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El Palomar, Argentina

Ferreyra-Garrott L.,Seccion Reumatologia | Meneses G.,Seccion Osteopatias Metabolicas | Plantalech L.,Seccion Osteopatias Metabolicas
Actualizaciones en Osteologia

Idiopathic Multicentric Osteolysis (IMO) is a rare disease characterized by osteolysis of carpus and tarsus, with inflammation and pain with onset in childhood and arrest y the second or third decade. It is classified by Hardegger in 5 Types, 1: Hereditary IMO with dominant transmission. 2: Hereditary IMO with recessive transmission. 3: Non Hereditary IMO, associated with nephropathy and hypertension. 4: Gorham's syndrome: massive osteolysis and replacement of bone by lymphatic or blood vessel tissue. 5: Winchester's syndrome: IMO with short stature, contractures, thick skin, corneal opacities and osteoporosis. A 50 year old male with a history of pain, swelling and deformity in both wrists and tarsi evolving from age 4, attends the consultation. He has functional involvement of hands and feet. At age 34 he had referred the presence of proteinuria, edema and hypertension, and developed chronic renal falilure (CRF). Dialysis and renal transplantation were indicated. No family history of IMO. Findings: Reduced function of boths hands, limited range of wrist and finger deformity, muscular forearms and legs dystrophy. He walked with difficulty. It is observed on radiographs, absence of carpal and tarsal bones, phalanges commitment. Physiotherapy rehabilitation and treatment with bisphosphonates and vitamin D was indicated. A patient with IMO associated with CRF and hypertension, was presented. He has absence of family history. It is considered Type III IMO. The IMO is a rare diseases, early diagnosis prevents unnecessary treatment and can treat kidney disease and hypertension at an earlier stage. Source

The number of adolescent patients with chronic diseases and special heath needs are increasing, and they are reaching adulthood. Sometimes the passage to the adult health care is abrupt, depending upon the chronological age reached or because of an acute health problem that requires hospitalization. In order to facilitate the transition process, preparation of the child, the family and the health professionals involved is needed, as well as the coordination between the pediatric group and the adult team that will be incharge of the patient. This review shows the obstacles to this process and the recommended implementation steps required to a successful transition. It also describes the main aspects of a program that we implemented at the Hospital Italiano de Buenos Aires in conjunction with some departments of adult health care high lighting the main steps to follow before and during program's implementation. Source

Ruta S.,Seccion Reumatologia | Reginato A.M.,Brown University | Pineda C.,Instituto Nacional Of Rehabilitacion | Gutierrez M.,Marche Polytechnic University
Journal of Clinical Rheumatology

Ultrasound (US) is a noninvasive imaging technique that continues to gain interest among rheumatologists because of its undoubted utility for the assessment of a wide range of abnormalities in rheumatic diseases. It also has a great potential to be used at the time of consultation as an extension of the clinical examination. Current data demonstrate that the standard clinical approach could result in an insensitive assessment of some the different aspects of the various rheumatic diseases for which US has become a feasible and effective imaging modality that allows early detection of anatomical changes, careful guidance for the aspiration and/or local treatment, and short- and long-term therapy monitoring at the joint, tendon, enthesis, nail, and skin levels. The spectrum of pathological conditions for which US plays a crucial role continues to increase over time and includes rheumatoid arthritis, spondyloarthropathies, osteoarthritis, crystal-related arthropathies, connective tissue disorders, and vasculitis. It is expected that the inclusion of more longitudinal studies with a larger number of patients and more rigorous methodological approach will undoubtedly provide a better understanding of the significance of the abnormal US findings detected in order to provide the proper diagnostic and/or therapeutic approaches. In this article, we analyze the current potential applications of US in rheumatology and discuss the evidence supporting its use in the daily rheumatologic practice. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Soriano E.R.,Seccion Reumatologia | Soriano E.R.,Instituto Universitario | Soriano E.R.,Rheumatology Unit
Journal of Rheumatology

Although several reviews and metaanalyses have shown lack of evidence of efficacy of traditional disease-modifying antirheumatic drugs (DMARD) in psoriatic arthritis (PsA), these drugs are very often used and are recommended by treatment guidelines around the world as first-line therapy for most patients with PsA. Some new investigations showed that higher doses of methotrexate (MTX) are more beneficial for patients with PsA with peripheral involvement. Also, observational studies have shown that retention of MTX for patients with PsA is comparable to that of patients with rheumatoid arthritis (RA), and that with MTX, remission is achievable by around 20% of patients with PsA. Sulfasalazine, leflunomide, and cyclosporine have also been shown to be effective in a small number of patients, although the overall effect on disease activity for these drugs is small. Although combination of anti-tumor necrosis factor agents with traditional DMARD is not mandatory in PsA as it is in RA, there is evidence that some extra benefit might be achieved when combinations are used, not only for the joints but for the skin. There is still room for the use of traditional DMARD in PsA, and for the time being, DMARD should still be considered as first-line therapy for most patients with PsA. The Journal of Rheumatology Copyright © 2012. All rights reserved. Source

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for treating symptoms of rheumatologic diseases, such as osteoarthritis and rheumatoid arthritis. Knowing their side effects and the way to minimize them is a medical responsibility. To reduce NSAID-related risk, clinicians should choose a gastroprotective strategy. This may include coprescribing a traditional NSAID with a proton pump inhibitor or a high-dose histamine 2-receptor antagonist (H 2RA), or using a cyclo-oxygenase (COX)-2 selective inhibitor or a COX-2 with a proton pump inhibitor. Assessing each patient's risk (cardiovascular and gastrointestinal) is a priority in order to decide the best intervention to minimize toxicity. In this article, we review some of the common interventions for reducing the gastrointestinal side effects of NSAIDs. © 2011 Scolnik and Singh, publisher and licensee Dove Medical Press Ltd. Source

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