Cartilage Oligomeric Matrix Protein (COMP) in systemic sclerosis (SSc): role in disease severity and subclinical rheumatoid arthritis overlap

ObjectiveThe aim of the present study was to compare the serum level of COMP in both subsets of Systemic sclerosis (SSc) as a marker of arthritis and reveal an associated subclinical RA overlap and a relation to clinical, laboratory and radiological findings in SSc.MethodsForty adult SSc patients were included in the study and grouped into the two subsets diffuse (dSSc) and limited (lSSc) SSc. Their mean age was 40 ± 9 years. Thorough history taking and clinical examination were performed to all patients. Skin thickness was scored according to the modified Rodnan skin score method (MRSS). The disease activity was assessed by measuring the Medsger severity score. The joints were extensively examined and the tenderness counted according to the Ritchie articular index (RAI). Relevant laboratory and radiological investigations were carried out. The serum COMP level was determined by ELISA.ResultsThe serum COMP was significantly higher in the SSc patients compared to the control and obviously higher in the dSSc compared to the lSSc patients. The level of COMP was higher in the females and significantly higher in the SSc patients with arthritis (56.5 ± 6.8 ug/ml) compared to those without (34 ± 8.3 ug/ml) (P 0.000).ConclusionThe COMP level may become a nonspecific but useful marker for joint involvement in SSc patients to identify patients at risk of joint damage and developing SSc-RA overlap syndrome even with mild arthritis.     

Anti-citrullinated peptides antibodies in systemic sclerosis: Meta-analysis of frequency and meaning

Objectives

Diagnosis of systemic sclerosis (SSc) is partially determined by the presence of specific autoantibodies often associated with specific clinical features. Recent studies report the presence of ACPA in SSc. We aimed to evaluate the prevalence of ACPA in SSc and to assess their influence on clinical presentation of SSc.

Squamous cell carcinoma antigen-IgM (SCCA-IgM) is associated with interstitial lung disease in systemic sclerosis

ObjectiveInterstitial lung disease (ILD) is the major determinant of prognosis in patients with systemic sclerosis (SSc). Squamous Cell Carcinoma Antigen (SCCA1) is a serin protease inhibitor which plays a pivotal role in inflammation and fibrosis. SCCA1 is overexpressed in pulmonary tissue of patients with idiopathic pulmonary fibrosis and can be detectable in serum as circulating immune complex bound to IgM (SCCA-IgM). We aimed to investigate the association between SCCA-IgM and clinical features of patients with SSc.MethodsNinety-seven patients with SSc (ACR/EULAR criteria) were consecutively enrolled in the study. Clinical and serological variables and organ involvement were recorded. Pulmonary involvement was investigated by high-resolution CT (HRCT) and respiratory function tests. SCCA-IgM serum levels were measured by a validated ELISA assay (Hepa-IC, Xeptagen, Venice, Italy). We set the cut-off value for serum levels of SCCA-IgM > 200 AU/ml, calculated as mean + 3 standard deviations in 100 healthy subjects.ResultsForty-one (42.3%) patients were affected with ILD. SCCA-IgM values were significantly higher in patients with ILD than in those without: 218 (80-402) vs. 87.5 (59-150) AU/mL, P = 0.003. Patients with positive SCCA-IgM had more frequently ILD (69.7% vs. 28.1%, P ≤ 0.0001) and a lower total lung capacity (TLC) (P = 0.024) compared with negative ones. No differences were found in any other clinical and serological features. At multivariate analysis, SCCA-IgM was found to be associated with ILD diagnosis (OR 10.6, IC 2.9-38.4, P = 0.001).ConclusionSCCA-IgM is associated with interstitial lung disease in scleroderma patients and might be used in the assessment of SSc-ILD.     

