Gout, a prevalent inflammatory arthropathy, predominantly affects males and arises from persistent hyperuricemia, resulting in monosodium urate crystal deposition. Hyperuricemia is associated with comorbidities, exacerbating patient morbidity. Conflicting literature exists regarding uric acid's impact on bone mineral density (BMD), with potential proinflammatory effects in gout patients. Localized bone destruction (erosions) is a hallmark of gout, necessitating early detection due to its predictive role in musculoskeletal disability.
This cross-sectional study included 26 tophaceous gout patients. Clinical and densitometric parameters were assessed, and high-resolution peripheral quantitative computed tomography (HR-pQCT) was used for bone microarchitecture evaluation, as well as bone erosions in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. A healthy control group of 52 age and BMI-matched individuals was included.
Despite normal areal bone mineral density (BMD), tophaceous gout patients exhibited impaired HR-pQCT parameters, including lower cortical volumetric BMD (Ct.vBMD) and higher cortical porosity at the distal radius. Similar trends were observed at the tibia. Bone erosions were prevalent (96%), with distribution across MCP and PIP joints. Patients with ≥ 4 erosions displayed increased tophi prevalence and longer uricosuric use. Erosions correlated with compromised microarchitecture, emphasizing their association with disease activity.
Despite normal BMD, tophaceous gout patients manifest systemic bone loss, with bone microarchitectural deterioration and localized bone erosions, underscoring the need for detailed clinical approaches to prevent musculoskeletal disabilities, including fragility fractures, in this population.
Type 2 lepromatous reaction is a severe complication triggered by proinflammatory cytokines, it affects patients with lepromatous leprosy and border lepromatous leprosy. This reaction can occur before, during, or after treatment.
We report a case of acute polyarthritis as type 2 lepromatous reaction debut. A 30-year-old male with a history of Hansen's disease 5 years ago received a complete therapeutic regimen with cure criteria. Consulted due to a 3-day history of arthralgia predominantly affecting the hands, knees, and feet. On the fifth day of hospitalization, the patient developed intensely painful, nodular erythematous lesions. The pathological history, clinical presentation, and the presence of polymorphonuclear cells led to the diagnosis of type 2 lepromatous reaction.
Identifying individuals with risk factors or a history of leprosy, along with a high index of suspicion, positively impacts the early identification of leprosy reactions as an imitator of other causes of acute or chronic symmetrical polyarthritis.
Ocrelizumab is a humanized monoclonal antibody, which acts as an anti-CD20 antibody. It is used as a treatment of both relapsing-remitting multiple sclerosis (RRMS) and Progressive types. The aim of this study is to report the first patient with alopecia universalis after switching from rituximab to ocrelizumab. A 37-year-old woman with a history of SPMS, diagnosed 8 years ago, used to be treated with rituximab. Her drug was switched to ocrelizumab from 6 months ago. She presented with patchy scalp hair loss a day after receiving the second dose of ocrelizumab. Her hair loss rapidly progressed in 3-4 days to total body hair loss in a patchy pattern. Ocrelizumab may be responsible for autoimmune reactions such as alopecia universalis in immunocompromised patients.
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