Bilateral septic arthritis of the hip with osteitis and psoas abcess in a 17-year-old adolescent

Septic arthritis remains an important and serious disease of the young because of its high potential to cause permanent sequelae. The hip is the most commonly involved joint in infants and in the young (35%). Most often, patients have a single joint involved. We report here a rare case of septic arthritis reaching both hips, shown by a severe septicemic shock and complicated unusually by a psoas abcess and osteitis in an immunocompetent adolescent.     

The uveitis and its relationship with disease activity and quality of life in Moroccan children with juvenile idiopathic arthritis

The aim of our study is to investigate ocular involvement in juvenile idiopathic arthritis (JIA) and its relationship with disease activity and quality of life in Moroccan patients who suffer from JIA. This is a cross-sectional study conducted between January and June 2012 which includes patients with juvenile idiopathic arthritis (n?=?30). All patients have undergone clinical and paraclinical assessment of JIA and a complete eye examination. Functional impairment is assessed by the Childhood Health Assessment Questionnaire while visual function is studied by the Effect of Youngsters’ Eyesight in Quality of Life instrument (EYE-Q). Quality of life is assessed using the Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0). Four patients (13.33 %) have uveitis with a confidence interval between 3.4 and 30.7. Involvement is bilateral in three children (75 %). One patient (25 %) has elevated intraocular pressure with loss of the right eye due to glaucoma. There is a strong but not significant relationship between uveitis and the number of awakenings (r?=?0.71, p?=?0.69) and morning stiffness (r?=?3.05, p?=?0, 21). This relationship is moderate with erythrocyte sedimentation rate (r?=?0.48, p?=?0.78) and C-reactive protein (r?=?0.25, p?=?0.88). A strong but not significant association is found between the overall quality of life assessed by the PedsQL 4.0 and visual function assessed by EYE-Q in the uveitis group (r?=??0.64, p?=?0.55). This study suggests that uveitis associated with JIA can present serious complications and could have a direct relationship with the activity of the JIA as well as with the quality of life of the patient.     

Results from a Geographically Focused,Community-Based HCV Screening,Linkage-to-Care and Patient Navigation Program

BACKGROUND

Many of the five million Americans chronically infected with hepatitis C (HCV) are unaware of their infection and are not in care.

OBJECTIVE

We implemented and evaluated HCV screening and linkage-to-care interventions in a community setting.

DESIGN

We developed a comprehensive, community-based HCV screening and linkage-to-care program in a medically underserved neighborhood with high rates of HCV infection in Philadelphia, Pennsylvania. We provided patient navigation services to enroll uninsured patients in insurance programs, facilitate referrals from primary care physicians and link patients to an HCV infectious disease specialist with intention to treat and cure.

PATIENTS

Philadelphia residents were recruited through street outreach.

MAIN MEASURES

We measured anti-HCV seroprevalence and diagnosis, linkage and retention in care outcomes for chronically infected patients.

KEY RESULTS

We screened 1,301 participants for HCV; anti-HCV seroprevalence was 3.9 % and 2.8 % of all patients were chronically infected. Half of chronically infected patients were newly diagnosed; the remaining patients were aware of infection but not in care. We provided confirmatory RNA testing and results, assisted patients with attaining insurance and linked most chronically infected patients to a primary care provider. The biggest barrier to retaining patients in care was obtaining referrals for subspecialty providers; however, we obtained referrals for 64 % of chronically infected participants and have retained most in subspecialty HCV care. Several have commenced treatment.

CONCLUSIONS

Non-clinical screening programs with patient navigator services are an effective means to diagnose, link, retain and re-engage patients in HCV care. Eliminating referral requirements for subspecialty care might further enhance retention in care for patients chronically infected with HCV.KEY WORDS: hepatitis C, HCV screening, community-based screening, patient navigation, continuum of care     

Erosive polyarthritis in Crohn's disease. Report of a case

Erosive polyarthritis in Crohn's disease is rare and raises diagnostic and pathophysiological problems. A case with destructive lesions of the shoulders and hips is reported in a 43-year-old woman with a 26-year history of Crohn's disease. Ankylosis of the spine and hips, motion range limitation of the shoulders and wrists, and boutonnière deformity of the third finger of the right hand were present. Tests were negative for rheumatoid factor and the HLA-B27 antigen. Plain radiographs showed a triple rail pattern at the spine; synostosis of the hips; and destructive lesions of the shoulders, wrists, tarsal bones, and third proximal interphalangeal joint of the right hand. Glucocorticoid therapy was effective in suppressing the bowel symptom flares but only partially improved the joint symptoms, whose treatment relied mainly on nonsteroidal antiinflammatory agents and rehabilitation therapy. Erosive arthritis in Crohn's disease is frequently monoarticular, with the hip being the most common target. It can complicate a spondylarthropathy or reveal granulomatous synovitis. Polyarticular forms pose difficult diagnostic and therapeutic challenges and add to the disability caused by the bowel disease. The potential role of genetic factors remains to be studied.