Purpose: This study aims to analyze the return to normal activities and sports after surgical management of peroneal tendon dislocation through different surgical techniques. Methods: This review included studies (retrospective case series, prospective cohort study) that analyzed different aspects: return to sport (RTS), American Orthopedic Foot and Ankle Society Score (AOFAS), Visual Analogue Scale (VAS), satisfaction, and redislocation episodes after surgical treatment. We performed a systematic review, analyzing 1699 articles. We researched our selected studies through PubMed, Scopus, and Cochrane. The last search was performed in December 2022. We used the MINORS score to perform a quality assessment of pooled data. In total, 20 studies were included. Results: The postoperative AOFAS score, VAS scale, and high satisfaction percentages all improve with surgical therapy. At long-term follow-up, the redislocation following surgical treatment is minimal. Compared to patients who only receive superior peroneal retinaculum (SPR) repair and other surgical procedures, patients with groove deepening and SPR repair have greater rates of returning to sports (bony and rerouting procedures). Conclusions: Peroneal tendon dislocation surgery offers good outcomes, a quick return to sport, and high patient satisfaction. Those who received both groove deepening and SPR repair as opposed to other surgical procedures have greater rates of returning to sports.

CASE: A 23-years-old man born in Rio de Janeiro with established ileocolonic Crohn’s disease (CD), eight years after the onset of symptoms. He started combination therapy (azathioprine and infliximab) after negative TB screening (negative PPD, normal chest x-ray). After six months, he was in clinical remission and presented with fever and headache lasting for one week. BMI was 16 kg/cm2. Laboratory findings showed an elevated ESR (90 mm/hr) and CRP level (23 mg/L), but white blood cells count was normal. Both drugs were discontinued and the patient was admitted. Cranial computed tomography (CT) was unremarkable. CT of the chest showed pleural thickening, fibro-atelectatic bands, and bronchiectasis in the upper left lobe, with calcified nodules, suggesting TB sequelae. CT of the abdomen showed splenomegaly and multiple small hypodense nodules. Abdominal MRI revealed that the lesions were isointense in T1, slightly hyperintense in T2, with a restricted-diffusion pattern, compatible with splenic abscesses. Echocardiogram was normal. HIV, EBV, CMV, HSV serology and serum latex-cryptococcus antigen test were negative. Hemoculture and urine cultures were negative. Sputum bacilloscopy and culture were also negative. Bronchoscopy with bronchoalveolar lavage fluid (BALF) showed culture and direct microscopic examination positives for cryptococcal infection. Due to the findings of splenic lesions, there was strong evidence of cryptococcal dissemination, and a lumbar puncture was performed. CSF analysis was normal, latex-cryptococcus antigen test, microscopic examination and culture were negative, excluding CNS involvement. He was discharged home with fluconazole 400 mg PO QD and his symptoms gradually subsided after 2 weeks. Three months after releasing azathioprine, it was necessary to be reintroduced due to a CD flare. After one month, he presented cough and pleuritic chest pain. Chest CT showed ground-glass opacification, and his symptoms improved with antibiotic therapy. Abdominal CT demonstrated an increase in the number and size of the spleen abscesses. A diagnostic laparoscopy with peritoneal lavage and biopsy was scheduled to investigate the etiology of splenic abscesses. However, as pleuritic chest pain and cough returned before that, he went to the emergency room where a new chest CT showed typical signs of pulmonary TB. Sputum culture confirmed the diagnosis. Hence, the abdominal findings were attributed to disseminated TB. He was discharged home with rifampin, isoniazid, pyrazinamide, and ethambutol, and will be followed up until clinical and radiologic response. This case illustrates two concomitant opportunistic infections associated with CD treatment with a clinical and radiological worsening related to an Immune Reconstitution Inflammatory Syndrome after azathioprine and infliximab withdrawal. Clinical reasoning was essential for definitive diagnosis. The possibility of two concomitant life-threatening infections with atypical manifestations in IBD patients should always be evaluated, mainly in Latin America.