High prevalence of salivary gland ultrasound abnormalities in systemic sclerosis

ObjectiveTo evaluate salivary gland (SG) involvement in patients with systemic sclerosis (SSc) using SG ultrasound (SGUS).MethodsPatients with SSc (n = 62), primary Sjögren's syndrome (pSS) (n = 59), and idiopathic Sicca syndrome (n = 43) were evaluated using the outcome measures in rheumatology clinical trial (OMERACT) definitions of the SGUS scoring system. The hyperechogenic bands using the 0–3 scoring system, intraglandular power Doppler signal (PDS), and SG volumes were also assessed.ResultsThe proportion of patients with OMERACT grades (≥ 2) among the four SGs was significantly higher in SSc (51.6%) and pSS (62.7%) groups than those in the idiopathic Sicca syndrome group (4.7%). Patients with SSc and pSS had significantly higher total fibrosis grades than controls. No difference in fibrosis grades was observed between SSc and pSS groups. The PDS scores of SGs were higher in the SSc group than in the idiopathic Sicca syndrome group. SG volumes did not differ between the groups. SSc patients with SGUS grades ≥ 2 had more anti-centromere antibodies (ACA) (65.6% vs. 30.0%) than individuals with grades 0–1. SSc patients with fibrosis grades ≥ 2 reported more Sicca symptoms than those with grades 0–1. Inhomogeneity and hyperechogenic bands within the SGs were not associated with organ involvement in SSc.ConclusionsMore than half of patients with SSc, specifically with ACA, showed SG involvement. SG fibrosis was more prominent in SSc than in idiopathic Sicca syndrome and was associated with subjective Sicca symptoms. However, hyperechoic bands within the SGs are not features that can differentiate between SSc and pSS.     

Lymphatic mapping after previous breast surgery

BackgroundTo assess the feasibility of lymphatic mapping and determine the lymphatic drainage pathways in patients previously treated with breast conserving therapy (BCT).MethodsWe included patients without current breast cancer that previously received BCT with sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND) for primary breast cancer. The study population consisted of 44 patients and was divided into two groups according to previous surgical treatment of the axilla: 22 patients after previous SNB and 22 patients after previous ALND. Standard lymphatic mapping was performed and the lymphatic drainage pattern was registered. Drainage located outside the ipsilateral axilla was recorded as aberrant.ResultsLymphoscintigraphy revealed a drainage pattern in 17 of 44 patients (39%). The identification rate in the SNB-group was 41% and 36% in the ALND-group (P = 0.760). 8 patients (18%) showed aberrant drainage, which tended to be more frequent in the ALND-group than in the SNB-group (27% versus 9%, P = 0.122). Lymphatic drainage to the contralateral axilla was observed in 2 patients, both previously treated with ALND.ConclusionsLymphatic mapping seems feasible after previous BCT with axillary treatment, in spite of a relatively low identification rate. Aberrant drainage tends to be more frequent after previous treatment with ALND.     

Predictors of the postoperative range of finger motion for comminuted periarticular metacarpal and phalangeal fractures treated with a titanium plate

BackgroundPlate and screw fixation was introduced for complex fractures of the hand. Several risk factors for a poor functional outcome have been identified, but there is a paucity of evidence regarding predictors of finger stiffness in difficult hand fractures. The purpose of this prospective cohort study was to identify independent prognostic factors of the postoperative total active motion (%TAM) in the treatment of metacarpal and phalangeal fractures.MethodsSeventy-two patients (62 males, 10 females; 37 ± 15 years) with periarticular fractures involving metaphyseal comminution and displacement were evaluated at a minimum of 1 year following surgery. There were 49 phalangeal bone fractures, 30 intra-articular fractures and 20 associated soft-tissue injuries. The locations of plate placement were lateral in 42 patients and dorsal in 30. The mean duration from injury to surgery was 7.6 days (range, 0–40 days). There were eight examined variables related to patient characteristics (age, gender and hand dominance), fracture characteristics (fracture location, joint involvement and associated soft-tissue injury) and surgical variables (location of plate placement and duration from injury to surgery). Univariate and multivariate linear regression analysis were used to identify the degree to which variables affect %TAM at the final follow-up.ResultsUnivariate analysis indicated moderate correlations of %TAM with fracture location, associated soft-tissue injury and age. Multiple linear regression modelling including fracture location, age and associated soft-tissue injury resulted in formulae that could account for 46.3% of the variability in %TAM: fracture location (β = ?0.388, p < 0.001), age (β = ?0.339, p < 0.001) and associated soft-tissue injury (β = –0.296, p = 0.002).ConclusionPhalangeal fracture, increasing age and associated soft-tissue injury were important risk factors to identify the postoperative %TAM in the treatment of comminuted periarticular metacarpal or phalangeal fracture with a titanium plate.     

