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Duarte-Salazar C, Vazquez-Meraz JE, Ventura-Ríos L, Hernández-Díaz C, Arellano-Galindo J. Polymyalgia Rheumatica Post-SARS-CoV-2 Infection. Case Reports Immunol 2024; 2024:6662652. [PMID: 38516555 PMCID: PMC10957256 DOI: 10.1155/2024/6662652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
There is growing evidence that infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to dysregulation of the immune system and, consequently, the development of autoimmune phenomena. Here, we describe the case of a 75-year-old woman with rheumatic manifestations characterized by intense musculoskeletal pain and stiffness in the neck and shoulders, with sudden onset and with the inability to raise her arms. The patient was admitted with severe pain located in the neck and shoulders. Previously, she had oropharyngeal pain, severe fatigue, and fever; a real-time polymerase chain reaction test for COVID-19 was positive. Two weeks later, the patient presented localized musculoskeletal pain in the neck and shoulders. Relevant laboratory results included an erythrocyte sedimentation rate of 46 mm/hr and a negative rheumatoid factor test; ultrasound findings with bilateral subacromial-subdeltoid bursitis were observed. A diagnosis of polymyalgia rheumatica (PMR) was initially made according to the EULAR/ACR provisional classification criteria for PMR; however, due to C-reactive protein negativity, the diagnosis was established based on symptoms. Management was with prednisone at the dose of 25 mg/day for 4 weeks and progressive reduction until prednisone suspension. The patient showed complete recovery at 6 months of follow-up. In this case, COVID-19 was implicated in the development of autoimmune and inflammatory rheumatic manifestations. PMR is a rare rheumatic condition that should be included in the wide range of rheumatologic manifestations expressed post-SARS-CoV-2 infection.
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Affiliation(s)
- Carolina Duarte-Salazar
- Departmento de Reumatología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | - Lucio Ventura-Ríos
- Departmento de Reumatología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Cristina Hernández-Díaz
- Departmento de Reumatología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - José Arellano-Galindo
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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Loredo C, Yañez P, Hernández-Díaz C, Cruz-Arenas E, Ventura-Ríos L. Low prevalence of subclinical synovitis in patients with juvenile idiopathic arthritis (JIA) in long-term clinical remission on medication. Clin Rheumatol 2024; 43:393-398. [PMID: 37542584 DOI: 10.1007/s10067-023-06729-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
Subclinical synovitis is highly prevalent in patients with JIA in clinical remission (CR) with a short duration. The objective was to evaluate its prevalence by ultrasound (US) in patients with JIA in long CR during a one-year follow-up. In this prospective and longitudinal study, we included 76 patients with JIA according to ILAR with CR by the Wallace modified criteria and JADAS27 and compared them with 22 patients with active disease. Clinical and demographic characteristics were recorded. US evaluation was by 10-joint count. Differences in US evaluations were analyzed by the Mann-Whitney U test. There were no differences among the two group with regard to disease duration at enrollment, and age (p = 0.540 and p = 0.080, respectively), but JADAS 27, CHAQ, and acute phase reactants were significantly higher (p < 0.001) in the clinically active group. The prevalence of subclinical synovitis at baseline and the end of the study in the CR group was 18.4% and 11.8%, respectively, while it was 100% and 40.9% in the active disease group. Subclinical synovitis at baseline was significantly more prevalent in the clinically active group (elbow, p = 0.01; wrist, p = 0.001; MCP 2, p = 0.001; knee, p = 0.001 and ankle p = 0.001; and PD only in the ankle, p = 0.002). The concordance of inter-reader reliability in all evaluated joints was excellent (p = 0.001). Although the prevalence of subclinical synovitis is low in patients with JIA with long-term clinical remission on medication, a percentage of patients continue to have subclinical involvement that could predict the risk of relapse and structural damage. Key Points • Subclinical synovitis is less prevalent in JIA in long-term clinical remission compared to patients in short-term remission. • The persistence of imaging signs of inflammation in a significant percentage of patients may indicate the need for ongoing medication.
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Affiliation(s)
- Claudia Loredo
- Department of Pediatric Rheumatology, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Patricia Yañez
- Department of Pediatric Rheumatology, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | - Esteban Cruz-Arenas
- Hospital Epidemiological Surveillance Unit-Sociomedical Research, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Lucio Ventura-Ríos
- Division of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Calzada Mexico-Xochimilco 289, Mexico City, Mexico.
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Guízar-Sánchez C, Hernández-Díaz C, Guízar-Sánchez D, Meza-Sánchez AV, Torres-Serrano A, Camacho Cruz ME, Ventura-Ríos L. Ultrasound findings in painful spastic hip. Muscle thickness in children with cerebral palsy. BMC Musculoskelet Disord 2023; 24:512. [PMID: 37349815 DOI: 10.1186/s12891-023-06610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND In cerebral palsy (CP), spasticity is the dominant symptom and hip pain is one of the most common secondary conditions. Aetiology is not clear. Musculoskeletal ultrasound (MSUS) is a low-cost, non-invasive imaging technique that allows assessment of structural status, dynamic imaging, and quick contralateral comparison. OBJECTIVE A retrospective case-matched-control study. To investigate associated factors with painful spastic hip and to compare ultrasound findings (focusing on muscle thickness) in children with CP vs. typically developing (TD) peers. SETTING Paediatric Rehabilitation Hospital in Mexico City, from August to November 2018. PARTICIPANTS 21 children (13 male, 7 + 4.26 years) with CP, in Gross Motor Function Classification System (GMFCS) levels IV to V, with spastic hip diagnosis (cases) and 21 children age- and sex-matched (7 + 4.28 years) TD peers (controls). CHARACTERISTICALLY DATA Sociodemographic data, CP topography, degree of spasticity, mobility arch, contractures, Visual Analog Scale (VAS), GMFCS, measurements of the volumes of eight major muscles of the hip joint and MSUS findings of both hips. RESULTS All children with CP group reported chronic hip pain. Associated factors for hip pain (high VAS hip pain score) were degree of hip displacement (percentage of migration), Ashworth Level, GMFCS level V. No synovitis, bursitis or tendinopathy was found. Significant differences (p < 0.05) were found in muscle volumes in all hip muscles (right and left) except in the right and left adductor longus. CONCLUSION Though possibly the most important issue with diminished muscle growth in CP children is the influence on their long-term function, it is likely that training routines that build muscle size may also increase muscle strength and improve function in this population. To improve the choice of treatments in this group and maintain muscle mass, longitudinal investigations of the natural history of muscular deficits in CP as well as the impact of intervention are needed.
