Radiology of seronegative spondyloarthropathies

Radiographic manifestations of the seronegative spondyloarthropathies superficially resemble the findings of rheumatoid arthritis although they differ in both distribution and pattern of disease. Ankylosing spondylitis has a predilection for the axial skeleton; psoriatic arthritis may involve distal interphalangeal joints; and Reiter's syndrome is most commonly associated with asymmetrical lower extremity alterations. The absence of osteoporosis and the presence of bony proliferation are also noted in these disorders. Sacroiliitis and spondylitis, which can be observed in any of these disease, may have distinctive features. In ankylosing spondylitis, bilateral saroiliac joint alterations and typical syndesmophytes are common; in Reiter's syndrome and psoriasis, asymmetrical saroiliac joint changes and bulky spinal outgrowths may be observed. The physician should be aware of typical roentgen findings in each of the spondyloarthropathies.     

Extraskeletal manifestations of seronegative spondyloarthropathies

Spondyloarthropathies constitute a cluster of interrelated and overlapping chronic inflammatory rheumatic diseases of unknown etiology that include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis and undifferentiated spondyloarthritis. These diseases are not associated with rheumatoid factor, they occur in genetically predisposed individuals and show a strong association with HLA-B27. The primary pathologic sites include the entheses, the sacroiliac joints and the axial skeleton with or without some nonarticular structures, such as the skin, eye, aortic valve, heart and kidney.     

The seronegative spondyloarthropathies of childhood

Most chronic arthritis in childhood is seronegative. Within "JRA" several distinct subgroups exist: one of these (pauciarticular disease type II) affects predominantly boys more than 8 years of age. It is clearly associated with sacroiliitis, HLA-B27, family history of spondyloarthropathy, and subsequent ankylosing spondylitis in an as yet underfined percentage of patients. This type of disease is probably classified appropriately with the spondyloarthropathies, although patients often may fulfill diagnostic criteria for "JRA" in the first years of their disease, and accounts for about 15% of "JRA." The other JRA subgroups do not appear to have features of seronegative spondyloarthropathy. Reiter's syndrome and psoriatic arthritis exist in children, but appear to be rare. The arthritis of inflammatory bowel disease in childhood resembles that in adulthood. The recognition of spondyloarthropathy in children, particularly the sizable group of patients with "JRA" pauciarticular disease type II, is of practical importance to permit proper therapy, follow-up and prevention of deformity.     

Radionuclide joint imaging in the seronegative spondyloarthropathies

Radionuclide joint imaging (RJI) of the peripheral and axial skeleton is a recent advance in the detection of early articular inflammation and has proven useful in establishing the extent and pattern of this involvement. The bone-seeking agents--the radiophosphates--are the radiopharmaceuticals presently favored for RJI in adults. They are more sensitive than the clinical examination in detecting inflammatory joint disease in all peripheral joints with the exception of the shoulders, elbows and knees. Radiophosphate may also be used to evaluate the axial skeletion for inflammatory involvement. The sacroiliac joints may be evaluated by a new technique, quantitative saroiliac scintigraphy (QSS). Studies to date have demonstrated that QSS is most sensitive in early sacroiliitis, a time when conventional radiography is normal or shows equivocal abnormalities. While extremely sensitive as a screening procedure for inflammatory articular disease, RJI is nonspecific diagnostically. Radiophosphate uptake by bone occurs in metabolic bone disease, osteoarthritis, trauma and juxta-articular bony abnormalities such as osteomyelitis and bone infraction. The results obtained by radionuclide joint imaging must be supplemented by the clinical findings and conventional investigations to establish a specific diagnosis.     

Fertility in male patients with seronegative spondyloarthropathies treated with infliximab

ObjectivesThe majority of patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are affected during their peak reproductive years. Tumor necrosis factor (TNF)α plays a pivotal role in the pathogenesis of both diseases. Today, anti-TNFα blockers are an essential treatment for these patients. To identify male patients who achieved pregnancy development during their management with anti-TNFα blockers (infliximab).MethodsWe reviewed the data of 65 patients with AS and 30 patients with PsA who were followed-up in our rheumatology outpatients clinic and they were on infliximab therapy between January 2001 and December 2010.ResultsWe identified overall seven male patients with AS and three male patients with PsA who had fathered 14 healthy infants. Moreover, we recognized one man with PsA who was on infliximab and on concomitant therapy with MTX at the time of conception, whose wife had to proceed to therapeutic abortion due to congenital abnormalities of the fetus (hydrocephalia), while she was on the first trimester of pregnancy.ConclusionsWe described male patients with AS and PsA who demonstrated no fertility problems while they were on infliximab treatment. The data designated in this report provide some supportive evidence for the safe use of infliximab in male patients who are affected of those inflammatory diseases during their peak reproductive years.     

