Biomedical subjects
Publications and source records attributed to G Pasero.
We describe a 65-year-old woman with ochronosis and ankylosing spondylitis. The coexistence of these 2 diseases has not previously been described. Differential radiological features of these conditions, which share some resemblances from the clinical point of view, are highlighted.
Sacroiliitis of seronegative spondyloarthropathy may sometimes show on pelvis plain films findings indistinguishable from those of osteitis condensans ilii. Computed tomography (CT) can differentiate earlier than plain radiography between the 2 conditions; furthermore, it should also be possible to make this differentiation clinically. The aim of our study was to verify whether the criteria recently proposed by the European Spondylarthropathy Study Group (EESG) for the classification of spondyloarthropathy are useful. CT scans through the synovial part of the sacroiliac joints of 7 consecutive patients meeting the ESSG criteria and showing typical findings of osteitis condensans ilii on plain films were mixed with those of 15 consecutive patients with osteitis condensans ilii not meeting the ESSG criteria. Scans were examined for joint space and surface abnormalities blindly and independently by 2 observers. Six patients in the spondyloarthropathy group and one in the osteiitis condensans ilii group showed clear erosions and/or joint space narrowing of less than 2 mm in at least one joint. The difference was statistically significant (p less than 0.001). Our results suggest that by using criteria valid for the whole group of seronegative spondyloarthropathies, it is possible to differentiate clinically between seronegative spondyloarthropathies with sacroiliitis mimicking osteitis condensans ilii and "true" osteitis condensans ilii.
We report the case of a man with ankylosing spondylitis involving the symphysis pubis and some intervertebral discs in addition to the sacroiliac joints. The bone adjacent to each inflammatory area showed an unusually exuberant sclerosis. In the early phases of evolution the appearance of sacroilitis was indistinguishable from that of osteitis condensans ilii.
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Twenty-four patients (9 M and 15 F, age range 51-82) with polymyalgia rheumatica receiving 6-methylprednisolone for a period of 9 months (16 mg/daily/two weeks, 14 mg/daily/two weeks, 12 mg/daily/1 month, 10 mg/daily/1 month, 8 mg/daily/1 month, 6 mg/daily/1 month and 4 mg/daily for the last four months) were randomly assigned to receive either 250HD3 (35 mcg/day for 25 days/month) (Group A) or placebo (Group B) in a double-blind study. All patients also received 500 mg elemental calcium daily. Before and at 3, 6 and 9 months ESR, tenderness on palpation and subjective pain were evaluated. At the same times, mineral metabolism parameters (serum calcium, phosphorus, alkaline phosphatase, 24-h urinary calcium, phosphate and 24-h hydroxyproline excretion) and radial bone mineral content (BMC) were evaluated. Activity indexes (ESR and clinical parameters) improved in both groups. Furthermore, serum alkaline phosphatase and 24-h hydroxyproline excretion decreased significantly only in Group A, and BMC decreased significantly in Group B but rose slightly in Group A. No side effects were observed in any of the patients.
A 53-year-old man affected by ankylosing spondylitis associated with psoriasis developed bilateral tarsal tunnel syndrome caused by synovitis of the accompanying sheaths of the tendons that run through the 'fibro-osseous tunnel'. This report confirms the hypothesis that the tarsal tunnel syndrome may be a clinical manifestation of seronegative spondyloarthropathy.
The development of articular manifestations in the course of chronic urticaria or in urticarial vasculitis has been widely reported. It is not completely clear, however, whether common pathogenetic mechanisms are involved in all patients with these clinical features. Four consecutive patients with simultaneous urticarial and articular manifestations, but without any evidence of an immune complex mediated disease, are described. The HLA-B51 antigen was positive in all these patients, suggesting that a common genetic background may be present in some cases of urticaria with articular complaints.
Two more cases of B27 associated peripheral arthritis triggered by physical injury are reported. One patient developed arthritis after a minor insult and in the other Reiter's syndrome occurred after the injury. Possibly, trauma causes release of self antigens from the injured joints.