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Affiliation(s)
- Claudia Guízar-Sánchez
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | | | - Diana Guízar-Sánchez
- Physiology Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, México, Av. Universidad 3004, Col. Copilco Universidad, Alcaldía Coyoacán, Cd. Universitaria.
| | - Ana Victoria Meza-Sánchez
- Radiology and Imaging Department, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubirán., Ciudad de México, México
| | - Alejandra Torres-Serrano
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | - María Elena Camacho Cruz
- Pediatric Physical Medicine and Rehabilitation Service, Hospital de Pediatría Centro Médico Nacional Siglo XXI (CMNSXXI), Mexico City, México
| | - Lucio Ventura-Ríos
- Rheumatology Department, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, México
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Nava-Bringas TI, Trani-Chagoya YP, Ventura-Ríos L, Hernández-Díaz C, Romero-Fierro LO, Macías-Hernández SI. Spine stabilization exercises are not superior to flexion exercises for ultrasound-detected muscle thickness changes in patients with chronic low back pain and lumbar spondylolisthesis. Acta Ortop Mex 2022; 36:230-233. [PMID: 36977642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION exercise programs can reduce pain and improve functionality in patients with degenerative spondylolisthesis and chronic low back pain. However, there is still no consensus surrounding the superiority of any specific routine for exercise-induced trophic changes of lumbar muscles. The aim was to compare the changes in the primary lumbar stabilizing muscle thickness after spine stabilization exercises and flexion exercises in patients with spondylolisthesis and chronic low back pain. MATERIAL AND METHODS prospective, longitudinal and comparative study was carried out. Twenty-one treatment-naive patients with a diagnosis of both chronic low back pain and degenerative spondylolisthesis over the age of 50 were included. A physical therapist taught participants either spine stabilization exercises or flexion exercises to execute daily at home. The thickness of the primary lumbar muscles was measured through ultrasound (at rest and contraction) at baseline and three months. A Mann-Whitney U test and Wilcoxon signed-rank test were performed for comparisons, and Spearman's rank correlation coefficients were calculated for associations. RESULTS we did not find statistically between the exercise programs: all patients presented significant changes in the thickness of the multifidus muscle but in none of the other evaluated muscles. CONCLUSION there is no difference between spine stabilization exercises and flexion exercises after three months in terms of the changes in muscle thickness evaluated by ultrasound.
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Affiliation(s)
- T I Nava-Bringas
- Department of Orthopedic Rehabilitation. Instituto Nacional de Rehabilitación «Luis Guillermo Ibarra Ibarra». Av. México-Xochimilco 289, C.P. 14389. Ciudad de México. México
| | - Y P Trani-Chagoya
- Department of Orthopedic Rehabilitation, Department of Rehabilitation. Hospital General Naval de Lázaro Cárdenas, Michoacán. México
| | - L Ventura-Ríos
- Department of Radiology and Research. Instituto Nacional de Rehabilitación «Luis Guillermo Ibarra Ibarra». Av. México-Xochimilco 289, C.P. 14389. Ciudad de México. México
| | - C Hernández-Díaz
- Department of Radiology and Research. Instituto Nacional de Rehabilitación «Luis Guillermo Ibarra Ibarra». Av. México-Xochimilco 289, C.P. 14389. Ciudad de México. México
| | - L O Romero-Fierro
- Department of Orthopedic Rehabilitation. Department of Rehabilitation. Hospital Naval de Tapachula. Tapachula, Chiapas. México
| | - S I Macías-Hernández
- Department of Orthopedic Rehabilitation. Instituto Nacional de Rehabilitación «Luis Guillermo Ibarra Ibarra». Av. México-Xochimilco 289, C.P. 14389. Ciudad de México. México
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Barbosa-Cobos RE, Torres-González R, Meza-Sánchez AV, Ventura-Ríos L, Concha-Del-Río LE, Ramírez-Bello J, Álvarez-Hernández E, Meléndez-Mercado CI, Enríquez-Sosa FE, Samuria-Flores CJ, Lugo-Zamudio GE, Hernández-Díaz C. A Novel Technique for the Evaluation and Interpretation of Elastography in Salivary Gland Involvement in Primary Sjögren Syndrome. Front Med (Lausanne) 2022; 9:913589. [PMID: 35746947 PMCID: PMC9210135 DOI: 10.3389/fmed.2022.913589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Ultrasound (US) of major salivary glands (MSG) evaluates echogenicity, border features and vascularization, with elastography, it can detect tissue elasticity and glandular fibrosis, related to inflammation in Primary Sjögren’s syndrome (pSS). This study aimed to develop a novel technique by pixel analysis for evaluation and interpretation of elastography in MSG in pSS. A cross-sectional and observational multicenter study was conducted. The US of MSG performed in orthogonal planes in grayscale, Doppler, and shear-wave elastography. For elastography images of each gland were analyzed with the open-source program ImageJ to perform a pixel analysis. Statistical analysis was performed with the IBM-SPSS v25 program. Fifty-nine women with a mean age of 57.69 (23–83) years were recruited; pSS mean duration of 87 (5–275) months, and 12 healthy women without sicca symptoms as a control group with a mean age of 50.67 (42–60) years. Intragroup analysis showed p-values >0.05 between sicca symptoms, ocular/dryness tests, biopsy, US, and pixel analysis; correlation between Hocevar and pixel analysis was not found (rho < 0.1, p >0.5). MSG anatomical size was 41.7 ± 28.2 mm vs. 67.6 ± 8.8 mm (p ≤ 0.0001); unstimulated whole saliva flow rate was 0.80 ± 0.80 ml/5 min vs. 1.85 ± 1.27 ml/5 min (p = 0.016). The elastography values (absolute number of pixels) were 572.38 ± 99.21 vs. 539.69 ± 93.12 (p = 0.290). A cut-off point risk for pSS identified with less than 54% of red pixels in the global MSG mass [OR of 3.8 95% CI (1.01–15.00)]. Pixel analysis is a new tool that could lead to a better understanding of the MSG chronic inflammatory process in pSS.