Assessment of hand trabecular bone texture with high resolution direct digital radiograph in rheumatoid arthritis: a case control study

ObjectivesRheumatoid arthritis is characterized by an early inflammatory related periarticular osteopenia. A new high resolution direct digital X-ray device has been recently developed to provide bone texture analysis which is designed to assess changes in trabecular bone architecture. For the first time, we have evaluated trabecular bone texture impairment in rheumatoid arthritis patients compared to healthy controls.MethodsIn this cross-sectional study, the reproducibility was assessed by three separate digital X-rays of the right hand, with repositioning in 14 late rheumatoid arthritis patients and 14 healthy subjects. Then, trabecular bone texture of the MCP2 and MCP3 from patients enrolled in a prospective cohort of 78 rheumatoid arthritis patients was compared with that of 50 healthy subjects, using three texture parameters: Hmean, co-occurrence and run-length.ResultsThe coefficients of variation of the high resolution direct digital X-ray measurements ranged from 0.5 to 1.8%. Only the Hmean parameter was significantly decreased in rheumatoid arthritis patients compared to healthy subjects at MCP2 (0.637 ± 0.040 vs 0.654 ± 0.032, P < 0.05) and at MCP3 (0.646 ± 0.044 vs 0.665 ± 0.037, P < 0.05). This reduction was significantly correlated to disease activity.ConclusionsThis study demonstrated both the good reproducibility of the high resolution digital X-ray measurements and the trabecular bone texture impairment at MCP joints in rheumatoid arthritis patients. In addition to provide a high resolution hand radiograph, this technique may represent an interesting tool to easily quantify periarticular osteopenia with a low radiation dose.     

Tireoidite de Hashimoto pode estar associada a um subgrupo de pacientes de esclerose sistêmica com hipertensão pulmonar

IntroductionRecent studies show an association between autoimmune thyroiditis and systemic sclerosis (SSc) and suggest that this condition may interfere with the ES phenotype. However these studies evaluate the autoimmune thyroiditis as a whole and none of them specifically addresses Hashimoto's thyroiditis (HT) in SSc.ObjectiveTo investigate the presence of HT in SSc patients and its possible association with disease manifestations.MethodsClinical manifestations of hypothyroidism, TSH and anti‐thyroid auto antibodies (anti‐TPO. anti TBG and TRAb) were studied in 56 patients with SSc. SSc patients with HT were compared with SSc patients without thyroiditis.ResultsHT was observed in 19.64% of patients with SSc. No association was observed between HT and the different forms of disease or profile of autoantibodies. Likewise, there was no difference between the mean modified Rodnan score and presence of Raynaud's phenomenon, scars, digital necrosis, myositis, arthritis, sicca symptoms, esophageal dysmotility and scleroderma renal crisis when the groups were compared. On the other hand, patients with HT had higher frequency of pulmonary hypertension in relation to patients without HT (66.6% vs 22.5%, p = 0.016).ConclusionsIn the studied sample patients with ES and HT had higher prevalence of pulmonary hypertension. Long‐term follow‐up studies with a larger number of TH and SSc patients are needed to confirm these data.     

Indices of the Scleroderma Assessment Questionnaire (SAQ) can be used to demonstrate change in patients with systemic sclerosis over time

ObjectiveThis study aims to estimate the value of the Scleroderma Assessment Questionnaire (SAQ) to demonstrate change in patients (pts) with systemic sclerosis (SSc) over time.MethodsSixty pts with SSc were evaluated at two occasions, 12 months apart. Pts were divided into three subgroups according to criteria of improved, unchanged or deteriorated status of vascular, respiratory, gastrointestinal and musculosceletal system. All pts filled in the SAQ as part of both evaluations, and the Index of Vascular Status (IVS), Index of Respiratory Status (IRS), Index of Gastrointestinal status (IGS) and Index of Musculoskeletal Status (IMSS) were calculated. Average index scores for particular organ system at the beginning and after the follow-up period in all subgroups of pts were compared.ResultsThe mean value of IVS decreased significantly in pts with objectively improved vascular status (1.91 vs. 1.29, p = 0.01), but increased in pts with deteriorated status (1.54 vs. 2.13, p = 0.003). In the subgroup of pts with unchanged vascular morphology or function, the IVS did not change significantly either (1.84 vs. 1.77, p = 0.36). The mean value of IRS decreased significantly in pts with objectively improved lung function (1.08 vs. 0.62, p = 0.027), and increased in pts with deteriorated function (0.69 vs. 1.12, p = 0.012). In the subgroup of pts with unchanged pulmonary function, the IRS did not change significantly (0.13 vs. 0.14, p = 0.18). A statistically significant decrease in mean IGS value was found in pts who were treated with prokinetics (1.20 vs. 0.70, p < 0.001). In pts who were not treated with prokinetics, an increase of IGS was observed (0.58 vs. 0.76, p = 0.002). Differences between mean values of the IMSS were statistically significant in subgroups of pts with improved (1.28 vs. 0.90, p = 0.004) or deteriorated musculoskeletal status (0.98 vs. 1.44, p = 0.012), but not in pts with unchanged condition of this organ system (0.72 vs. 0.68, p = 0.498).ConclusionThe SAQ is a sensitive measurement to demonstrate change in patients with SSc over time.     

Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis

AimsThe aim of this retrospective study was to investigate the correlation between MPV and the clinical disease activity indices of rheumatoid arthritis and ankylosing spondylitis.MethodsThe study consisted of 32 active RA patients (males/females: 7/25, mean age: 49 ± 13) and 30 active AS patients (males/females: 15/15, mean age: 36 ± 12) along with 26 osteoarthritis (OA) patients (males/females: 4/22, mean age: 52 ± 8) and 29 age-matched healthy subjects (males/females: 5/24, mean age: 41 ± 7) as control groups for RA and AS, respectively.ResultsMPV was significantly lower in both AS patients and RA patients with active disease as compared to controls (RA vs OA p < 0.001, AS vs healthy subjects p < 0.001). After treatment MPV values significantly increased in AS and RA (p < 0.001 for all). However, MPV values remained somewhat lower in RA patients than OA patients (p = 0.019). There was a negative correlation between MPV values and BASDAI scores in AS patients after two months of treatment (r = ?0.507; p = 0.004).ConclusionOur results suggest that assessment of MPV may provide additional information about inflammation in AS and RA.     

The prevalence of "risky behaviour" in adults with cystic fibrosis

BackgroundThe prevalence of “risky-behaviour” including alcohol and illicit drug use, smoking and unprotected sexual intercourse, of adults with cystic fibrosis (CF) is unknown. We conducted this prospective questionnaire-based study to further explore this issue.MethodsAn anonymous 71-point questionnaire was sent to all adult patients aged ≥ 18 years attending the Royal Brompton CF Unit. Results were compared to national (non-CF) data.Results83% (n = 151) drink alcohol and 13% (n = 23) drink more than recommended by national guidelines. 46% (n = 84) have tried smoking and 3% (n = 5) continue to smoke regularly. 35% (n = 64) have tried illicit drugs and 3% (n = 6) continue to use them. 86% (n = 154) are sexually active; 60% use contraception (males 46%, females 62%). Compared with the general (non-CF) UK population, less CF patients drink heavily (13 vs. 23%; p < 0.001), smoke (3 vs. 21%; p < 0.001), have tried illicit drugs (35 vs. 37%; p < 0.001) and are sexually active (86 vs. 97%; p < 0.001).The same proportion use contraception (60 vs. 61%; p = 0.8).ConclusionParticipation in risky behaviour was modest. With improved life expectancy this may increase. Awareness of this is important so that health promotion measures can be introduced early.     

Sintomas de doença e adaptação psicológica em pacientes brasileiros com esclerodermia

ObjectiveTo characterize the prevalence and impact of symptoms of scleroderma in Brazilian patients and to describe their satisfaction with medical care and psychological symptoms.MethodsOne-hundred and twenty eight Brazilian scleroderma patients participated in an online survey by fi lling out a Portuguese version of the Canadian Scleroderma Patient Survey of Health Concerns and Research Priorities. The mean age of participants was 38 years old (SD = 12.33), and most of the participants were females (n = 108, 88%).ResultsHardening/tightening of skin, itchy skin and joint pain were symptoms reported as being most frequent, whereas muscle pain and difficulty climbing stairs were symptoms reported as having a higher impact. Participants reported dissatisfaction regarding the medical care. Psychological evaluations suggested that participants who scored above clinical values for depression was significantly high (90%; n = 77). In addition, 48% (n = 42) of participants fit the clinical criteria for anxiety disorder, and 40% (n = 35) of participants fit the clinical criteria of social phobia. Finally, body image disturbance was reported by 69% (n = 88) of participants.ConclusionsThe physical and psychological symptoms associated with scleroderma have a significant impact on patient quality of life. The Brazilian patients in the current sample report higher levels of dissatisfaction with medical care than patients from Canada and European countries. These Brazilian patients also report more psychopathology, particularly symptoms of depression. The current results suggest that there is a need for professionals to consider and attend to the individual problems of scleroderma patients.     

