Acta reumatologica portuguesa最新文献

Introduction: The aim of our study was to assess the efficacy of hypertonic dextrose infiltrations for pain control in individuals with rotator cuff tendinopathy and to assess the characteristics of the treatment and the presence of side effects or adverse reactions through a systematic review and meta-analysis.

Methods: The search for the articles was performed in the electronic databases PUBMED, EMBASE, SCOPUS, SCIELO, DIALNET and Google Scholar, published up to August 2020. The keywords used were "prolotherapy" or "proliferation therapy" or "hypertonic dextrose infiltrations" or "hypertonic dextrose injection" and "Rotator Cuff" or "Rotator Cuff Injury" or "Rotator Cuff Tear" or "Rotator Cuff Tendinosis" or "supraspinatus". The effectiveness of hypertonic dextrose infiltrations was expressed as standardized mean difference (d) and 95% CI.

Results: In the pooled analysis, hypertonic dextrose infiltrations were an effective intervention to reduce long-term pain in patients with rotator cuff tendinopathy when compared to controls; furthermore, in the individual analyses, hypertonic dextrose infiltrations were more effective in the short, medium and long terms than non-invasive treatments, and more effective in the long-term than infiltrations with local anesthetics. On the other hand, hypertonic dextrose infiltrations were not more effective than injections with corticosteroids or PRP. Finally, no complications or serious adverse effect were observed when hypertonic dextrose infiltrations were used.

Conclusions: We found that hypertonic dextrose infiltrations reduced pain in individuals with rotator cuff in the long-term. Hypertonic dextrose infiltrations could be an alternative to non-invasive treatments when no favorable results can be achieve. However, due to the small number of studies included in this meta-analysis, new studies are necessary to clarify the efficacy and safety of this intervention.

Infective endocarditis has a wide range of clinical manifestations, making the diagnosis complex. Musculoskeletal symptoms whose prevalence is not negligible are often underestimated. This clinical case is about a 44-year-old female patient with previous aortic and mitral valvuloplasty for rheumatic fever valve disease referred to the outpatient Rheumatology department for the migratory onset of pain and swelling of the left lateral malleolus, right wrist, right first finger and left fifth distal phalanx associated with painful punctate lesions of the digital pulps and lateral edge of the feet and migratory and painful erythematous papules lasting for three months. The susceptibility for IE combined with the finding of spleen infarcts, Osler's nodes and a microorganism from HACEK group on blood cultures supported the diagnosis of subacute infectious endocarditis. Other diagnoses were ruled out. The patient was treated with intravenous antibiotic therapy with complete resolution. This case aims to illustrate the difficulty in diagnosing subacute infective endocarditis, the importance of multidisciplinary work and to briefly review the musculoskeletal manifestations of infective endocarditis described in the literature.

Hypertrophic pachymeningitis (HP) is a rare clinical entity which uncommonly occurs in rheumatoid arthritis (RA) patients. We describe the case of a rheumatoid factor and anti-citrullinated protein antibody positive RA male that was diagnosed with HP and multiple mononeuropathy. Although histological evaluation was not performed, after excluding infectious and neoplastic causes, it was possible to determine a probable inflammatory etiology. He was treated with glucocorticoids and rituximab with a good clinical evolution. This case represented a challenging differential diagnosis but the need for an accurate diagnosis should not delay the introduction of an effective therapy for a potentially lethal disease.

Vasculitides have been classically considered to be mostly of autoimmune origin, but the role of the innate immune system is being increasingly recognized among primary systemic vasculitides. For example, Behçet's syndrome (BS) shares more common features with autoinflammatory disorders (AIDs) than autoimmune diseases (ADs) and has recently been considered to be a polygenic AID by several authors, while others have classified it as a "mixed-pattern" disorder. This review aims to make a balance between autoinflammatory and autoimmune features of primary systemic vasculitides, including sex prevalence, association and/or familial aggregation with others AIDs or ADs, with human leukocyte antigen (HLA) system and/or disease-specific autoantibodies, type of cellular infiltration (neutrophilic or lymphocytic), clinical pattern (episodic or progressive), size of involved joints when articular involvement occurs, presence of lymphadenopathy or hypergammaglobulinemia, and therapeutic benefit of colchicine, IL-1 inhibitors and rituximab. Except for Henöch-Schonlein purpura, autoimmunity is usually predominant in small vessel vasculitides, where disease-specific autoantibodies are common. On the other hand, medium vessel and even variable vessel vasculitides such as BS often course with autoinflammatory features (e.g. increased levels of IL-1, neutrophilic infiltration) are often more obvious than those typical of autoimmunity. Therefore, it is possible that disorders like polyarteritis nodosa or Kawasaki disease may be considered as "mixed-pattern" diseases in the future. Finally, both the innate and adaptive immune systems can have significant roles in large vessel vasculitis.

COVID-19 pandemic significantly increased the already large number of victims of osteoporosis in Portugal. Osteoporosis outpatient clinics were either closed or had limited presential appointments. Many hospitals reduced orthopaedic services to make space for patients with COVID-19. In addition, the volunteer or forced sedentarism, as imposed by the pandemic, increased the risk of falls and fractures drastically. It urges to intensify the current efforts to improve the management of bone health and to prioritize fragility fracture care and prevention. This paper addresses the challenges in osteoporosis management during the COVID-19 pandemic and provides guidance on osteoporosis management. This position paper is a joint initiative of several health professionals and patients dedicated to osteoporosis.

Objectives: There is comparatively scarce data on bone health in prediabetes (PD). This study aimed to evaluate osteoporosis, fracture risk, and to determine related factors in adults with PD comparing them with healthy participants.

Materials and methods: A controlled, observational, cross-sectional study was conducted. All post-menopausal women and men aged over 65 years were recruited from a tertiary care hospital. A total of 120 participants (90 prediabetic, 30 control group) were enrolled in the study. All participants were screened for clinical status, Dual-Energy X-ray Absorptiometry(DEXA) was used to assess for osteoporotic fracture risk factors, and then the Fracture Risk Assessment Tool (FRAX) was calculated.

Results: Age, gender, body mass index (BMI), presence of obesity and insulin resistance, and risk factors for osteoporotic fracture were similar between groups. Frequency of osteoporosis was higher in the PD group (p=0.045). Bone mineral density (BMD) and T scores of the lumbar and femoral neck regions were lower in the PD group (p=0.042, p=0.039, p=0.039, and p=0.042, respectively). Although there were statistically significant differences in BMD and T scores, 10-year probability of hip fracture and major osteoporotic fracture were similar in both groups. In the femoral neck region, BMD and T scores were weakly and negatively correlated with age. FRAX-major was correlated positively and weakly with age and FRAX-hip was positively and weakly correlated with age and negatively weakly correlated with BMI.

Conclusions: Almost one quarter of the post-menopausal prediabetic women had osteoporosis and osteoporosis was more common in the prediabetics than in the normoglycemic control group participants. While evaluating prediabetics, it is important to assess bone mineral density.