Patterns of dyslipidemia in young patients with seronegative spondyloarthropathies without cardiovascular diseases

ObjectivesPatients with seronegative spondyloarthritis (SpA) – psoriatic arthritis (PsA) and ankylosing spondylitis (AS) – have a higher risk of cardiovascular morbidity and mortality. The aim of the present study was to evaluate the incidence and type of dyslipidemia, a potent atherosclerosis risk factor, in SpA patients.Material and methodsIt was a two-center, case-control study. Patients diagnosed with PsA and AS aged 23–60 years, with disease duration < 10 years, were enrolled. The inflammatory activity, serum levels of C-reactive protein (CRP) and lipid profile were evaluated in each patient. In patients > 40 years old, the 10-year risk of fatal cardiovascular disease (CVD), using Systematic Coronary Risk Evaluation (SCORE), was estimated.ResultsIn total 79 patients with SpA were included in the study, with PsA diagnosed, n = 39 (mean age 45.1 ±9.6 years; 21, 53.9%, women), and with AS diagnosed, n = 40 (age 40.3 ±9.5; 12.3%, women), control group (CG): n = 88 (age 42.3 ±8.1; 42, 47.7% women). Based on the interview and laboratory tests, dyslipidemia was diagnosed in 19 (47.5%) patients with AS and in 28 (71.8%) patients with PsA. Most patients had hypercholesterolemia or mixed hyperlipidemia. Types of dyslipidemia were similar. In SpA patients (PsA and AS), the level of triglycerides (TG) and atherogenic index (AI) were significantly higher than in the CG, respectively TG in SpA: 116 (83–156) and in the CG: 91.2 (72.6–134.6) mg/dl, p = 0.0182; AI in SpA: 3.77 ±1.26 and in the CG: 2.58 ±1.27, p < 0.0001.The low-density cholesterol (LDL) level was significantly lower in SpA patients than in the CG, SpA: 109.1 ±29.4 vs. CG: 125.2 ±35.9 mg/dl, p = 0.0023. There was a strong negative correlation between CRP levels and HDL cholesterol levels in patients with PsA, rho = 0.42, p = 0.0132. Mean SCORE values were 2.33% in PsA patients and 2.38% in AS patients, which results in moderate 10-year risk of death from CVD.ConclusionsIn young patients with spondyloarthropathies, inflammatory factors significantly influence dyslipidemia patterns, which result in higher TG and lower LDL cholesterol levels. In patients with PsA, dyslipidemia was diagnosed more often than in patients with AS.     

Serum levels of IL-1 beta,TNF-alpha,IL-8, and acute phase proteins in seronegative spondyloarthropathies

OBJECTIVES: Some immunological abnormalities have been described in seronegative spondyloarthropathies (SpA). The aim of this study is to determine the serum levels of IL-1beta, TNF-alpha and IL-8, which are proinflammatory cytokines in active and inactive patients with SpA, to compare the results with those of controls and to investigate a relationship with clinical activity and acute phase proteins. METHODS: Forty-two patients (34 males and eight females) and 22 healthy controls (17 M and 5 F) were included in the study. All patients fulfilled Amor criteria for the classification of SpA. Among patients 23 had active and 19 had inactive disease. IL-1beta, TNF-alpha and IL-8 were determined by enzyme-linked immunosorbent assay ( ELISA), acute phase proteins were measured by nephelometric assay. RESULTS: There was no statistically significant difference between mean IL-1beta levels of patient groups and controls. Serum mean TNF-a levels in active and inactive patients were significantly increased as compared to that in the controls (P < 0.05, P < 0.05, respectively). Serum mean IL-8 levels in active patients was significantly increased as compared to that in the controls and in inactive patients (P < 0.01, P < 0.01, respectively). High serum IL-8 levels correlated well with C-reactive protein and haptoglobulin, but there was no correlation between IL-1beta or TNF-alpha levels and acute phase proteins such as C-reactive protein, alpha-1 acid glycoprotein, alpha-1 antitrypsin and haptoglobulin. CONCLUSIONS: These results suggest that serum IL-8 may reflect clinical activity of the disease and may be helpful for monitoring patients with SpA.     

New pharmacotherapeutic approach to the treatment and prophylaxis of ischemic insult

Complex analysis of Extra Erbisol influence on cerebral hemodynamics, bioelectric activity of the brain in patients, who survived the ischemic insult, the expediency of the preparation application in complex of treatment and rehabilitation of the patients were suggested. There was established, that Extra Erbisol application had promoted the cerebral hemodynamics improvement and intrahemispheric interrelationship harmonization. This substantiates the recommendations for including of the preparation to the complex treatment of patients, who had survived an ischemic insult.     

Vascular involvement in axial spondyloarthropathies

Ankylosing spondylitis (AS) is a chronic inflammatory joint disease that involves the entheses, causing inflammatory pain and functional impairments. Patients may experience extraarticular manifestations such as uveitis, psoriasis, and inflammatory bowel disease. These, together with the increased risk of cardiovascular disease and osteoporosis and the development of spinal fusion, are the main determinants of adverse disease outcomes. As with many systemic inflammatory diseases, AS is associated with excess cardiovascular mortality due to increased risks of myocardial infarction, stroke, and venous thromboembolism. Studies of markers for subclinical atheroma (endothelial dysfunction, arterial stiffness, and intima-media thickness) have shown earlier onset of arterial disease compared to healthy controls, with the difference being greatest for patients with active AS. The potential vascular effects of drugs used to treat AS have not been established. Few studies have focused on nonsteroidal antiinflammatory drugs and biologics in patients with AS, and their results do not conclusively establish a beneficial or deleterious effect in axial spondyloarthritis. Statins have been found to improve endothelial dysfunction and to decrease mortality. The latest EULAR recommendations on cardiovascular risk management in patients with inflammatory joint disease indicate that statins should be used in compliance with national guidelines.     

