Some commonly unrecognized manifestations of metabolic arthropathies

The metabolic arthropathies are characterized by the deposition of abnormal substances in or around joints. Certain features of some of these arthropathies and their significance have only recently been recognized and others have been insufficiently emphasized. An important group of conditions are the arthropathies related to renal failure and its treatment, namely, aluminum toxicity, periarticular calcification and crystal deposition, hyperparathyroidism, and dialysis-related amyloidosis. Crystal deposition diseases, specifically, gouty arthritis, calcium pyrophosphate deposition, and calcium hydroxyapatite deposition, are also reviewed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30253/1/0000648.pd

La radiografia digitale in Reumatologia.

Il testo è dedicato alla descrizione dei quadri radiologici osservabili in corso delle diverse malattie reumatiche. Vengono esaminate tutte le malattie e riportati i quadri morfologici caratteristici. Una particolare attenzione è dedicata agli aspetti diagnostico differenziali. Le implicazioni, i vantaggi e la versatilità della nuova tecnologia digitale vengono illustrate nel dettaglio

MALATTIE DELL’OSSO

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NEOPLASIE E SINDROMI PANAREOPLASTICHE

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Physico chemical aspects upon the dissolution behaviour of different forms of carbamazepine

ACTA TECHNOL. LEGIS MED

CASE-REPORT 375 - DIAGNOSIS - MULTICENTRIC RETICULOHISTIOCYTOSIS

A case of MR in a 18-years old girl is presented with dramatic demonstration of the progressive lesions of the hands demonstrated by xerography

REUMATISMI EXTRA-ARTICOLARI

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Utilità della RMN nella valutazione dell’artrite reumatoide iniziale

La Risonanza Magnetica consente la visualizzazione precoce delle lesioni erosive in epoca pre-radiologica in corso di artrite reumatoide in fase early

Sternocostoclavicular hyperostosis and the impact of diagnostic delay: comment on the article by Van der Kloot et al.

We read with great interest the article by van der Kloot et al, recently published in Arthritis Care & Research, regarding the diagnostic delay in sternocostoclavicular hyperostosis (SCCH) (1). We fully agree with van der Kloot et al, both on the detrimental consequences of a delayed diagnosis of SCCH on various aspects of the quality of life, and on the need for greater awareness of the anterior chest wall (ACW) pain syndromes by the general practitioners. In 1987, Kahn suggested the acronym SAPHO (which stands for synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome) in order to unify various conditions characterized mainly by osteitis/hyperostotic lesions of the ACW (2). Therefore, SAPHO syndrome can be considered a “useful concept” that unifies several disorders sharing some clinical, radiologic, and pathologic characteristics, especially osteitis/hyperostotic lesions of the ACW. This means that the understanding of SAPHO syndrome is also very important in musculoskeletal radiology, since such awareness could facilitate the differentiation from other entities that produce similar radiographic findings but have different prognoses and treatments, such as osteomyelitis, Ewing’s sarcoma, metastasis, and Paget’s disease of bone (3). Our work, previously published in Arthritis Care & Research, indicated that SCCH represents the first osteoarticular symptom in 70% of patients with SAPHO syndrome followed in our tertiary referral rheumatology unit (4). In our experience, the diagnostic delay led to the execution of inappropriate investigations and the prescription of inadequate treatment. In addition, we reported that 19 patients had a history of several admissions to the emergency room for a suspected acute cardiac event. The median ages, both at the time of the first osteoarticular symptom of the disease and at the time of the diagnosis, are shown in Table 1. It is also worth recalling that skin lesions may not be accounted for when they are either episodic or appear after bone lesions. We would like to point out that SCCH is the typical target of SAPHO syndrome, representing the mainstay of the diagnosis, but it is not pathognomonic of the disease. A similar involvement may also be seen in spondylarthropathies, especially in psoriatic arthritis (PsA). In PsA, however, SCCH is more frequently a late complication of the disease and does not usually involve the medial end of the claviculae. We think osteitis/hyperostosis of this difficult anatomic site should be regarded as a distinguishing feature of SAPHO syndrome. In conclusion, we agree that diagnostic delays are relevant, but they could be due to the fact that the first referral of these patients is usually not to a rheumatologist. Therefore we firmly hope, as already suggested (4), that other specialists such as dermatologists, emergency room doctors, and general practitioners have greater confidence in recognizing this condition

Transient regional osteoporosis.

Transient osteoporosis of the hip and regional migratory osteoporosis are uncommon and probably underdiagnosed bone diseases characterized by pain and functional limitation mainly affecting weight-bearing joints of the lower limbs. These conditions are usually self-limiting and symptoms tend to abate within a few months without sequelae. Routine laboratory investigations are unremarkable. Middle aged men and women during the last months of pregnancy or in the immediate post-partum period are principally affected. Osteopenia with preservation of articular space and transitory edema of the bone marrow provided by magnetic resonance imaging are common to these two conditions, so they are also known by the term regional transitory osteoporosis. The appearance of bone marrow edema is not specific to regional transitory osteoporosis but can be observed in several diseases, i.e. trauma, reflex sympathetic dystrophy, avascular osteonecrosis, infections, tumors from which it must be differentiated. The etiology of this condition is unknown. Pathogenesis is still debated in particular the relationship with reflex sympathetic dystrophy, with which regional transitory osteoporosis is often identified. The purpose of the present review is to remark on the relationship between transient osteoporosis of the hip and regional migratory osteoporosis with particular attention to the bone marrow edema pattern and relative differential diagnosi