A 33-day-old female with an ulcerated infantile hemangioma (IH) undergoing oral therapy with propranolol 2 mg/kg per day developed hyperkalemia and hyperphosphatemia 24 h after starting medication. No electrocardiographic or clinical abnormalities secondary to the electrolyte changes were noticed. A laboratory tumor lysis syndrome (TLS) was diagnosed after excluding other causes of electrolyte imbalance in the diagnostic workup. No treatment was required to reverse the TLS condition, and the propranolol therapy was continued as the electrolyte alterations were only mild. One month later, the IH was remarkably reduced in size and no longer ulcerated. Maintenance of propranolol was extended for a total of 6 months. Parallel to the gradual involution of the IH, serum potassium and phosphorus levels returned within normal levels. We suggest that TLS may be a rare complication of ulcerated IH treated with propranolol. Clinicians must be aware and order appropriate screening tests for TLS in patients at risk.

The purpose of this study is to review the current literature on the use of hyaluronic acid (HA) specifically applied to the treatment of osteoarthritis (OA) secondary to primary inflammatory rheumatic diseases. Osteoarthritis should be carefully considered because it has potentially devastating effects on health-related quality of life. Locally injected HA seems to be an effective treatment for OA but it is not clear how to place this treatment in the context of inflammatory rheumatic disorders. To retrieve relevant articles, we conducted the search through MEDLINE, EMBASE and Cochrane Databases performing the PICO strategy. We finally selected four randomized clinical trials and six observational studies and grouped them in accordance with its main objective within three focuses: the clinical effect of HA therapy in joints without any signs of inflammation, the clinical effects of HA therapy in joints with active synovitis, and the involvement and changes of synovial fluid in the treatment of secondary OA. Our qualitative analysis clearly showed that the current literature is marked by high levels of heterogeneity and therefore difficult to interpret. Therefore, our hypothesis that viscosupplementation should be considered as a treatment for chronic moderate symptomatic OA secondary to inflammatory rheumatic diseases, and not for flares with joint swelling, cannot be definitely supported. Welldesigned studies are necessary to definitively clarify the range of application of intra-articular HA injections in the treatment of inflammatory rheumatic disorders.

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Hip osteoarthritis affects a substantial and growing number of people worldwide. Its incidence and prevalence are increasing due to ageing and obesity. It is estimated that it affects between 10 and 18% of individuals over 60 years of age and up to 1 in 3 patients over the age of 85 with a substantial proportion of them experiencing persistent pain, loss of function and decline in health-related quality of life. Our work was aimed at updating the latest data on this field. We searched the following terms on PubMed: ‘injection therapy’, ‘osteoarthritis’ and ‘hip’. We limited our search to the period from 1-1-2018 until 22-6-2019 and to the English language. We retrieved 31 works. We decided to divide the works into three groups: hyaluronic acid in hip OA, other therapies in hip OA and emerging radiological techniques to measure the efficacy of injection therapy. So far, in the literature there is no solid evidence that supports the efficacy of intra-articular infiltration therapies in hip osteoarthritis. The international guidelines reflect this lack of solid scientific evidence. We believe that only original works that show high-level evidence can highlight the benefits of these therapies.