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Affiliation(s)
- Rosa Elda Barbosa-Cobos
- Servicio de Reumatología, Hospital Juárez de México, Centro Médico ABC y Grupo "Manifestaciones Oculares en Reumatología" MOR, Mexico City, Mexico
| | - Rubén Torres-González
- Dirección de Educación e Investigación en Salud, Unidad Médica de Alta Especialidad (UMAE) de Traumatología, Ortopedia, Rehabilitación "Dr. Victorio de la Fuente Narváez," Instituto Mexicano del Seguro Social (IMSS) y Grupo "Manifestaciones Oculares en Reumatología" MOR, Mexico City, Mexico
| | - Ana Victoria Meza-Sánchez
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico.,División de Reumatología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
| | - Lucio Ventura-Ríos
- División de Reumatología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
| | - Luz Elena Concha-Del-Río
- Clínica de Enfermedades Inflamatorias Oculares, Asociación Para Evitar la Ceguera en México (APEC), Hospital de la Ceguera "Dr. Luis Sánchez Bulnes," y Grupo "Manifestaciones Oculares en Reumatología" MOR, Mexico City, Mexico
| | - Julián Ramírez-Bello
- Departamento de Endocrinología, Instituto Nacional de Cardiología, Mexico City, Mexico
| | | | | | | | - Cinthia Jahoska Samuria-Flores
- Servicio de Reumatología, Hospital Juárez de México, Centro Médico ABC y Grupo "Manifestaciones Oculares en Reumatología" MOR, Mexico City, Mexico
| | - Gustavo Esteban Lugo-Zamudio
- Servicio de Reumatología, Hospital Juárez de México, Centro Médico ABC y Grupo "Manifestaciones Oculares en Reumatología" MOR, Mexico City, Mexico
| | - Cristina Hernández-Díaz
- División de Reumatología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
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Ventura-Ríos L, Cazenave T, Hernández-Díaz C, Gallegos-Nava S, Gómez-Ruiz C, Rosemffet M, Silva-Luna K, Rodríguez-Henríquez P, Vázquez-Mellado J, Casasola-Vargas J, Cruz-Arenas E, de Miguel EM. Entheseal Involvement in Spondyloarthritis (SpA) and Gout: An Ultrasound Comparative Study. Front Med (Lausanne) 2022; 9:871760. [PMID: 35685413 PMCID: PMC9170994 DOI: 10.3389/fmed.2022.871760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the assessment of entheses in subjects with spondyloarthritis (SpA) with patients with gout by the Madrid Sonographic Enthesis Index (MASEI). Method This cross-sectional study includes videos of entheses evaluated by ultrasound (US) of 30 patients with SpA diagnosed according to the ASAS criteria and 30 patients with gout established by the presence of monosodium urate crystals. Entheses were evaluated for MASEI in 2 Institutes located in two different countries. Demographic and clinical data were registered. Total MASEI score, MASEI-inflammatory, and MASEI-chronic damage were analyzed. Comparisons between groups were obtained by chi-square test and Student's t-test. An inter-reading US reliability was realized. Results Patients with gout were older and had significantly more comorbidities than those with SpA. The total MASEI score was not significantly different among diseases (p = 0.07). MASEI-inflammatory was significantly more prevalent at the Achilles tendon in SpA, while the proximal patellar tendon was in gout. Power Doppler was higher in SpA compared to gout (p = 0.005). MASEI-chronic damage related to calcification/enthesophytes predominated in gout (p = 0.043), while calcaneal erosions did in SpA (p = 0.008). The inter-reader concordance was excellent (0.93, CI 95% 0.87–0.96, p = 0.001). Conclusions SpA and gout similarly involve entheses according to MASE, however, some inflammatory and chronic lesions differ significantly depending on the underlying disease and tendon scanned.
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Affiliation(s)
- Lucio Ventura-Ríos
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Tomas Cazenave
- Department of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Cristina Hernández-Díaz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Selma Gallegos-Nava
- Department of Rheumatology, Hospital General Dr. Darío Fernández Fierro, Mexico City, Mexico
| | | | - Marcos Rosemffet
- Department of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Karina Silva-Luna
- Service of Rheumatology, Hospital Universitario "Dr. JoséEleuterio González", Monterrey, Mexico
| | | | | | | | - Esteban Cruz-Arenas
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Unidad de Vigilancia Epidemiológica Hospitalaria-Investigación Sociomédica, México City, Mexico
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Silva-Luna K, Ventura-Ríos L, López-Macay A. Prolidase expression in knee osteoarthritis and healthy controls: Observational study. Medicine (Baltimore) 2021; 100:e27059. [PMID: 34477138 PMCID: PMC8415933 DOI: 10.1097/md.0000000000027059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
Prolidase enzyme activity is important for collagen resynthesis. In late stages of osteoarthritis (OA) its activity is decreased.To evaluate prolidase expression in knees of patients undergoing total arthroplasty for OA, and compare with young people undergoing knee arthroscopy due to traumatic injuries.In this cross-sectional study we included 20 patients with OA grade IV who underwent total knee arthroplasty and 20 controls of young patients who underwent arthroscopy for another reason besides OA. All participants were evaluated by knee ultrasound before the procedure. During the procedure, synovial tissue biopsies were taken and analyzed by immunofluorescence to search inflammation. Measures of central tendency, dispersion measures and position measures were used for the case of quantitative variables. Student t test or Mann-Whitney U test, and the logistic regression of Cox, was used.Prolidase expression in the synovial biopsy was significantly lower in the OA group than in the controls (0.017 ± 0.009 vs 0.062 ± 0.094, P < .05). Power Doppler (PD) signal was present in the synovitis of all knee recesses of the OA group in grayscale and in 17 (85%) of knees. The mean of the micro-vessel count in patients with OA was significantly higher vs controls (11 + 5.3 vs 4 + 2.1, P = .001). The neovascularization correlated significantly with the presence of PD signal in patients with OA (1.16, 95% CI, 1.02-1.34, P = .02).The prolidase expression in the synovial membrane evaluated by immunofluorescence, in patients with late stages of knee OA, is low, which may be interpreted as an evidence of decreased collagen resynthesis.