BackgroundNailfold capillaroscopy (NC) is a useful tool to study Raynaud's phenomenon (RP) and other diseases. Different findings and patterns has been described however there is currently no work that validates the qualitative and quantitative NC findings.ObjectivesTo describe the morphological and metrological findings of NC in patients with RP and autoimmune diseases.2-Describe the morphological and metrological findings of CP in patients with RF and several systemic autoimmune diseases.To Describe the morphological and metrological findings of NC in patients with RP and other autoimmune diseases.MethodsObservational study performed in 10 hospitals by rheumatologists with experience in NC. Patients with diffuse systemic sclerosis (dSSc), limited systemic sclerosis (lSSc), dermatomyositis (DM), polimyositis (PM), systemic lupus erythematosus (SLE) Primary Sjögren's syndrome (PSS), rheumatoid arthritis (RA), primary RP and a control group without RP or rheumatological condition were collected.A video NC 200x magnification were made in all patients. 8 Fingers in each hand were analyzed to find: megacapillary and dilated capillaries, giant capillaries, loss of density (<7/mm), tortuous capillaries, ramifications, haemorrhages, thrombosis and destructuration. Also we analyzed the diameter of the afferent and efferent loop, the capillary apex, the capillary diameter and density/mm. The following variables were also collected: sex, age, years of evolution of the disease and RP, history of digital ulcers or medication for RP, smoking and presence of hypertension or diabetes. To compare qualitative variables, the test was used Chi-square or Fisher's test. To compare quantitative vs qualitative variables Student's T test was used. Significance was considered for those values with p<0.05.ResultsBetween May 2014 to December 2016 images of 406 patients were collected: 24 dSSc, 41 lSSc, 19 DM, 14 PM, 40 SLE, 39 PSS, 37 RA, 44 PRP and 145 controls. C 84.5% were women, the age of the sample were 51.32±15.21 years. 28.9% had a history of smoking and 21.1% and 5.5% of hypertension or diabetes, respectively. Excluding the cases of dSSc, lSSc, PRP and the 145 controls, the presence of RP was observed in 18/152 (11.84%). The afferent, efferent, apical diameter And capillary was 26.01±19.01; 31.93±24.51um; 37.95±36.67um and 82.68±58.10um respectively. The most frequent qualitative finding were tortuosities. The control group showed no difference in the presence of hypertension or diabetes except in patients with PM. We also observed more women in SLE and PSS patients vs control group and greater presence of digital ulcers in lSSc, dSSc, SLE and DM. Only the lSSc presented differences in the presence of tortuosities with respect to the control group.ConclusionsExcept in the lSSc no differences were observed in the presence of tortuosities with the rest of groups and its presence may not be relevant in different diseases.Disclosure of InterestNone declared

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BackgroundComposite scores developed in Rheumatoid arthritis (RA) not include all dimensions of disease activity. An index based on essential clinical plus a ultrasound (US) measures, focused on simplicity, with appropriate validation, would allow a better classification at different levels of disease activity than a clinical only or US only index.ObjectivesTo develop and validate a mixed clinical-US inflammation score in RA for use in clinical practice.MethodsMixed methods. Experts elicited items reflecting inflammation which were prioritised by Delphi. Patients with RA with various grades of activity underwent clinical [28 swollen and tender joints counts, patient and physician global assessment (PhGA), erythrocyte sedimentation rate, and C-reactive protein (CRP)] and US assessments [synovitis or tenosynovitis by grey-scale (GS) and Power Doppler (PD) of 42 structures], blinded to the clinical assessment. An index was created after supported selection of US structures and scoring method. Construct validity was tested by correlation with DAS28, SDAI, CDAI, and PhGA. Reliability was evaluated in a subgroup of patients with the intraclass correlation coefficient (ICC).ResultsUS of joints and tendons, CRP, and swollen joints were the items that passed the prioritisation phase. Then, 281 patients were randomly divided into design (n=141) and validation analysis (n=140). The combination of US sites chosen detected the maximum proportion of GS and PD present. Were elected wrist, 2–3 MCP, Knee, tibio-talar and 2–3 MTP joints, and the following tendons: carpal extensor and flexor tendons, tibial posterior and peroneal. For scoring structures, three methods were tested: semiquantitative (0–3 GS +0–3 PD), dichotomous (0/1 GS +0/1 PD), and qualitative (0/1 based on algorithm [image 1]). All showed strong correlation with activity measures (rho ≥0.60), and reliability (ICC 0.89 to 0.93). The most feasible index, qualitative, was chosen.The proposed formula for USAS was: USAS=N° swollen joints+US score+CRP Abstract AB1195 – Figure 1ConclusionsUSAS is a valid and reliable measure of inflammation in RA equal to the sum of 28 swollen joint count, a simplified (0/1) US assessment of 11 structures and CRP.Disclosure of InterestNone declared