Bone Mineral Density in Patients with Ankylosing Spondylitis: Incidence and Correlation with Demographic and Clinical Variables

Objective: To evaluate bone mineral density (BMD) in patients with ankylosing spondylitis (AS) and determine its correlation with the demographic and clinical characteristics of AS. Patients and Methods: Demographic, clinical and osteodensitometric data were evaluated in a cross-sectional study that included 136 patients with AS. Spine and hip BMD were measured by means of dual energy X-ray absorptiometry (DXA). Using the modified Schober’s test we assessed spine mobility. We examined the sacroiliac, anteroposterior and lateral dorso-lumbar spine radiographs in order to grade sacroiliitis and assess syndesmophytes. Disease activity was evaluated using C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR). Demographic data and BMD measurements were compared with those of 167 age- and sex-matched healthy controls. Results: Patients with AS had a significantly lower BMD at the spine, femoral neck, trochanter and total hip as compared to age-matched controls (all p<0.01). According to the WHO classification, osteoporosis was present in 20.6% of the AS patients at the lumbar spine and in 14.6% at the femoral neck. There were no significant differences in BMD when comparing men and women with AS, except for trochanter BMD that was lower in female patients. No correlations were found between disease activity markers (ESR, CRP) and BMD. Femoral neck BMD was correlated with disease duration, Schober’s test and sacroiliitis grade. Conclusion: Patients with AS have a lower spine and hip BMD as compared to age- and sex-matched controls. Bone loss at the femoral neck is associated with disease duration and more severe AS

A rare case of primary tuberculous pyomyositis

Abstract Tuberculosis involving the soft tissue as extending from adjacent bone or joint is well recognized. However, the primary tuberculous pyomyositis is rare. Due to atypical presentation the diagnosis is often delayed. We report one case of primary tuberculous pyomyositis of the thigh in an immunocompromised patient. Tuberculous myositis should be suspicioned, in immunocompromised patients with unexplained soft tissue swelling, especially in endemic area. Keywords: tuberculosis, pyomyositis, corticosteroids, diabetes mellitus Rezumat Afectarea, prin contiguitate, a ţesuturilor moi în contextul unei infecţii tuberculoase osoase şi/sau articulare respectiv a unui abces rece de vecinătate, reprezintă o entitate clinică bine definită. Cu toate acestea (pio)miozita tuberculoasă primară este foarte rar întâlnită în practica clinică curentă. Manifestările clinice şi localizările atipice contribuie semnificativ la întârzierea diagnosticului. Prezentăm cazul unei paciente imunosupresate cu (pio)miozită tuberculoasă primară a coapsei drepte. Pentru stabilirea unui diagnostic de (pio)miozită tuberculoasă este nevoie de un înalt grad de suspinciune clinică în faţa oricărei tumefieri inexplicabile de ţesuturi moi, în mod particular în cazul pacienţilor imunosupresaţi din zonele endemice

Frail Silk: Is the Hughes-Stovin Syndrome a Behçet Syndrome Subtype with Aneurysm-Involved Gene Variants?

Hughes-Stovin syndrome is a rare disease characterized by thrombophlebitis and multiple pulmonary and/or bronchial aneurysms. The etiology and pathogenesis of HSS are incompletely known. The current consensus is that vasculitis underlies the pathogenic process, and pulmonary thrombosis follows arterial wall inflammation. As such, Hughes-Stovin syndrome may belong to the vascular cluster with lung involvement of Behçet syndrome, although oral aphtae, arthritis, and uveitis are rarely found. Behçet syndrome is a multifactorial polygenic disease with genetic, epigenetic, environmental, and mostly immunological contributors. The different Behçet syndrome phenotypes are presumably based upon different genetic determinants involving more than one pathogenic pathway. Hughes-Stovin syndrome may have common pathways with fibromuscular dysplasias and other diseases evolving with vascular aneurysms. We describe a Hughes-Stovin syndrome case fulfilling the Behçet syndrome criteria. A MYLK variant of unknown significance was detected, along with other heterozygous mutations in genes that may impact angiogenesis pathways. We discuss the possible involvement of these genetic findings, as well as other potential common determinants of Behçet/Hughes-Stovin syndrome and aneurysms in vascular Behçet syndrome. Recent advances in diagnostic techniques, including genetic testing, could help diagnose a specific Behçet syndrome subtype and other associated conditions to personalize the disease management

Bone status and aortic calcifications in chondrocalcinosis patients

Aim: We aimed to examine the association between several circulating bone turnover markers [ osteocalcin (OC), osteoprotegerin (OPG), beta-CrossLaps (β-CTx)], hip and spine bone mineral density (BMD) and abdominal aortic calcification (AAC) in patients with chondrocalcinosis (CC)

SYNOVIAL AND SERUM LEVELS OF OSTEOCALCIN, OSTEOPROTEGERIN AND Β-CROSSLAPS IN PATIENTS WITH CALCIUM PYROPHOSPHATE DEPOSITION DISEASE

