Arthritis in acute febrile neutrophilic dermatosis (Sweet's Syndrome)

Sir: Acute febrile neutrophilic dermatosis or Sweet's syndrome' is an uncommon condition characterised by fever, polymorphonuclear leucocytosis, painful erythematous cutaneous plaques, and a dense dermal infiltrate of neutrophils without vasculitis at the site of the skin lesions. Although many investigators suggest that acute febrile neutrophilic dermatosis is a hypersensitivity reaction,2 no defmitive cause is known. The role of the neutrophil as a cause or effect in this syndrome has not been clarified. Acute febrile neutrophilic dermatosis is histologically and clinically mimicked by several disorders, and the differential diagnosis with pyoderma gangrenosum3 and with some reactive erythemas such as erythema multiforme2 is usually difficult

Tratamiento de las coxitis reumáticas con prótesis total cementada

Se estudia una serie de 82 prótesis totales de cadera cementadas tipo Muller implantadas en enfermos afectos de coxitis reumáticas, fundamentalmente artritis reumatoide. Los casos tienen un seguimiento medio de cuatro años y una edad media de cincuenta y un años; la mitad de ellos tenían afectados entre siete y 10 articulaciones y en la cadera el 28 por 100 presentaban protrusión acetabular. En el postoperatorio consta un 2,5 por 100 de complicación séptica y 2,5 por 100 de tromboembolismos. El análisis clínico de los resultados se basa en el dolor, la movilidad y la marcha según el baremo de Merle d'Aubigne y en la capacidad funcional segiin los criterios de STEINBROCKER. En grupo aparte se ha estudiado el resultado en los casos con un seguimiento mínimo de cinco años, en los que tenían dolor importante y en los que presentaban protrusión. En conjunto obtienen resultado muy bueno el 52,5 por 100 y bueno o aceptable el 30 por 100. El aflojamiento aumenta con el paso del tiempo y es del 18 por 100 en la serie global, pero alcanza al 30 por 100 en los casos con seguimiento de cinco años o más y las profusiones. El resultado funcional depende de las varias intervenciones practicadas en las extremidades y con el programa quirúrgico complejo conseguimos que algo más de la mitad de los enfermos recuperen una autonomía para la vida diaria fuera de su casa

Evaluation of circulating type I procollagen propeptides in patients with Paget's disease of bone

We evaluated circulating aminoterminal and carboxyterminal propeptides of type I procollagen and total alkaline phosphatase levels in eighty consecutive patients affected by Paget's disease of bone. We compared the biochemical data with the extent of bone disease calculated on the basis of the bone scintigraphic indices. Serum aminoterminal propeptide of type I procollagen levels were high in 77% of patients, serum carboxyterminal propeptide of type I procollagen levels in 22% and serum total alkaline phosphatase levels in 76%. We found significant correlations between the three markers studied. The three biochemical markers correlated significantly with the bone scintigraphic activity indices, but the highest correlation coefficient was between the aminoterminal propeptide and total alkaline phosphatase. We conclude that there is a discrepancy between serum levels of the propeptides studied in relation to Paget's disease of bone. The sensitivity of the carboxyterminal propeptide of type I procollagen in this disease is low. In contrast the aminoterminal propeptide may be as sensitive a marker for the evaluation of this disorder as total alkaline phosphatase, and in addition may be more specific

Tratamiento de las coxitis reumáticas con prótesis total cementada

Se estudia una serie de 82 prótesis totales de cadera cementadas tipo Muller implantadas en enfermos afectos de coxitis reumáticas, fundamentalmente artritis reumatoide. Los casos tienen un seguimiento medio de cuatro años y una edad media de cincuenta y un años; la mitad de ellos tenían afectados entre siete y 10 articulaciones y en la cadera el 28 por 100 presentaban protrusión acetabular. En el postoperatorio consta un 2,5 por 100 de complicación séptica y 2,5 por 100 de tromboembolismos. El análisis clínico de los resultados se basa en el dolor, la movilidad y la marcha según el baremo de Merle d'Aubigne y en la capacidad funcional segiin los criterios de STEINBROCKER. En grupo aparte se ha estudiado el resultado en los casos con un seguimiento mínimo de cinco años, en los que tenían dolor importante y en los que presentaban protrusión. En conjunto obtienen resultado muy bueno el 52,5 por 100 y bueno o aceptable el 30 por 100. El aflojamiento aumenta con el paso del tiempo y es del 18 por 100 en la serie global, pero alcanza al 30 por 100 en los casos con seguimiento de cinco años o más y las profusiones. El resultado funcional depende de las varias intervenciones practicadas en las extremidades y con el programa quirúrgico complejo conseguimos que algo más de la mitad de los enfermos recuperen una autonomía para la vida diaria fuera de su casa

Computed digital absorptiometry of the hand: screening method of bone loss in postmenopausal women with RA.