双阴性血清阴性脊柱关节病的门诊诊治

目的：探讨双阴性血清阴性脊柱关节病（Both Negative-Seronegtive Spondyloarthro Pathies BNSPA）的门诊诊治。方法20例具有SPA症状的患者HLA-B27检测全部报告阴性,骶髂关节影像学报告全部阴性,均按SPA的诊治思路做进一步检查治疗。结果经抗SPA治疗后,症状全部得以明显控制,无一例出现典型的骶髂关节影像学变化。结论国民体质的提高,早期抗SPA的干预是HLA-B27阴性频率较高的一个重要因素,而骶髂关节炎影像学的误判也是SIJ阳性率不高的一个重要原因。根据临床征象以BNSPA诊治,取得良好效果。     

Rational treatment of burns

Minor burns may be satisfactorily treated by several methods which relieve pain and allow healing to progress under aseptic conditions. In the burns of serious extent general treatment must be instituted for primary shock and toxemia. The local use of tannic acid has diminished the amount of toxic absorption and produced a type of wound which is dry, insensitive and aseptic. Because of these facts and the reported decrease in mortality since the introduction of tannic acid, this is the treatment of choice in all serious burns.     

Cardiovascular disease in patients with spondyloarthropathies

Spondyloarthropathies are associated with a greater cardiovascular risk than expected based on the cardiac lesions known to occur in these diseases. The prevalence of several conventional risk factors is high in spondyloarthropathy patients, and chronic inflammation also contributes to premature plaque formation. In addition, susceptibility genes for spondyloarthropathies may be associated with an increased risk of cardiovascular disease. Finally, several drugs used to treat spondyloarthropathies may contribute to the occurrence of cardiovascular events. A careful evaluation of the cardiovascular risk profile is a key component of the management of patients with spondyloarthropathies.     

Rational treatment of empyema in children

HYPOTHESIS: Efficacious and cost-effective treatment of pediatric empyema can be accomplished following a protocol based on its radiographic appearance. Therapeutic modalities include thoracostomy tube drainage (TTD) with or without fibrinolytic therapy (FT) and video-assisted thoracoscopic debridement (VATD). DESIGN: Retrospective case series. SETTING: Tertiary referral center. RESULTS: From 1995 through 1999, 31 children were treated ranging in age from 11 months to 18 years (mean age, 5.1 years). Twenty-seven (87.1%) underwent TTD; of these, 22 (81.5%) received FT with urokinase. The TTD failed in 4 children (14.8%) who required salvage VATD. Primary VATD was performed in another 4 children (12.9%). The mean length of stay was 14.6 days (TTD, 14.1 days; salvage VATD, 20. 0 days; primary VATD, 11.5 days), ranging from 8.0 to 30.0 days. Complications included readmission for fever (2 patients [6.5%]) and gastrointestinal bleeding (1 patient [3.2%]). There were no anaphylactic reactions or bleeding episodes due to urokinase. Two patients (7.4%) treated with TTD and FT developed an air leak that resolved spontaneously. The mean hospital charges were $78,832 (TTD with or without FT, $75,450; salvage VATD, $107,476; primary VATD, $69,634). The procedural charges were highest for salvage VATD. CONCLUSIONS: Most cases of pediatric empyema can be treated by TTD with or without FT. This therapy is safe and effective for children with nascent disease. Primary VATD is preferred in children with advanced disease. Cost-effectiveness could be further improved through better prediction of those patients likely to fail TTD and require salvage VATD. An algorithmic approach based on findings from computed tomography or (better) ultrasonography of the chest may be the best way to make this distinction and rationalize care.     

Pathology and clinico-pathologic correlations in spondyloarthropathies

The term "spondyloarthritis" encompasses a variety of conditions that manifest as inflammation of the synovial membranes and entheses. The synovial inflammation lacks specificity and shares many features with rheumatoid synovitis. The hallmark of spondyloarthritis is inflammation of the entheses, which manifests as a combination of hyperostosis, osteitis, and periostitis. The entheses include not only the sites where tendons, ligaments, and joint capsules attach to bone, but also other fibrous structures such as the amphiarthroses (pubic symphysis, manubriosternal symphysis, and discovertebral junctions) and the diarthro-amphiarthroses (sacroiliac area, chest wall joints, and tips of the fingers and toes). This vast entheseal territory is the target selectively involved in patients with spondyloarthropathy.     

Rational method of surgical treatment in nephroptosis

The article is devoted to surgical treatment of patients with nephroptosis. New and rational methods of nephropexy are described such as subcapsular along the posterior surface of the lower pole, by paranephral fatty tissue of the lower pole and by the fatty tissue with conducting the muscle flap through it. The data concerned with the number and results of the operations performed are given, the differential approach to using the methods in question being formulated.