Background. Calcium pyrophosphate deposition disease is defined by deposition of calcium pyrophosphate crystals in hyaline cartilage, fibrocartilage and soft tissues. The study of bone markers is of great interest in different types of arthritis. In patients with calcium pyrophosphate deposition disease, bone turnover markers may yield additional information from many perspectives. Objectives. To measure synovial and serum levels of osteocalcin, osteoprotegerin and β-CrossLaps in patients with calcium pyrophosphate deposition disease. Material and methods. In this pilot, prospective study were enrolled eight patients with calcium pyrophosphate deposition disease. Osteocalcin, osteoprotegerin and β-CrossLaps were measured in serum and in the synovial fluid using ELISA kits. Results. Synovial fluid osteocalcin was significantly lower comparative with serum osteocalcin (2.1±0.6 versus 9.21 ±46, p=0.02). Synovial fluid osteoprotegerin was significantly higher than serum osteoprotegerin (55.5±284 versus 8.44±7; p=0.0001). Synovial fluid β-CrossLaps wasn’t statistically different from serum levels (6146±66818 versus 6077±12212; p=0.5). Ratios between synovial fluid and serum levels were 0.22 for osteocalcin, 6.57 for osteoprotegerin and 1.01 for β-CrossLaps. Conclusions. Osteocalcin was higher in serum than in the synovial fluid. β-CrossLaps had similar values in serum and synovial fluid. Osteoprotegerin was higher in synovial fluid than serum

Relation between intima-media thickness and bone mineral density in postmenopausal women: a cross-sectional study

CONTEXT AND OBJECTIVES: Controversy exists regarding the relationship between atherosclerosis and osteoporosis. The aim of this study was to determine the relationship between intima-media thickness (IMT) of the common carotid artery (CCA), presence of calcified atherosclerotic plaques and bone mineral density (BMD) evaluated by dual energy X-ray absorptiometry (DXA), in postmenopausal women. DESIGN AND SETTING: Cross-sectional study at Second Internal Medicine Clinic, Cluj-Napoca, Romania. METHODS: We studied the IMT (left and right CCA and mean IMT) and T-score (lumbar spine L2-L4, femoral neck and total hip) in 100 postmenopausal women (mean age 64.5 years). The presence of calcified atherosclerotic plaque and osteoporotic vertebral fractures was also noted. RESULTS: IMT in the left and right CCA and mean IMT were significantly associated with T-score measured for the lumbar spine L2-L4, femoral neck and total hip, with lower T-score, in the osteoporotic group than in the normal and osteopenic groups (P < 0.05). IMT had a significantly negative correlation with the lumbar spine T-score and femoral neck T-score; and mean IMT with lowest T-score. Mean IMT (P < 0.001), high blood pressure (P = 0.005) and osteoporotic vertebral fractures (P = 0.048) showed statistical significance regarding the likelihood of developing atherosclerotic plaque. CONCLUSIONS: In women referred for routine osteoporosis screening, the relationship between CCA, atherosclerosis and osteoporosis can be demonstrated using either cortical or trabecular BMD. Vertebral fractures may be considered to be a likelihood factor for atherosclerotic plaque development

CLINICAL AND RADIOGRAPHIC FINDINGS IN PATIENTS WITH CHONDROCALCINOSIS

Background. Calcium pyrophosphate deposition disease results from the deposition of calcium pyrophosphate crystals and needs to fulfil McCarty criteria for diagnosis. Chondrocalcinosis is defined as cartilage and fibrocartilage calcification identified by imaging or histological examination. The presence of calcium-containing crystals in synovial fluid is associated strongly with the degenerative joint disease, but the exact mechanism remains to be elucidated. Objectives. To compare the clinical and radiographic characteristics in patients with and without chondrocalcinosis. Material and methods. One hundred and forty-three patients, 86 with chondrocalcinosis and 57 controls with primary osteoarthritis were consecutively enrolled in this case-control, transversal, prospective study performed in the Rheumatology Department, Emergency Clinical County Hospital Cluj-Napoca, Romania, between January 2015 and January 2018. A subgroup of 39 patients fulfilled McCarty criteria for calcium pyrophosphate deposition (CPPD) disease. Demographic data, clinical data, laboratory data, knee radiographs, knee ultrasound, were recorded in both groups. Kellgren-Lawrence score was graded in all patients at the knee level. Results. The patients with chondrocalcinosis had higher tender joint count (3.1±6.8 versus 1.9±0.1, p<0.05), swollen joint count (1.37±0.9 versus 0.28±0.3, p<0.05), visual analogue scale for pain (7.72±1.28 versus 6.5±3.5, p<0.05). Kellgren-Lawrence score at the knee level was higher in the chondrocalcinosis group (p<0.05) comparing to controls, but not when comparing the CPPD group with the chondrocalcinosis group. Osteoarthritis was associated with chondrocalcinosis when compared to controls and with definite CPPD when comparing to chondrocalcinosis subgroup. Conclusions. Chondrocalcinosis was associated with pain, arthritis and higher Kellgren-Lawrence score than the controls