2 (2.4%) infliximab. During follow-up, 18 (21%) patients presented a second episode of thrombosis and 5 (5.9%) a third. The median time between thrombosis was 26 months (range 1-260). Deep venous thrombosis in the legs was the most frequent (n=13), followed by inferior vena cava thrombosis (n=4), cerebral venous sinus thrombosis (n=3), stroke (n=2), and right ventricle thrombosis (n=1). Other concurrent symptoms of BD were seen in 87% of these events. Treatment at the moment of rethrombosis was anticoagulation in 5; corticosteroids in 9, and immunosuppressants in 5. Rethrombosis was treated with anticoagulants in 20 (87%) cases, corticosteroids in 11 (48%), immunosuppressants in 7 (30%) and adalimumab in one (1%) case.Univariate analysis showed significant association between rethrombosis and central nervous system (CNS) involvement, but it appears unrelated to other clinical signs, gender, use of immunosuppressants or anticoagulation at the moment of the thrombotic event. The Cox multivariate analysis confirmed the relation between rethrombosis and CNS involvement (p=0.26; HR 3.1 CI95% 1.1-8.4)ConclusionsIn the REGEB cohort, thrombosis was present in 16% of patients and re-thrombosis in 3.3%, respectively. Re-thrombosis was accompanied by other symptoms of disease activity in the majority of cases and were associated with CNS involvement. Prevalence of immunossupressant agents was no different in patients with rethrombosis. Of note, re-thrombosis occurred in one-fifth of patients receiving anticoagulation.Disclosure of InterestNone declared

L a luxación aislada carpo-metacarpiana del quinto dedo es infrecuente y puede pasar inadvertida. Los autores presentan un caso de luxación volar-cubital de la base del quinto metacarpiano de un año de evolución. Se realiza un recuerdo anatómico de esta articulación y se discuten etiología, diagnóstico y opciones de tratamiento. CASO CLÍNICOMujer de 32 años, ama de casa, remitida a la Unidad de Mano de nuestro Servicio por deformidad y dolor en el quinto dedo de la mano derecha. Refiere caída un año antes, quedando la mano derecha atrapada entre el tórax y el suelo. El episodio fue diagnosticado como contusión y se trató con férula antebraquial veinte días. En consulta verificamos deformi- Las luxaciones aisladas de la articulación carpometacarpiana del quinto dedo son infrecuentes. Nalebuff clasificó estas luxaciones según el desplazamiento de la base del quinto metacarpiano. Una paciente con luxación volar-cubital carpometacarpiana del quinto dedo fue remitida a la consulta de mano doce meses después de la lesión. En lesiones agudas la reducción cerrada es la técnica utilizada. Sin embargo en situación de retraso en el tratamiento la reducción abierta proporciona mayor éxito funcionalPalabras clave: articulación carpo-metacarpiana quinto dedo, luxación carpo-metacarpiana, reducción abierta.Isolated dislocation of the fifth carpometacarpal joint is rare. Nalebuff classified these dislocation according to the displacement of the fifth metacarpal base. A patient with an ulnopalmar fith carpometacarpal joint dislocation was referred to the hand clinic twelve months later the injury. Close reduction has commomly been used in dislocation acute. However in situation with delay in treating the open reduction offers more success functional.