ReumatismoPub Date : 2023-12-19DOI: 10.4081/reumatismo.2023.1557
E Yılmaz
{"title":"Can restless legs be a sign of something else? A case report of spondyloarthritis presenting with restless legs syndrome and a review of the literature.","authors":"E Yılmaz","doi":"10.4081/reumatismo.2023.1557","DOIUrl":"10.4081/reumatismo.2023.1557","url":null,"abstract":"<p><p>Restless legs syndrome (RLS) is a chronic movement disorder characterized by an urge or need to move the limbs, usually associated with uncomfortable sensations in the legs and sleep disorders. In general, two clinical forms of RLS are described: primary and secondary. Although primary RLS has a familial component, the underlying mechanism is still not fully understood but seems to be related to abnormalities in the dopaminergic and glutamatergic pathways of the central nervous system. The secondary forms of the syndrome are associated with iron deficiency, renal failure, pregnancy, diabetes mellitus, peripheral neuropathy, and several rheumatologic disorders such as rheumatoid arthritis and Sjögren's syndrome. In a few clinical trials, an increased frequency of RLS has been reported in patients with spondyloarthritis. In this report, a case of coexistence of spondyloarthritis and RLS is presented, showing satisfactory improvement with conservative treatment and additionally adding naproxen. Anemia of chronic disease occurring in rheumatic diseases, and associated iron deficiency may contribute to the development of RLS.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"75 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138808584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ReumatismoPub Date : 2023-12-19DOI: 10.4081/reumatismo.2023.1562
F Masini, K Gjeloshi, E Pinotti, R Ferrara, C Romano, G Cuomo
{"title":"Polymyositis following varicella and mumps infection in adults: report of two cases.","authors":"F Masini, K Gjeloshi, E Pinotti, R Ferrara, C Romano, G Cuomo","doi":"10.4081/reumatismo.2023.1562","DOIUrl":"10.4081/reumatismo.2023.1562","url":null,"abstract":"<p><p>Idiopathic immune myopathies (IIMs) are autoimmune diseases caused by immune-mediated muscle damage. The etiology remains unclear. Epidemiological and experimental studies, both in animals and humans, hint at viruses as major environmental factors able to trigger aberrant immune responses through many different mechanisms. However, only a few cases of either dermatomyositis or polymyositis following a specific viral infection have been reported in the literature. The objective of this study is to describe the clinical features and the treatment strategy of 2 cases of polymyositis developing shortly after chickenpox and mumps, respectively, and to review the existing literature on the topic. The clinical records of the 2 patients suspected to have developed inflammatory myositis following a viral infection were reviewed. Their clinical history, main laboratory findings, and treatment outcome are presented here. Moreover, a literature search was performed in the PubMed and MEDLINE databases to identify reports describing the association between viral infections and IIMs in patients aged ≥18. The 2 patients reported here developed polymyositis shortly after chickenpox and mumps, respectively, suggesting a causal role for viruses in triggering autoimmunity. Only a few reports published between 1990 and 2020 were found in the literature, possibly linking infections to myositis development. Intravenous immunoglobulin and rituximab were effective for the treatment of viral-triggered polymyositis.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"75 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138808610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ReumatismoPub Date : 2023-09-18DOI: 10.4081/reumatismo.2023.1539
A M Treichel, D X Zheng, G C Ranasinghe, A S Zeft, W F Bergfeld, C B Bayart