Dual energy x ray absorptiometry (DXA) is the most commonly used method of measuring bone mineral density (BMD); it has been shown to be a good predictor of the future risk of fracture.1Unfortunately, the generalised use of DXA is limited as it is expensive and time consuming, is not portable, and is available only in specialised clinics.#N##N#Computed digital absorptiometry (CDA) of the hand is a new bone densitometry technique, designed to assess the BMD of the middle phalanx of the third finger using a direct, automated measurement of x ray attenuation.2This technique is similar to radiographic absorptiometry but provides immediate results; in current radiographic absorptiometry, radiographs are sent to an off site processing centre and the results are received a few days later. CDA is cheap and quick. Its precision and accuracy seem to be acceptable, but its ability to discriminate between patients with osteoporosis and normal subjects, to predict risk of

Sequential study of bone mineral density in patients with systemic lupus erythematosus.

A loss of bone mineral density has been reported1`S in premenopausal women with systemic lupus erythematosus (SLE), but its pathogenesis is uncertain.4 Studies on the sequential changes in bone mass in these patients are scarce..

Trauma and seronegative spondiloarthropathy: rapid joint destruction triggered by physical injury in HLA-B27

Sir: Several cases ofHLA-B27 positive patients whodevelopedperipheralarthritisimmediately after injury have been reported in the last few year

Munchausen's syndrome simulating reflex sympathetic dystrophy

A 15 year old girl who had pain, oedema of her left hand, and fever of four months' duration is described. Marked demineralisation of her hand was shown by radiography, and increased articular uptake by technetium-99m bone scan. All these changes were indistinguishable from reflex sympathetic dystrophy. After two admissions to hospital and multiple explorations we discovered that she had induced her symptoms herself and a diagnosis of Munchausen's syndrome was made. As far as we know this presentation has not been previously reported and might help to explain the physiopathology of some signs of reflex sympathetic dystrophy

Arthritis in acute febrile neutrophilic dermatosis (Sweet's Syndrome)

Sir: Acute febrile neutrophilic dermatosis or Sweet's syndrome' is an uncommon condition characterised by fever, polymorphonuclear leucocytosis, painful erythematous cutaneous plaques, and a dense dermal infiltrate of neutrophils without vasculitis at the site of the skin lesions. Although many investigators suggest that acute febrile neutrophilic dermatosis is a hypersensitivity reaction,2 no defmitive cause is known. The role of the neutrophil as a cause or effect in this syndrome has not been clarified. Acute febrile neutrophilic dermatosis is histologically and clinically mimicked by several disorders, and the differential diagnosis with pyoderma gangrenosum3 and with some reactive erythemas such as erythema multiforme2 is usually difficult

Microalbuminuria is associated with limited joint mobility in type I diabetes mellitus.

OBJECTIVE--To determine whether limited joint mobility (LJM) is associated with microalbuminuria in type I diabetes mellitus. METHODS--Joint mobility was measured in a control group of 63 healthy subjects and in 63 type I diabetic patients, older than 18 years (mean 31.7 years, range 18-57), recruited from the outpatient clinic of the Endocrine Unit. Patients with established diabetic nephropathy (proteinuria or increased creatinine) were excluded. Joint mobility was assessed qualitatively with the prayer manoeuvre and quantitatively by measuring the angles of maximal flexion and extension of the fifth and third metacarpophalangeal (MCP) joints and wrist. Diabetic retinopathy was assessed by direct ophthalmoscopy. Urinary albumin excretion (UAE) was determined in at least two 24 hour urine samples. RESULTS--Joint mobility was limited in diabetic patients compared with control subjects. Diabetic patients with LJM had longer duration of diabetes (12.1 (SD 6.4) years compared with 6.9 (5.7) years; p < 0.001). Joint mobility was limited in patients with retinopathy: prayer manoeuvre was positive in 96.4% of patients with retinopathy, but in only 40.0% of patients with no retinopathy (p < 0.001); mobility of MCP joints and wrist was limited in diabetic patients with retinopathy even when the longer duration of their diabetes was taken into consideration. Microalbuminuria, present in 11 patients (17.5%), was associated with LJM: prayer manoeuvre was positive in 90.9% of patients with microalbuminuria, but in only 57.4% of patients with normal UAE (p < 0.05). Maximal flexion of MCP joints was reduced in patients with microalbuminuria. Microalbuminuria, but not LJM, was associated with risk factors of cardiovascular disease. CONCLUSION--LJM is associated with microalbuminuria and retinopathy in type I diabetes. The association is independent of age and duration of diabetes