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Affiliation(s)
- Karina Silva-Luna
- Rheumatology Service and Clinical Immunology of the University Hospital “Dr. José Eleuterio González,” Monterrey, Nuevo León, Mexico
| | - Lucio Ventura-Ríos
- Musculoskeletal and Joint Ultrasound Laboratory, National Institute of Rehabilitation “Luis Guillermo Ibarra Ibarra,” Mexico City, Mexico
| | - Ambar López-Macay
- Laboratory of Neuromuscular Diseases, National Institute of Rehabilitation “Luis Guillermo Ibarra Ibarra,” Mexico City, Mexico
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Zamudio-Cuevas Y, Martínez-Nava GA, Martínez-Flores K, Ventura-Ríos L, Vazquez-Mellado J, Rodríguez-Henríquez P, Pineda C, Franco-Cendejas R, Lozada-Pérez CA, Fernández-Torres J. Synovial fluid analysis for the enhanced clinical diagnosis of crystal arthropathies in a tertiary care institution. Clin Rheumatol 2021; 40:3239-3246. [PMID: 33598809 DOI: 10.1007/s10067-021-05610-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION/OBJECTIVES Few studies have addressed the detection and clinical impact of different crystals in patients with diverse rheumatologic diagnoses in Latin America. The aim of this study was to assess the consistency between the clinical referring diagnosis and the identification of crystals, such as monosodium urate (MSU) and calcium pyrophosphate (CPP), in the synovial fluid (SF) of patients from a Mexican tertiary care institution. METHODS We reviewed the results of 264 SF analyses to identify any changes in diagnosis upon SF analysis. We reported patient medical file data on sex, age, diagnosis, and microscopic SF analysis results. We performed consistency analyses between referring diagnoses and SF findings with McNemar's test. RESULTS The prevalence of MSU crystals in SF was noted in 89.1% of gout cases and 9.09% of cases of calcium pyrophosphate disease (CPPD). CPP crystals were present in 54.5% of CPPD cases, 42.9% of osteoarthritis (OA) cases, and 7.27% of gout cases. Calcium hydroxyapatite (HA) crystals were identified in 5.45% of gout cases, 33.3% of rheumatoid arthritis (RA) cases, 57.1% of OA cases, and 63.6% of CPPD cases. Cholesterol and lipid crystals were present in small proportions in RA cases. Glucocorticoid crystals were observed in 1.85% of gout cases, 44.4% of RA cases, and 42.9% of OA cases. We observed an association of MSU identification with clinical suspicion of gout (P = 0.08), CPP with OA (P = 0.26) and CPPD (P = 0.50). An association was noted between HA and the diagnosis of CPPD (P = 0.84) and OA (P > 0.99). The number of initial diagnoses that changed upon SF analysis was 14.3%. CONCLUSIONS SF analysis has major diagnostic value regarding MSU crystals and gout. Our findings underscore the importance of SF crystal analysis in identifying the prevalence of crystals in the Mexican population. SF analysis provides for better diagnosis of crystal arthropathies and improves the quality of the medical care that the patient receives. Key Points • Synovial fluid analysis in laboratories from developing countries has been scarce. • In some cases, the initial diagnosis is modified after of synovial fluid analysis. • This study confirmed that synovial fluid analysis exhibits major diagnostic value for urate crystals and gout.
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Affiliation(s)
- Yessica Zamudio-Cuevas
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra-Ibarra (INR-LGII), Calzada México-Xochimilco 289, Colonia Arenal de Guadalupe, 14389, Mexico City, Tlalpan, Mexico
| | - Gabriela Angélica Martínez-Nava
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra-Ibarra (INR-LGII), Calzada México-Xochimilco 289, Colonia Arenal de Guadalupe, 14389, Mexico City, Tlalpan, Mexico
| | - Karina Martínez-Flores
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra-Ibarra (INR-LGII), Calzada México-Xochimilco 289, Colonia Arenal de Guadalupe, 14389, Mexico City, Tlalpan, Mexico
| | - Lucio Ventura-Ríos
- Laboratorio de Ultrasonido Músculo-Esquelético Articular, INR-LGII, Mexico City, Mexico
| | - Janitzia Vazquez-Mellado
- Department of Rheumatology, Hospital General de México Eduardo Liceaga, Dr. Balmis 148. Doctores, 06720, México City, Cuauhtémoc, Mexico
| | - Pedro Rodríguez-Henríquez
- Department of Rheumatology, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, Belisario Domínguez Seccion 16, 14080, Mexico City, Tlalpan, Mexico
| | - Carlos Pineda
- División de Enfermedades Músculo-Esqueléticas y Reumáticas, INR-LGII, Mexico City, Mexico
| | | | | | - Javier Fernández-Torres
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra-Ibarra (INR-LGII), Calzada México-Xochimilco 289, Colonia Arenal de Guadalupe, 14389, Mexico City, Tlalpan, Mexico. .,Biology Department, Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, 04510, Mexico City, Coyoacán, Mexico.
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Ferrusquia-Toriz D, Hernández-Díaz C, Amezcua-Guerra LM, Ventura-Ríos L, Higuera-Ortiz V, Lozada-Navarro AC, Silveira LH. Ultrasound characterization of the nail bed in patients with systemic lupus erythematosus. Lupus 2021; 30:608-614. [PMID: 33470159 DOI: 10.1177/0961203320988609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To characterize the ultrasound findings of the nail plate and nail bed in systemic lupus erythematosus (SLE) and its association with nail dystrophy. METHODS Thirty-two SLE patients, 36 patients with osteoarthritis (OA) and 20 healthy individuals were studied. High-frequency linear ultrasound was performed in nails of the second to fifth fingers in all participants. Disease activity (SLEDAI-2K index), accrued organ damage (SLICC/ACR index), autoantibody profile, and Raynaud's phenomenon were also assessed in SLE patients. RESULTS Nail bed thickness in SLE patients was higher than in healthy individuals (1.25 ± 0.31 mm vs 1.17 ± 0.29 mm; P = 0.01) but lower than in OA (1.39 ± 0.37 mm; P < 0.001), while nail plate thickness was similar among groups. Nail dystrophy was found more frequently in SLE and OA than in healthy individuals. SLE patients with nail dystrophy were older than their counterparts with no dystrophy (39.4 ± 10.4 years vs 27.8 ± 5.6 years; P = 0.004), although nail dystrophy showed no association with SLICC/ACR, SLEDAI-2K, nail bed vascularity, or autoantibodies. CONCLUSIONS Nail bed in SLE patients is thicker than in healthy individuals but thinner than in OA patients. Nail dystrophy in SLE is associated with advanced age, but not with accrued organ damage, disease activity, Raynaud's phenomenon, or DIP synovitis assessed by ultrasound.
