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A case of adult periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome associated with endocapillary proliferative glomerulonephritis
No full textPFAPA is an acronym for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis. This syndrome has been usually described in pediatric patients and it generally resolves spontaneously. The endocapillary proliferative glomerulonephritis (EPG) is a glomerular injury characterized by hypercellularity in glomerular lumen and is caused by post-infectious or autoimmune diseases. In this paper, we describe the case of a 35-year-old man affected by PFAPA and EPG. To our knowledge this association has never been reported in the literature before
Upadacitinib for the treatment of adult patients with active psoriatic arthritis
No full textIntroduction: Psoriatic arthritis (PsA) is a rheumatic disorder that may be responsible for relevant articular impairment. The recently licensed Janus Kinase (JaK) inhibitors represent a new opportunity to improve PsA treatment. This review deals with the clinical usefulness of the selective JaK-1 inhibitor upadacitinib (UPA) in patients with PsA. Covered areas: Two phase-III studies are available: SELECT-PsA 1, performed in patients with an inadequate response to non-biological therapies, and SELECT-PsA 2, conducted in biologic-experienced patients. Long-term extension results and post-hoc analysis data of these two trials are also available. Expert opinion: The results provided by the trials indicate that UPA may be used to treat all of the clinical manifestations of PsA. Venous thromboembolism, cardiovascular events, and malignancy, the most feared adverse events associated with JaK inhibitor use, were not increased in the trial populations, yet long-term observational studies are needed to make sure that UPA is safe in this respect
A case of adult periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome associated with endocapillary proliferative glomerulonephritis
No full textPFAPA is an acronym for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis. This syndrome has been usually described in pediatric patients and it generally resolves spontaneously. The endocapillary proliferative glomerulonephritis (EPG) is a glomerular injury characterized by hypercellularity in glomerular lumen and is caused by post-infectious or autoimmune diseases. In this paper, we describe the case of a 35-year-old man affected by PFAPA and EPG. To our knowledge this association has never been reported in the literature befor
Imaging in polymyalgia rheumatica
Get PDFPolymyalgia rheumatica (PMR) is a chronic, inflammatory disorder of unknown cause clinically characterized by pain and prolonged morning stiffness affecting the shoulders and often the pelvic girdle and neck. Imaging has substantially contributed to defining PMR as a disease mainly involving extra-articular structures. This review article analyses the role of the different imaging techniques in the diagnosis and follow-up of patients with PMR with particular emphasis on the role of ultrasound, PET/CT and MRI
US Examination of Wrists and Hands: A Comparison Between Rheumatoid Arthritis and Psoriatic Arthritis
No full textBackground/Purpose: Very little is known about the possible differences in the involvement of joints and periarticular structures in rheumatoid or psoriatic arthritis (PsA). The main pathological features detected by US in rheumatoid arthritis (RA) are synovitis and bone erosion while, in spondyloarthropathies, entheseal inflammation is the common feature. Tendon involvement is particu- larly frequent and dactylitis is a typical PsA manifestation. Aim of the study was to investigate the features of wrist and hand involvement in PsA and RA. Methods: Bilateral ultrasound (US) examination of the wrist and hand was performed, by the same physician, in a group of subjects affected by RA (n50; F:M43:7; mean age: 61.312.7 years; disease duration: 112.985.5 months) and PsA (n50; F:M24:26; mean age: 57.412.5 years; disease duration: 100.297.4 months), using a Logiq 9 (General Electrics Medical Systems, Milwaukee, WI) with a linear probe operating at 14 MHz. We examined radiocarpal, intercarpal, metacarpophalangeal, proximal interphalangeal and distal interphalangeal (DIP) joints and flexor and extensor tendons (both in wrist and hand). The patients were recruited on a time-criteria (the last 25 patients for each diagnosis who came for an outpatient control) from the whole number of subjects referring to the US unit of our Clinic. Results: US examination showed joint wrist synovitis in 37/50 (74) RA and 29/50 (58) PsA patients, hand synovitis in 33/50 (66) and in 36/50 (72) RA and PsA patients respectively. Tendon involvement was present in the 21/50 (42) and 13/50 (26) patients in the wrist and 18/50 (36) in the hand, both in RA and PsA group. Finally, bone erosions were present in 33/50 (66) and 29/50 (58) RA and PsA patients respectively. Conclusion: We did not observed significant differences in wrist or hand involvement (both in joint and tendon structures) between RA and PsA patients, even if a slightly higher frequency of wrist synovitis and tenosynovitis was present in RA group
ULTRASOUND EXAMINATION OF KNEE JOINT: A COMPARISON BETWEEN PSORIATIC ARTHRITIS AND RHEUMATOID ARTHRITIS