The Association between Iliac Fixation and Proximal Stent-graft Migration during EVAR Follow-up: Mid-term Results of 154 Talent Devices

ObjectiveThis study investigated the importance of iliac fixation to secure endograft fixation.Materials and methodsComputed tomography (CT) scans of patients who underwent endovascular aneurysm repair with an endoprosthesis of great columnar strength (Talent? stent graft) were analysed retrospectively. Patients were enrolled consecutively between June 2000 and January 2007 and prospectively followed up with serial CT imaging. The superior mesenteric artery was used as a reference point to determine endograft migration (centerline endograft displacement of ≥10 mm). Proximal and distal fixation lengths were defined as the length of the endograft that was in full apposition to the aortic neck or common iliac arteries, respectively.ResultsProximal endograft migration occurred in 32 of 154 patients (21%) at a follow-up duration of 32 ± 14 months; 13 migrations required treatment (8%). Migration was more frequent in patients treated with aorto-uniiliac devices than bifurcation devices (p < 0.008). The migrator and non-migrator groups had similar demographic and abdominal aortic aneurysm (AAA) characteristics. The migrator group had significantly shorter proximal (30 ± 12 mm vs. 41 ± 13 mm, P < 0.001) and distal endograft fixation lengths (31 ± 18 mm vs. 47 ± 15 mm, P < 0.001). By multivariate regression analysis, proximal and distal endograft fixations were significant predictors for endograft migration at follow-up (P < 0.001).ConclusionIliac endograft fixation, along with proximal fixation, is a significant predictor for endograft migration.     

Distal radial fracture arthroscopic intraarticular gap and step-off measurement after open reduction and internal fixation with a volar locked plate

PurposeA persistent articular gap and a step-off of ≥1 mm after a distal radial fracture (DRF) may lead to post-traumatic arthritis of the radiocarpal joint. This study aims to arthroscopically assess the reduction in the articular surface in patients requiring volar locked-plate fixation for DRF via fluoroscopy-guided open reduction and internal fixation (ORIF).MethodsSeventy consecutive patients with DRF were prospectively enrolled. Posteroanterior and lateral radiographs and axial, coronal, and sagittal computed tomography (CT) scans were obtained before ORIF for DRF. The widest articular gap (pregap) and step-off (prestep-off) at the radiocarpal joint surface of the distal radius were measured on all radiographs and CT images. Total predisplacement was defined as the sum of all pregaps and prestep-offs. The DRF was reduced under fluoroscopic guidance, and a volar locked-plate was applied after fluoroscopic ORIF. The residual maximum articular gap and step-off (postgap and poststep-off) were measured arthroscopically with a calibrated probe. Total incongruity was defined as the sum of postgap and poststep-off. The receiver operating characteristic curve was applied within the pregaps, prestep-offs and total incongruity in order to identify the cutoff values of pregap and prestep-off beyond which total incongruity would exceed 1 mm.ResultsOf the 70 patients, 40 had a postgap of ≥1 mm, and 15 had a poststep-off of ≥1 mm. All pregap and pre- step-off cutoff values were judged to be unsuitable as the screening criteria for arthroscopic reduction of DRF because of their low sensitivity and specificity. The cutoff value obtained from total predisplacement was 7.85 mm, and its sensitivity and specificity were 90 and 70 %, respectively.ConclusionsSince the cutoff value of 7.85 mm derived from total predisplacement is a good indicator of post-ORIF residual total incongruity of ≥1 mm, it is also a good indicator of the need for arthroscopic reduction.     

Initial predictors associated with outcome in injured multiple traumatic limb amputations: A Kandahar-based combat hospital experience