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Affiliation(s)
| | - Cristina Hernández-Díaz
- Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Luis M Amezcua-Guerra
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Lucio Ventura-Ríos
- Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Violeta Higuera-Ortiz
- Department of Rheumatology, The American British Cowdray Hospital, Mexico City, Mexico.,Department of Rheumatology, General Hospital No. 8, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ana C Lozada-Navarro
- Internal Medicine, Hospital Faro del Mayab/Christus Muguerza, Mérida Yucatán, Mexico
| | - Luis H Silveira
- Department of Rheumatology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Duarte-Salazar C, Marín-Arriaga N, Ventura-Ríos L, Alpízar-Aguirre A, Pichardo-Bahena R, Arellano Hernández A. Gota tofácea en la columna lumbar causando radiculopatía. ACTA ACUST UNITED AC 2020; 16:410-412. [DOI: 10.1016/j.reuma.2018.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 02/01/2023]
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Ventura-Ríos L, Sánchez Bringas G, Hernández-Díaz C, Cruz-Arenas E, Burgos-Vargas R. Subclinical synovitis and tenosynovitis by ultrasonography (US) 7 score in patients with rheumatoid arthritis treated with synthetic drugs, in clinical remission by DAS28. ACTA ACUST UNITED AC 2019; 15:e5-e9. [DOI: 10.1016/j.reuma.2017.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/18/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
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12
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Hernández-Díaz C, Sánchez-Bringas G, Ventura-Ríos L, Robles-San Román M, Filippucci E. Ankle pain in rheumatoid arthritis: comparison of clinical and sonographic findings. Clin Rheumatol 2019; 38:2891-2895. [DOI: 10.1007/s10067-019-04532-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 12/30/2022]
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Ventura-Ríos L, Faugier E, Barzola L, De la Cruz-Becerra LB, Sánchez-Bringas G, García AR, Maldonado R, Roth J, Hernández-Díaz C. Reliability of ultrasonography to detect inflammatory lesions and structural damage in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2018; 16:58. [PMID: 30223838 PMCID: PMC6142317 DOI: 10.1186/s12969-018-0275-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Musculoskeletal Ultrasonography (MSUS) is an important tool for the clinical assessment in Juvenile Idiopathic Arthritis (JIA). The objective of this study was to evaluate the reliability of MSUS to detect elementary lesions: synovitis, tenosynovitis, cartilage damage and bone erosions in the wrist and metacarpal (MCP) joints of patients with JIA. METHODS Thirty children in various subgroups of JIA according to ILAR criteria, were included in this cross-sectional study. Clinical data including painful, swollen and limited joints were recorded. Five rheumatologist ultrasonographers, blinded to the clinical evaluation, evaluated the presence of elementary lesions in the wrist and MCP 2 and 3 joints bilaterally. The synovitis was graded in B-Mode and Power Doppler (PD). In addition to descriptive statistics intra- and inter-observer reliability was calculated using Cohen's kappa according to Landis and Koch. RESULTS US detected more synovitis than the clinical examination (62% vs 28%, 30% vs 23% and 22% vs 17% in the wrist, second and third MCP joints respectively). The intra-observer concordance for synovitis in all joints was excellent in B-Mode (k 0.84 .63-1.0 p = 0.001), except for MCP 2, where it was good (0.61, IC 95% .34-89, p = 0.001). For both modalities (PD, B-Mode) tenosynovitis, cartilage damage and bone erosions it was also excellent. Regarding synovitis grading the concordance was excellent for all grades (0.83-1.0, IC 95% 0.51.1.0, p = 0.001), except for grade 1 where it was good (0.61, IC 95% 0.43-.83, p = 0.001). Reliability inter-observer for grayscale synovitis (0.67-0.95, IC 95% 0.67-1.0, p = 0.001), tenosynovitis grayscale (0.89, IC 95% 0.78-0.99, p.001), damage cartilage (0.89, IC 95% 0.78-0.99, p = 0.001), PD (0.66, IC 95% 0.39-1.0, p = 0.001). The concordance for grading synovitis was excellent, but for grayscale grade 1 and 2 (.66, IC 95% .53-.74, p = 0.007) and PD grade 1 and 2 (0.63, IC 95% .58-.91, p = 004) was good. CONCLUSIONS The intra- and inter-observer reliability of MSUS for inflammatory and structural lesions is good to excellent for the wrist and MCP in patients with JIA.
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Affiliation(s)
- Lucio Ventura-Ríos
- Laboratorio de ultrasonido musculoesquelético y articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, 14389, Mexico city, Mexico.