{"title":"Eosinophilic fasciitis in a young male auto mechanic exposed to organic solvents.","authors":"A M Treichel, D X Zheng, G C Ranasinghe, A S Zeft, W F Bergfeld, C B Bayart","doi":"10.4081/reumatismo.2023.1539","DOIUrl":"https://doi.org/10.4081/reumatismo.2023.1539","url":null,"abstract":"<p><p>We report a case of eosinophilic fasciitis in a teenage auto mechanic who was most likely affected by occupational exposure to organic solvents, including the aromatic hydrocarbons benzene, trimethylbenzene, naphthalene, toluene, and xylene. The patient presented with an 8-month history of painful induration of his extremities and an abnormal gait. A deep excisional biopsy of the fascia was obtained, demonstrating subcutaneous fibrosis with perivascular and interstitial inflammation, with lymphocytes and plasma cells spilling into the sclerosed fascia, and focal fibrinoid necrosis. Treatment was begun with intravenous pulse doses of methylprednisolone, prednisone (20 mg daily), and subcutaneous methotrexate (25 mg weekly), and the patient's painful induration had resolved and gait had normalized at the 6-month follow-up. Our case suggests that exposure to organic solvents could be implicated in the pathogenesis of eosinophilic fasciitis and highlights the importance of a thorough occupational history to prevent repeat exposures to potentially causative agents.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"75 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10300469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ReumatismoPub Date : 2023-09-18DOI: 10.4081/reumatismo.2023.1623
H Quiñones-Moya, A Camargo-Coronel, M R Hernández-Zavala
{"title":"Response to: myositis after SARS-CoV-2 vaccination occurs more frequently than assumed and is probably causally related.","authors":"H Quiñones-Moya, A Camargo-Coronel, M R Hernández-Zavala","doi":"10.4081/reumatismo.2023.1623","DOIUrl":"https://doi.org/10.4081/reumatismo.2023.1623","url":null,"abstract":"<p><p>We thank Finsterer et al. for the attention paid to our publication; we recognize the validity of the points mentioned in their letter to the editor and will try to answer the observations made.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"75 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10300462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ReumatismoPub Date : 2023-09-18DOI: 10.4081/reumatismo.2023.1586
R Deniz, N Güner, Ş A Ekmen, I N Mutlu, D S Özgür, B Karaalioğlu, G Akkuzu, F Yıldırım, K Kalkan, G Güzelant-Özköse, B İnce, M Erdoğan, Y Özlük, I Kılıçaslan, C Bes
{"title":"Discrepancies between clinical and pathological findings seen at renal biopsy in rheumatological diseases.","authors":"R Deniz, N Güner, Ş A Ekmen, I N Mutlu, D S Özgür, B Karaalioğlu, G Akkuzu, F Yıldırım, K Kalkan, G Güzelant-Özköse, B İnce, M Erdoğan, Y Özlük, I Kılıçaslan, C Bes","doi":"10.4081/reumatismo.2023.1586","DOIUrl":"https://doi.org/10.4081/reumatismo.2023.1586","url":null,"abstract":"<p><strong>Objective: </strong>Renal biopsy contributes to the diagnosis, follow-up, and treatment of many rheumatic conditions. This study assessed the diagnostic role and safety of renal biopsies in a tertiary rheumatology clinic.</p><p><strong>Methods: </strong>Renal biopsies performed between June 2020 and December 2022 were screened, and demographic, clinical, histopathological, and safety data were collected from patient records.</p><p><strong>Results: </strong>In this study, 33 males and 38 females were included. Except for 1 patient who received acetylsalicylic acid, antiaggregant, and/or anticoagulant drugs were stopped before the biopsy. Complications included a decrease of hemoglobin in 8 patients (11.3%) and microscopic hematuria in 40 patients (56.3%). Control ultrasonography was performed in 16 patients (22.5%), and a self-limiting hematoma was found in 4 of them (5.6%) without additional complications. While less than 10 glomeruli were obtained in 9 patients (9.9%), diagnosis success was 94.4%. Histopathological data were consistent with one of the pre-biopsy diagnoses in 54 of 67 cases (80.6%) but showed discrepancies in 19.4% (n=13) of patients. A repeat biopsy was performed in 7 patients for re-staging or insufficient biopsy.</p><p><strong>Conclusions: </strong>Renal biopsy significantly contributes to rheumatology practice, especially in patients with complex clinical and laboratory findings or in whom different treatments can be given according to the presence, severity, and type of renal involvement. Although the possibility of obtaining insufficient tissue and the need for re-staging and repeat biopsy in the follow-up might be expected, complication risk does not seem to be a big concern. Renal biopsy often evidenced discrepancies between pre-biopsy diagnosis and histopathological findings.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"75 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10307170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ReumatismoPub Date : 2023-09-18DOI: 10.4081/reumatismo.2023.1530