IntroductionImprovised explosive devices (IEDs) are the defining mechanism of injury during Operation Enduring Freedom. This is a retrospective analysis of initial management for IED blast injuries presenting with bilateral, traumatic, lower-extremity (LE) amputations with and without pelvic and perineal involvement.MethodsA database of trauma admissions presenting to a North Atlantic Treaty Organization (NATO) Role 3 combat hospital in southern Afghanistan over a 7-month period was created to evaluate the care of this particular injury pattern. Patients were included if they were received from point of injury with at least bilateral traumatic LE amputations and had vital signs with initial resuscitation efforts.ResultsThirty-two presented with double LE amputations (36%) and nine with triple amputations (10%). After excluding 10 patients who failed to meet the inclusion criteria, 22 patients were analysed. The mean age was 29 years, and the average ISS and admission haemoglobin were 22 and 11.3 mg l^?1, respectively. Patients received an average of 54 units of blood products and underwent 1.6 operations with a mean operative time of 142.5 min. The pattern of injury was associated with an increase in the total blood products required for resuscitation (pelvis n = 12, p = 0.028, gastrointestinal tract (GI) n = 14, p = 0.02, perineal n = 15, p = 0.036). There was no relationship between ISS or admission haemoglobin and the need for massive transfusion. Low Glasgow Coma Scale (GCS) was associated with increased 30-day mortality. Hollow viscus injury and operative hemipelvectomy were also associated with mortality.ConclusionsEarly 30-day follow-up demonstrated that IED injuries with bilateral LE amputations with and without pelvic and perineal involvement are survivable injuries. Standard measures of injury and predictors of survival bore little relationship to observed outcomes and may need to be re-evaluated. Long-term follow-up is needed to assess the extent of functional recovery and overall morbidity and mortality.     

Entheses ultrasound assessment in primary Sjogren's syndrome

ObjectiveMusculoskeletal pain is a common complaint among patients with primary Sjogren's syndrome (pSS). Joints clinical examination is oftenly normal. A periarticular origin of this pain may be possible. Since clinical examination lacks sensitivity and precision, the use of musculoskeletal ultrasound (US) is more interesting in the evaluation of the entheses involvement, as it is shown to be a more sensitive tool. Our objective was to assess, by an ultrasonographic study, the entheses involvement in the widespread pain of patients with pSS.MethodsThis is a prospective study including 25 women with pSS and 25 age and sex matched healthy controls. An ultrasound examination, using grey scale and Doppler US, of five enthesitic sites (distal quadricipital, proximal patellar, distal patellar, distal Achillian and distal brachial tricipital) sought bilaterally the following lesions: hypoechogenicity, thickening, loss of fibrillar structure, erosions, enthesophytes, calcifications or Doppler hypervascularisation. A final score was calculated by summing the abnormalities scores of all entheses.ResultsThe mean age was 53.2 ± 11.3 years in the pSS group and 50.6 ± 9.7 years in the control group. The mean number of pathological entheses on ultrasound was 3.92 ± 1.93 in the pSS group versus 4.52 ± 2.27 in the control group (P > 0.05). The total score for enthesitis abnormalities was 4.96 ± 2.59 versus 5.72 ± 2.92 (P > 0.05), respectively. There was a positive correlation between total score of ultrasound enthesitic abnormalities and age in both groups.ConclusionIn patients with pSS, clinically painful sites were more frequently found than in US. Musculoskeletal pain was not due to enthesitis.     

The accuracy of magnetic resonance imaging of the hands and feet in the diagnosis of early rheumatoid arthritis

ObjectiveTo analyze MRI findings of early RA in the hand and foot joints and to determine any discrepancies between MRI findings in the hands and feet.MethodsTwenty one patients who fulfilled the 1987 American College of Rheumatology (ACR) criteria for the diagnosis of RA at the onset underwent MRI of both hands and feet.ResultsIn 18 out of 21 patients, rheumatoid changes were observed in the hand and foot joints. However, rheumatoid changes were observed only in the hand joints of the three remaining patients. MRI revealed pathologic findings suggested RA in the hands of 21 of 21 patients. In the feet, MRI findings suggested RA in 18 of 21 patients. Bone erosions were seen in the hands of 14 patients (67%). Observers found as many bony changes in the hands as in the foot joints. MRI detected active synovitis in 17 patients (81%) in the hands and in 15 patients (71%) in the feet. MRI findings suggested bone edema in the hand and foot joints in 14 (63%) and 11 patients (52%), respectively. There was no significant difference between the MCP and MTP joints with respect to RA-based changes obtained in the MRI (p > 0.05).ConclusionEvidence of foot involvement is a frequent occurrence in early RA.     