| | - Enrique Faugier
- 0000 0004 0633 3412grid.414757.4Reumatología Pediátrica, Hospital Infantil de México, Mexico city, Mexico
| | - Laura Barzola
- grid.414547.7Reumatología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - L. B. De la Cruz-Becerra
- 0000 0004 1760 058Xgrid.464574.0Hospital Universitario “Dr. José E. González”, UANL, Monterrey, Nuevo León Mexico
| | - Guadalupe Sánchez-Bringas
- 0000 0001 2159 0001grid.9486.3Embriology Department, Medicine School, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Andrés Rodríguez García
- 0000 0004 0633 3412grid.414757.4Reumatología Pediátrica, Hospital Infantil de México, Mexico city, Mexico
| | - Rocío Maldonado
- 0000 0004 0633 3412grid.414757.4Reumatología Pediátrica, Hospital Infantil de México, Mexico city, Mexico
| | - Johannes Roth
- 0000 0000 9402 6172grid.414148.cDivision of Pediatric Dermatology & Rheumatology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Cristina Hernández-Díaz
- 0000 0004 0633 2911grid.419223.fLaboratorio de ultrasonido musculoesquelético y articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, 14389 Mexico city, Mexico
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Ventura-Ríos L, Hayes-Salinas M, Ferrusquia-Toriz D, Cariño-Escobar RI, Cruz-Arenas E, Gutiérrez-Martínez J, González-Ramírez L, Hernández-Díaz C. Motion deficit in nodal interphalangeal joint osteoarthritis by digital goniometer in housewives. Clin Rheumatol 2018; 37:1645-1652. [PMID: 29350331 DOI: 10.1007/s10067-018-3981-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/03/2018] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
Abstract
Range of motion (ROM) measured objectively in nodal hand osteoarthritis (NHOA) is missing. Evaluation of collateral ligaments by ultrasound (US) is unknown in NHOA also. To compare ROM in interphalangeal joints in housewives with nodal OA, with a control group by a digital system using angle to voltage (Multielgon). The second objective was to assess correlation between collateral radial and ulnar ligaments thickness and ROM. For this cross-sectional observational study, we assessed 60 hands with symptomatic NHOA and 30 hands of healthy housewives matched for age. We obtained clinical and demographic characteristics (a complete standardized physical examination of hand joints, DASH questionnaire, pain surveys, gross grasp hand goniometer, and ROM measurements by Multielgon. Presence of synovitis, power Doppler signal, osteophytes, and collateral ligaments thickness was evaluated by US. We used descriptive statistics, Spearman correlation, X2 test, t test and odds ratio. Significant less gross grasp and ROM in the right hand were observed in NHOA (p = 0.01 for both). Presence of OA, painful joints, disease duration, and score DASH were significant correlated with reduced ROM (OR 4.12, 4.12, 1.04 and 1.09, respectively). Reduced ROM was statistical significant in thumb MCP and IP joints, second and third DIP in dominant hand. There was no association between collateral radial and ulnar ligaments and reduced ROM. Synovitis and osteophytes were more prevalent in OA group. Multielgon demonstrated the pattern of reduced ROM in nodal OA of housewives particularly in MCP and IP thumb joints, second and third distal interphalangeal joints.
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Affiliation(s)
- L Ventura-Ríos
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, 14389, Mexico City, Mexico.
| | - M Hayes-Salinas
- Servicio de Reumatología, Hospital Escuela y de Clínicas "Virgen María de Fátima", La Rioja, Argentina
| | - D Ferrusquia-Toriz
- Servicio de Reumatología, Hospital General de Tláhuac, Mexico City, Mexico
| | - R I Cariño-Escobar
- División de Investigación Biomédica, Subdirección de Investigación Tecnológica, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - E Cruz-Arenas
- Unidad de Vigilancia Epidemiológica-Investigación Sociomédica, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - J Gutiérrez-Martínez
- División de Investigación Biomédica, Subdirección de Investigación Tecnológica, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - L González-Ramírez
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, 14389, Mexico City, Mexico
| | - C Hernández-Díaz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, 14389, Mexico City, Mexico
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Ventura-Ríos L, Ferrusquia-Toriz D, Saldarriaga LM. Erratum to «Hydroxyapatite and calcium pyrophosphate crystals mimicking gout in systemic sclerosis» [Reumatol Clin. 2017;13(4):235-236]. Reumatol Clin (Engl Ed) 2018; 14:63. [PMID: 29362137 DOI: 10.1016/j.reuma.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Lucio Ventura-Ríos
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación «Luis Guillermo Ibarra Ibarra», Ciudad de México, México.
| | - Diana Ferrusquia-Toriz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación «Luis Guillermo Ibarra Ibarra», Ciudad de México, México
| | - Lina María Saldarriaga
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación «Luis Guillermo Ibarra Ibarra», Ciudad de México, México
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Ventura-Ríos L, Hernández-Díaz C, Sanchez-Bringas G, Madrigal-Santillán E, Morales-González JA, Pineda C. A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound. Clin Rheumatol 2016; 35:2269-76. [PMID: 27393079 DOI: 10.1007/s10067-016-3338-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 02/07/2023]
Abstract
The aim of this study is to characterize bone erosions in metatarsal heads (MTH) in rheumatoid arthritis (RA) and gout by grayscale ultrasound. In a descriptive, cross-sectional study, we evaluated 40 patients with RA and 40 with gout, both diagnosed according to the American College of Rheumatology/European League Against Rheumatism criteria, respectively. All patients had bone erosion demonstrated by ultrasound, which was used, following OMERACT criteria, to describe the shape, size, number, border definition, overhanging margin, topography (intra- or extra-articular), and distribution (over dorsal, medial, lateral, or plantar aspect) of the lesions in the MTH. Descriptive statistics were used and a concordance exercise between two ultrasonographers blinded to the diagnosis was performed. Bone erosions in RA were observed most frequently at the plantar and lateral aspect of the fifth MTH, round in 96 %, small-sized (2.43 ± 0.9 mm), intra-articular (100 %), and single (75 %). Few bone erosions had a well-defined border an overhanging margin while in gout were found most frequently in the medial and dorsal aspect of the first MTH, single in 71 %, intra-articular in 100 %, and of median size (4.0 ± 2.3). For shape, 51 % was round and 49 % was oval. A well-defined border was present in 39 %, and an overhanging margin in 62 %. Inter-rater reliability kappa was excellent (0.81, 95 % CI 0.56-1.00). Some characteristics of bone erosions in RA, including shape, size, ill-defined border, and localization in the fifth MTH could distinguish the lesions from gout. Grayscale US has excellent reliability to describe bone erosions in RA and gout.