No full textIntroduction: The knee joint is frequently involved in psoriatic arthritis (PsA) and in rheumatoid arthritis (RA). Very little is known about the possible differences of such involvement in these arthritides. Aim of the Study: To investigate the features of knee involvement in PsA and RA by ultrasound examination (US). Methods: Bilateral US examination of the knee was performed by the same rheumatologist, experienced in US, in 30 PsA patients (F:M15:15; disease dura- tion: 78.41±79.45 months) and in 30 RA patients (F:M23:7; disease duration: 123.12±79.56 months) using a Logiq 9 (General Electrics Medical Systems, Mil- waukee, WI) with a linear probe operating at 10MHz for the evaluation of joints and 14MHz for the assessment of tendons. Results: Joint effusion with synovial proliferation was observed in 31 out of 60 (51) knees of PsA patients and in 41 out of 60 (68) knees of RA patients. In 7 PsA and in 4 RA patients also a positive PD signal was visualized. Baker’s cyst was detected in 24 knees in the RA group and in 11 knees in the PsA. No bone erosions were imaged in any of the PsA patients while 2 out of the 30 (6.7) RA subjects showed erosions. Quadricipital tendon enthesopathy was present in 20 PsA (66) and 5 RA (16), while patellar tendon enthesopathy was visualized in 3 RA (10) and 11 PsA patients (36). Conclusion: We observed a more frequent prevalence of enthesopathy in the PsA than in the RA group. No significant difference in the occurrence of joint effusion and synovitis was de- tected. Further investigations on knee involvement, by US technique, in a larger number of PsA and RA patients would be useful to establish the prevalence and the features of articular and periarticular involvement
US Examination of Wrists and Hands: a Comparison Between Rheumatoid Arthritis and Psoriatic Arthritis
No full textPurpose: Very little is known about the possible differences in the involvement of joints and periarticular structures in rheumatoid or psoriatic arthritis (PsA). The main pathological features detected by US in rheumatoid arthritis (RA) are synovitis and bone erosion while, in spondyloarthropathies, entheseal inflammation is the common feature. Tendon involvement is particularly frequent and dactylitis is a typical PsA manifestation. Aim of the study was to investigate the features of wrist and hand involvement in PsA and RA. Method: Bilateral ultrasound (US) examination of the wrist and hand was performed, by the same physician, in a group of subjects affected by RA (n25; F:M20:5; disease duration: 12.5±11 years) and PsA (n25; F:M8:17; disease duration: 8.5±7 years), using a Logiq 9 (General Electrics Medical Systems, Milwaukee, WI) with a linear probe operating at 14 MHz. We examined radiocarpal, intercarpal, metacarpophalangeal, proximal interphalangeal and distal interphalangeal (DIP) joints and flexor and extensor tendons (both in wrist and hand). The patients were recruited on a time-criteria (the last 25 patients for each diagnosis who camed for an outpatient control) from the whole number of subjects referring to the US unit of our Clinic. Results: US examination showed joint wrist synovitis in 10/25 (40) and 12/25 (48) patients (in PsA and RA respectively), hand synovitis in 14/25 (56) and in 16/25 (64) RA and PsA patients respectively. We found DIP joint involvement in only 1 PsA patient, as it was for dactylitis (in a different PsA patient). Bone erosions were present in 10/25 (40) patients, both in RA and PsA group. Tendon involvement was present in the 7/25 (28) and 5/25 (20) in the wrist and 7/25 (28) and 10/25 (40) in the hand respectively. Conclusion: We did not observed significant differences in wrist or hand involvement (both in joint and tendon structures) between RA and PsA patients, except for a more frequent involvement of PIP joints and a slightly higher hand’s tenosynovitis in PsA group
MRI pattern of arthritis in systemic lupus erythematosus: a comparative study with rheumatoid arthritis and healthy subjects
No full textOBJECTIVE:
In this study we aimed to describe the magnetic resonance imaging (MRI) pattern of the distribution of bone marrow edema (BME) and joint erosion in hands and wrists of patients with systemic lupus erythematosus (SLE) with arthritis in comparison with rheumatoid arthritis (RA) and healthy subjects (H).
METHODS:
SLE patients with arthritis (n = 50), patients with RA (n = 22), and H (n = 48) were enrolled. Every patient underwent a non-dominant hand (2nd-5th metacarpophalangeal joints) and wrist MRI without contrast injection with a low-field extremity dedicated 0.2-Tesla instrument.
RESULTS:
BME was observed in two SLE patients in the hand (4%) and in 15 in the wrist (13%) versus three (30%), and 14 (63%) RA patients. No BME was found in H. Erosions were observed in the hand in 24 SLE patients (48%), 15 RA patients (68%), and 9 H (18 %); in the wrist, in 41 (82%) SLE, all RA and 47 (97%) H. The cumulative erosive burden in SLE was significantly higher than in H (c = 0.002) but similar to RA patients.
CONCLUSIONS:
Joint involvement of the wrist in SLE is similar to RA and is not as rare as expected, as shown by the comparison with healthy subjects. On the contrary, the involvement of the hand in SLE is significantly lower compared to RA
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