V Bruzzese, C Marrese, P Scolieri, J Pepe
{"title":"Efficacy of a gluten-free diet in reducing the widespread pain index and symptom severity scale in patients affected by fibromyalgia.","authors":"V Bruzzese, C Marrese, P Scolieri, J Pepe","doi":"10.4081/reumatismo.2023.1530","DOIUrl":"https://doi.org/10.4081/reumatismo.2023.1530","url":null,"abstract":"<p><strong>Objective: </strong>Dietary interventions to improve fibromyalgia (FM) symptoms reported conflicting results. This study aimed to treat FM patients with a gluten-free diet (GFD), alternated with a non-restricted gluten-containing diet, followed by a rechallenge of the GFD.</p><p><strong>Methods: </strong>Twenty postmenopausal women with FM and no history of celiac disease participated. A GFD was assigned for 6 months. This was followed by 3 months of a non-restricted gluten-containing diet and then a new GFD for another 6 months. At each visit, the widespread pain index (WPI) and the symptom severity scale (SS) scores were evaluated.</p><p><strong>Results: </strong>The mean age of the patients enrolled was 53.9±10 years. None of the patients had a diagnosis of irritable bowel disease, although they reported vague gastrointestinal symptoms. After 6 months of a GFD, a statistically significant reduction was observed for the WPI (10.3±1.8 vs 7.7±1.4; p<0.0001) and the SS scale (6.4±1.8 vs 4.15±1.6; p=0.0002). The D percentage reduction of the WPI after 6 months of GFD was -24%±9%, while for the SS scale, it was -36%±21%. The following reintroduction of a gluten-containing diet brought about a statistically significant rise in the absolute SS scale and WPI, as well as a D modification of the WPI (21%±13%) and of the SS scale (74%±90%). The rechallenge of the GFD showed a significant improvement in absolute and D WPI (-24%±7%) and SS (-36%±11%). No modifications to the body mass index were found.</p><p><strong>Conclusions: </strong>A GFD improved FM symptoms evaluated with WPI and SS. This was confirmed for the first time, also with a rechallenge of the GFD that followed a non-restricted gluten-containing diet.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"75 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ReumatismoPub Date : 2023-09-18DOI: 10.4081/reumatismo.2023.1563
D G Fernández-Ávila, Ó R Vargas-Vanegas, L Galindo-Rozo, Á García-Peña, Ó Muñoz-Velandia
{"title":"Clinical characteristics and outcomes of patients with inflammatory and autoimmune rheumatological diseases admitted for intensive care in Colombia.","authors":"D G Fernández-Ávila, Ó R Vargas-Vanegas, L Galindo-Rozo, Á García-Peña, Ó Muñoz-Velandia","doi":"10.4081/reumatismo.2023.1563","DOIUrl":"https://doi.org/10.4081/reumatismo.2023.1563","url":null,"abstract":"<p><strong>Objective: </strong>Contemporary studies reporting outcomes of critical care in patients with inflammatory and autoimmune rheumatological diseases are scarce. This study describes 15 years of experience from 2005-2019 in a Colombian referral hospital.</p><p><strong>Methods: </strong>This observational, descriptive, consecutive case series study was performed on adult patients with inflammatory and autoimmune rheumatic diseases who were admitted to the intensive care unit (ICU) of the San Ignacio University Hospital in Bogotá (Colombia), from January 1, 2005, to December 21, 2019. We describe the sociodemographic characteristics, admission causes and criteria, lengths of stay, immunosuppressive treatment, systemic support, and mortality.