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Affiliation(s)
- Lucio Ventura-Ríos
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México.
| | - Cristina Hernández-Díaz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México
| | - Guadalupe Sanchez-Bringas
- Servicio de Cirugía de Columna. Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México
| | - Eduardo Madrigal-Santillán
- Laboratorio de Medicina de Conservación. Escuela Superior de Medicina. Instituto Politécnico Nacional, México City, México
| | - José Antonio Morales-González
- Laboratorio de Medicina de Conservación. Escuela Superior de Medicina. Instituto Politécnico Nacional, México City, México
| | - Carlos Pineda
- Dirección de Investigación, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, México City, México
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Hernández Díaz C, Ventura-Ríos L, De la Cruz Becerra L, Barzola L, Rodríguez García A, Sanchez Bringas G, Faugier E, Roth J. AB0943 Reliability of Musculoskeletal Ultrasound To Detect Elementary Lesions in Juvenile Idiopathic Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Ventura-Ríos L, Sánchez-Bringas G, Pineda C, Hernández-Díaz C, Reginato A, Alva M, Audisio M, Bertoli A, Cazenave T, Gutiérrez M, Mora C, Py G, Sedano O, Solano C, de Miguel E. Tendon involvement in patients with gout: an ultrasound study of prevalence. Clin Rheumatol 2016; 35:2039-2044. [DOI: 10.1007/s10067-016-3309-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/06/2016] [Accepted: 05/11/2016] [Indexed: 12/27/2022]
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Ventura-Ríos L, Ferrusquia-Toriz D, Saldarriaga LM. Hydroxyapatite and calcium pyrophosphate crystals mimicking gout in systemic sclerosis. ACTA ACUST UNITED AC 2016; 13:235-236. [PMID: 27247113 DOI: 10.1016/j.reuma.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/29/2016] [Accepted: 04/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Lucio Ventura-Ríos
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación «Luis Guillermo Ibarra Ibarra», Ciudad de México, México.
| | - Diana Ferrusquia-Toriz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación «Luis Guillermo Ibarra Ibarra», Ciudad de México, México
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Hernández-Díaz C, Ventura-Ríos L, Gutiérrez M, Roth J. Ultrasonography in pediatric rheumatology in Latin America. Expanding the frontiers. Clin Rheumatol 2016; 35:1077-80. [PMID: 26971255 DOI: 10.1007/s10067-016-3217-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/15/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
For the past two decades, musculoskeletal ultrasonography (MSKUS) has developed exponentially and has become an essential tool in rheumatology practice. This development has been far more limited in pediatric rheumatology which is partially related to deficits in the evidence base. Many studies have shown that MSKUS is more sensitive than the clinical examination for detecting synovitis and enthesitis in adults. At the same time, there is a lack of studies demonstrating its validity, reliability, and reproducibility in pediatric rheumatology. In addition, clear definitions for the normal pediatric joint and enthesis as well as various findings in pathology associated with juvenile idiopathic arthritis (JIA) and juvenile spondyloarthritis (JSpA) have only started to emerge. Most of this work is being done through the Outcome Measurement in Rheumatology Clinical Trials (OMERACT) ultrasound pediatric task force but the Pan American League of Associations for Rheumatology (PANLAR) US Pediatric Task Force is also working on validating MSKUS in children. In addition, several MSKUS courses for pediatric rheumatologists have been offered in Latin American countries; these will not only complement the scientific work pediatric-specific ultrasonography training, but also represents an essential component for the successful implementation of this technique into daily practice as well.
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Affiliation(s)
- Cristina Hernández-Díaz
- Laboratorio de Ultrasonido Musculoesquelético, Instituto Nacional de Rehabilitación, Calzada México-Xochimilco 289, Col. Arenal de Guadalupe, Del. Tlalpan, 14389, México, D.F., Mexico.
| | - Lucio Ventura-Ríos
- Laboratorio de Ultrasonido Musculoesquelético, Instituto Nacional de Rehabilitación, Calzada México-Xochimilco 289, Col. Arenal de Guadalupe, Del. Tlalpan, 14389, México, D.F., Mexico
| | - Marwin Gutiérrez
- Laboratorio de Ultrasonido Musculoesquelético, Instituto Nacional de Rehabilitación, Calzada México-Xochimilco 289, Col. Arenal de Guadalupe, Del. Tlalpan, 14389, México, D.F., Mexico.,Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Johannes Roth
- University of Ottawa and Division of Pediatric Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Zamudio-Cuevas Y, Martínez-Flores K, Fernández-Torres J, Hernández-Díaz C, Camacho-Galindo J, Santamaría-Olmedo M, Lόpez-Macay A, Ventura-Ríos L, Cerna-Cortés J, Pineda C, Lόpez-Reyes A. AB0111 Monosodium Urate Crystals Promote an Oxidative State Which Induces Apoptosis in Human Synoviocytes. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ventura-Ríos L, Hernández-Díaz C, Gutiérrez-Pérez L, Bernal-González A, Pichardo-Bahena R, Cedeño-Garcidueñas AL, Pineda C. Ochronotic arthropathy as a paradigm of metabolically induced degenerative joint disease. A case-based review. Clin Rheumatol 2014; 35:1389-95. [PMID: 24647979 DOI: 10.1007/s10067-014-2557-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 02/23/2014] [Indexed: 10/25/2022]
Abstract
Alkaptonuria is a rare, hereditary metabolic disorder in which a deficiency in the homogentisate 1,2-dioxygenase enzyme results in an accumulation of homogentisic acid. Deposition of excess homogentisic acid in different intra- and extra-articular structures with high content of connective tissue causes brownish-black pigmentation and weakening, ultimately resulting in tissue degeneration and finally osteoarthritis. Ochronotic arthropathy is considered a rapidly progressive, disabling condition in which weight-bearing joints and the thoracolumbar spine are predominantly affected. Patients often require multiple joint replacements, such as in the case of the patient presented here. At present, there is no definitive cure for ochronosis, and management is predominantly symptomatic.
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Affiliation(s)
- L Ventura-Ríos
- Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación, Calzada México-Xochimilco 289, Col. Arenal de Guadalupe, Del. Tlalpan, 14389, México, D.F., Mexico
| | - C Hernández-Díaz
- Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación, Calzada México-Xochimilco 289, Col. Arenal de Guadalupe, Del. Tlalpan, 14389, México, D.F., Mexico
| | - L Gutiérrez-Pérez
- Musculoskeletal Ultrasound Diploma Course, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - A Bernal-González
- Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación, Calzada México-Xochimilco 289, Col. Arenal de Guadalupe, Del. Tlalpan, 14389, México, D.F., Mexico
| | - R Pichardo-Bahena
- Anatomical Pathology Service, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | | | - C Pineda
- Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación, Calzada México-Xochimilco 289, Col. Arenal de Guadalupe, Del. Tlalpan, 14389, México, D.F., Mexico.