The prevalence of musculoskeletal complaints suggestive of the fibromyalgia syndrome (FS) was evaluated in 30 patients with primary Sjögren's syndrome (1 degree SS) and in two control groups of patients with osteoarthritis (OA) and diabetes mellitus (DM). In addition, the presence of depressive state was investigated in patients and controls using the Hamilton rating scale and an Italian self-evaluating test. Fibromyalgia features were found in 14 1 degree SS patients (47%), in 21 OA (70%) and in 10 DM (33%) controls. 1 degree SS patients showed the highest prevalence (47%) of moderate-severe depression with respect to OA (20%) and DM (7%) groups (p less than 0.01). Furthermore, while FS features correlated closely with both tests for depression in 1 degree SS (p less than 0.001), this correspondence was absent or much less significant in the other disease groups. Finally, neither psychopathological features nor FS complaints appeared to be related to the other clinical and serological findings of 1 degree SS.
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Two B27 positive patients developed peripheral arthritis immediately after a significant musculoskeletal injury. Unlike previously reported peripheral arthritis precipitated by trauma in B27 positive subjects the arthritis was rapidly destructive.
The case of a 45 year old woman affected by both Behçet's syndrome (BS) and ankylosing spondylitis (AS) is reported. Cervical spine involvement was observed long before the appearance of the sacroiliac and lumbar changes.
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Forty-four patients with typical palindromic rheumatism were typed for HLA-A,B,C and DR antigens. The mean duration of follow-up of our patients was 4.0 yrs. (range 1-12 yrs.). During this time 27% of patients showed a seropositivity; 22% of patients developed polyarthritis, 1 patient revealed a Sjögren syndrome and 3 patients showed a spontaneous improvement. The HLA-B16 antigen was increased in patients compared with controls, but the difference was not statistically significant. A, C and other B antigens were found with normal frequencies. The HLA-DR antigens did not reveal any differences between patients' and controls' values, either 40% of patients who developed RA carried the HLA DR4 antigen.
Tigason (etretinate, RO-10-9359) is an oral aromatic retinoid acid which is effective in psoriasis and other dermatological syndromes. The present study reports the results of the use of this drug in 15 patients with a confirmed diagnosis of psoriatic arthritis, aged between 42 and 74 (average 60.2) years. Two patients dropped out after one month because they showed dryness of lips, chapping and intolerable itching, and another two due to intolerable pruritus and deterioration of their skin lesions. The 11 remaining patients, five males and six females, were treated with a daily dose of 50 mg etretinate, reduced to 25 mg after two weeks. Assessments which included grip strength, Ritchie joint index, pain, and dermatological assessment were performed at monthly intervals. Routine blood tests for toxic effects and erythrocyte sedimentation rate (ESR) were also performed, as well as CPR (C-protein reactive) as a test of disease activity. All patients showed an improvement in the psoriasis, joint swelling and pain. The elevated ESR observed in all patients studied also fell gradually during the course of etretinate treatment, as did as the intake of antiinflammatory agents. Elevated serum lipid levels (cholesterol and triglycerides) were found in three patients; further drug-specific side-effects such as dryness of lips and mouth, loss of hair, thinning of skin and scaling were frequently found in all patients, but they remained tolerable.
The effect of S-adenosylmethionine (SAMe) and placebo was evaluated in a short-term crossover study of 17 patients with primary fibromyalgia. Eleven of 17 patients had a significant depressive state as assessed by either the Hamilton Depression Rating Scale or the Scala di Autovalutazione per la Depressione (SAD) rating scale. The number of trigger points plus painful anatomic sites decreased after administration of SAMe (p less than 0.02) but not after placebo treatment. In addition, scores on both the Hamilton and SAD rating scales improved after SAMe administration (p less than 0.05 and p less than 0.005, respectively), whereas they did not significantly change after placebo treatment. In all the patients, there was a good correlation between scores on the Hamilton rating scale and the number of trigger points. Thus, this preliminary study confirms the close relationship between primary fibromyalgia and psychologic disturbances, particularly with regards to a depressive state. SAMe treatment, by improving the depressive state and reducing the number of trigger points, seems to be an effective and safe therapy in the management of primary fibromyalgia.