A new approach to urinary stone analysis according to the combination of the components: experience with 7949 cases

ObjectiveTo evaluate a new approach to urinary stone analysis according to the combination of the components.Materials and methodsA total of 7949 stones were analysed and their main components and combinations of components were classified according to gender and age. Statistical analysis was performed using the chi-square test.ResultsCalcium oxalate monohydrate (COM) was the most frequent component in both males (39%) and females (37.4%), followed by calcium oxalate dihydrate (COD) (28%) and uric acid (URI) (14.6%) in males and by phosphate (PHO) (22.2%) and COD (19.6%) in females (p = 0.0001). In young people, COD and PHO were the most frequent components in males and females respectively (p = 0.0001). In older patients, COM and URI (in that order) were the most frequent components in both genders (p = 0.0001). COM is oxalate dependent and is related to diets with a high oxalate content and low water intake. The progressive increase in URI with age is related mainly to overweight and metabolic syndrome. Regarding the combinations of components, the most frequent were COM (26.3%), COD + Apatite (APA) (15.5%), URI (10%) and COM + COD (7.5%) (p = 0.0001).ConclusionsThis study reports not only the composition of stones but also the main combinations of components according to age and gender. The results prove that stone composition is related to the changes in dietary habits and life-style that occur over a lifetime, and the morphological structure of stones is indicative of the aetiopathogenic mechanisms.     

Predictors of osteoarthritis following operative treatment of medial tibial plateau fractures

PurposeTo determine factors influencing the development of posttraumatic osteoarthritis (OA) following medial tibial plateau fractures and to evaluate concomitant injuries associated with these fractures.Materials and methodsA chart review of patients with operatively treated medial tibial plateau fractures admitted to our Level I trauma centre from 2002 to 2008 was performed. Of 63 patients, 41 participated in a clinical and radiographic examination. The mean age was 47 years (range 16–78) and the mean follow-up time was 7.6 (range 4.7–11.7) years. All patients had preoperative computed tomography (CT) scans and postoperative radiographs. At the end of follow-up, standing radiographs, mechanical axis, and CT scans were evaluated.ResultsOf the 41 patients, 24 had no or mild (Kellgren-Lawrence grade 0–2) OA and 17 had severe (grade 3–4) OA. Initial articular depression measured from preoperative CT scans was a significant predictor of OA (median 1.8 mm vs 4.5 mm, p = 0.009). Fracture line extension to the lateral plateau (p = 0.68) or fracture comminution (p = 0.21) had no effect on the development of posttraumatic OA, nor did articular depression at the end of follow-up (p = 0.68) measured from CT scans. Mechanical axis >4° of varus and ≥2 mm articular depression or step-off were associated with worse WOMAC pain scores, but did not affect other functional outcome scores. Six patients (10%) had permanent peroneal nerve dysfunction. Ten patients (16%) required LCL reconstruction and nine (14%) ACL avulsions were treated at the time of fracture stabilisation.ConclusionsThe amount of articular depression measured from preoperative CT scans seems to predict the development of posttraumatic OA, probably reflecting the severity of chondral injury at the time of fracture. Restoration of mechanical axis and articular congruence are important in achieving a good clinical outcome.     

The cultural adaptation and validation of the "Burn Specific Health Scale-Revised" (BSHS-R): version for Brazilian burn victims

BackgroundThe Burns Specific Health Scale-Revised (BSHS-R) is of easy application, can be self-administered, and it is considered a good scale to evaluate various important life aspects of burn victims.ObjectivesTo translate and culturally adapt the BSHS-R into the Brazilian–Portuguese language and to evaluate the internal consistency and convergent validity of the translated BSHS-R.MethodsThe cultural adaptation of the BSHS-R included translation and back-translation, discussions with professionals and patients to ensure conceptual equivalence, semantic evaluation, and pre-test of the instrument. The Final Brazilian–Portuguese Version (FBPV) of the BSHS-R was tested on a group of 115 burn patients for internal consistency and validity of construct (using the Rosenberg Self-Esteem Scale (RSES) and the Beck Depression Inventory (BDI)).ResultsAll values of Cronbach's alpha were greater than .8, demonstrating that the internal consistency of the FBPV was very high. Self-esteem was highly correlated with affect and body image (r = .59, p < .001), and with interpersonal relationships (r = .51, p < .001). Correlations between the domains of the FBPV and the BDI were all negative but larger in magnitude than the correlations with RSES. Depression was highly correlated with affect and body image (r = −.77, p < .001), and with interpersonal relationships (r = −.67, p < .001).ConclusionsThe results showed that the adapted version of the BSHS-R into Brazilian-Portuguese fulfills the validity and reliability criteria required from an instrument of health status assessment for burn patients.