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Guinsburg M, Ventura-Ríos L, Bernal A, Hernández-Díaz C, Pineda C. [Usefulness, validity, and reliability of ultrasound in the diagnosis of osteoarthritis: a critical review of the literature]. GAC MED MEX 2013; 149:509-520. [PMID: 24108337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Ultrasound is outstripping other diagnostic imaging techniques in the evaluation of osteoarthritis (OA). Due to its sub-millimetric resolution, ultrasound has the ability to detect minimal morphostructural abnormalities, even from preclinical or asymptomatic disease stages located in the main joint structures predominantly affected by OA: articular cartilage, synovial membrane, and subchondral bone. As of today, ultrasound has proven to be a useful tool for the detection of abnormalities occurring within soft tissues, including synovial hypertrophy, fluid accumulation, and synovial cysts, as well as bony abnormalities, such as osteophyte formation. Additionally, power Doppler signal correlated with histologic evidence of synovial membrane vascularization. In order to describe the ultrasonographic findings of OA, its utility, reliability, and validity as a diagnostic and monitoring tool, a critical review of the literature of hand, hip, and knee OA is provided.
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Affiliation(s)
- Mara Guinsburg
- Hospital General de Agudos Dr. Enrique Tornú, Buenos Aires, Argentina.
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Ventura-Ríos L, Bañuelos-Ramírez D, Hernández-Quiroz MDC, Robles-San Román M, Irazoque-Palazuelos F, Goycochea-Robles MV. Terapia biológica: sobrevida y seguridad en padecimientos reumáticos. Resultados del Registro Nacional Biobadamex 1.0. ACTA ACUST UNITED AC 2012; 8:189-94. [DOI: 10.1016/j.reuma.2012.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 02/10/2012] [Accepted: 02/13/2012] [Indexed: 10/26/2022]
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Álvarez-Hernández E, Peláez-Ballestas I, Boonen A, Vázquez-Mellado J, Hernández-Garduño A, Rivera FC, Teran-Estrada L, Ventura-Ríos L, Ramos-Remus C, Skinner-Taylor C, Goycochea-Robles MV, Bernard-Medina AG, Burgos-Vargas R. Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2012; 8:168-73. [PMID: 22704914 DOI: 10.1016/j.reuma.2012.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/17/2012] [Accepted: 05/02/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND The cost of certain diseases may lead to catastrophic expenses and impoverishment of households without full financial support by the state and other organizations. OBJECTIVE To determine the socioeconomic impact of the rheumatoid arthritis (RA) cost in the context of catastrophic expenses and impoverishment. PATIENTS AND METHODS This is a cohort-nested cross-sectional multicenter study on the cost of RA in Mexican households with partial, full, or private health care coverage. Catastrophic expenses referred to health expenses totaling >30% of the total household income. Impoverishment defined those households that could not afford the Mexican basic food basket (BFB). RESULTS We included 262 patients with a mean monthly household income (US dollars) of $376 (0–18,890.63). In all, 50.8%, 35.5%, and 13.7% of the patients had partial, full, or private health care coverage, respectively. RA annual cost was $ 5534.8 per patient (65% direct cost, 35% indirect). RA cost caused catastrophic expenses in 46.9% of households, which in the logistic regression analysis were significantly associated with the type of health care coverage (OR 2.7, 95%CI 1.6–4.7) and disease duration (OR 1.024, 95%CI 1.002–1.046). Impoverishment occurred in 66.8% of households and was associated with catastrophic expenses (OR 3.6, 95%CI 1.04–14.1), high health assessment questionnaire scores (OR 4.84 95%CI 1.01–23.3), and low socioeconomic level (OR 4.66, 95%CI 1.37–15.87). CONCLUSION The cost of RA in Mexican households, particularly those lacking full health coverage leads to catastrophic expenses and impoverishment. These findings could be the same in countries with fragmented health care systems.
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Chávez-López MA, Hernández-Díaz C, Moya C, Pineda C, Ventura-Ríos L, Möller I, Naredo E, Espinosa R, Peña A, Rosas-Cabral A, Filippucci E. Inter- and intra-observer agreement of high-resolution ultrasonography and power Doppler in assessment of joint inflammation and bone erosions in patients with rheumatoid arthritis. Rheumatol Int 2012; 33:173-7. [DOI: 10.1007/s00296-011-2297-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 12/10/2011] [Indexed: 11/29/2022]
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Mould-Quevedo J, Peláez-Ballestas I, Vázquez-Mellado J, Terán-Estrada L, Esquivel-Valerio J, Ventura-Ríos L, Aceves-Avila FJ, Bernard-Medina AG, Goycochea-Robles MV, Hernández-Garduño A, Burgos-Vargas R, Shumski C, Garza-Elizondo M, Ramos-Remus C, Espinoza-Villalpando J, Alvarez-Hernández E, Flores-Alvarado D, Rodríguez-Amado J, Casasola-Vargas J, Skinner-Taylor C. [Social costs of the most common inflammatory rheumatic diseases in Mexico from the patient's perspective]. GAC MED MEX 2008; 144:225-231. [PMID: 18714591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To estimate the social costs of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout from the patient's perspective. METHODS We carried out a cross-sectional analysis of the cost and resource utilization of 690 RA, AS, and gout patients from 10 medical centers and private facilities in five cities of Mexico. The information was obtained from the baseline of a dynamic cohort. We estimated out-of-pocket expenses, institutional direct costs, and direct medical costs. RESULTS The mean (SD) annual out-of-pocket expense (USD) was $610.0 ($302.2) for RA, $578.6 ($220.5) for AS, and $245.3 ($124.0) for gout. Figures correspond to 15%, 9.6%, and 2.5% of the family income. They also represented 26.1%, 25.3%, and 24.4% of the total annual cost per RA, AS, and gout patients, respectively. The expected direct institutional patient/year costs were 1,724.2 for RA, $1,710.8 for AS, and $760.7 for gout. The total patient annual costs were $2,334.3 for RA, $2,289.4 for AS, and $1,006.1 for gout. Most out-of-pocket expenses were used to purchase drugs, pay for laboratory tests, imaging studies, and alternative therapies. CONCLUSIONS From the patient's perspective, the cost of RA, AS, and gout represents 25% of direct medical costs. The cost of RA is higher than that for AS and gout.
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Affiliation(s)
- Joaquín Mould-Quevedo
- Unidad de Investigación en Economía de la Salud, Instituto Mexicano del Seguro Social, México D.F., México
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