</p><p><strong>Results: </strong>The study included 300 patients with a median age of 48 years [interquartile range (IQR) 31-62 years], predominantly female (76%). Disease exacerbations (30%), infections (17.6%), and cardiovascular diseases (15%) were the main causes of admission. Respiratory failure (23%) most commonly caused by septic shock (24%) was the principal indication for intensive care admission. The most frequent infections were community-acquired pneumonia (11.6%) and soft-tissue infections (9%). In 40.3% of patients, inotropic and vasopressor support was required. The median length of stay was 4 days (IQR 2-8), and global mortality was 21.6%.</p><p><strong>Conclusions: </strong>Rheumatic diseases in the ICU are still associated with high morbidity and mortality. Patients with inflammatory and autoimmune rheumatic diseases require a meticulous clinical approach, strict clinical monitoring, frequent assessment of complications, evaluation of systemic support needs, and specific management.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"75 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ReumatismoPub Date : 2023-09-18DOI: 10.4081/reumatismo.2023.1566
D S Meena, D Kumar, G K Bohra
{"title":"Acute severe gouty arthritis secondary to isotretinoin toxicity in a young male: a case report.","authors":"D S Meena, D Kumar, G K Bohra","doi":"10.4081/reumatismo.2023.1566","DOIUrl":"https://doi.org/10.4081/reumatismo.2023.1566","url":null,"abstract":"<p><p>Acute gouty arthritis is a recognized complication of hyperuricemia and one of the most common forms of inflammatory arthritis in adults. Drug-induced hyperuricemia is increasingly prevalent in clinical practice. Diuretics, antitubercular medications, and immunosuppressants are the common drugs associated with hyperuricemia. Oral isotretinoin is the drug of choice for different forms of severe acne and is rarely associated with hyperuricemia. We present the case of a 30-year-old male with severe acne vulgaris who was prescribed isotretinoin and later presented with acute gout. The patient developed hyperuricemia and swelling of the right first metatarsophalangeal joint within two months of isotretinoin commencement. There was a second episode of similar joint swelling three months later, parallel to the isotretinoin rechallenge. The dose of isotretinoin was reduced with the addition of febuxostat. The patient did not develop further episodes and remained symptom-free without urate-lowering therapy.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"75 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10308494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ReumatismoPub Date : 2023-09-18DOI: 10.4081/reumatismo.2023.1550
H Beyaztas, S Aktas, E M Guler, E Ata
{"title":"Oxidative stress may be a contributing factor in fibromyalgia patients' pain mechanisms.","authors":"H Beyaztas, S Aktas, E M Guler, E Ata","doi":"10.4081/reumatismo.2023.1550","DOIUrl":"https://doi.org/10.4081/reumatismo.2023.1550","url":null,"abstract":"<p><strong>Objective: </strong>The pathophysiology of fibromyalgia (FM), a continuously painful syndrome with no known origin, has been related to mitochondrial dysfunction, oxidative stress, and inflammation. Recent studies have shown that FM may be associated with an oxidative balance disorder. The objective of this study was to measure the levels of oxidative stress in FM patients and try to understand the association between FM and free radicals.</p><p><strong>Methods: </strong>This study was performed on 100 volunteers admitted to the University of Health Sciences, Sultan 2, Abdulhamid Han Health Application and Research Center Physical Therapy and Rehabilitation Clinic, including 50 healthy controls and 50 patients with FM. To analyze oxidative stress biomarkers, total oxidant status (TOS) and total antioxidant status (TAS) levels were measured. Total thiol (TT) and native thiol (NT) concentrations were measured to determine the relationship between thiol groups. Disulfide (DIS) and oxidative stress index (OSI) were calculated with mathematical formulas.</p><p><strong>Results: </strong>While TOS and OSI levels were statistically higher in FM patients, TAS levels were significantly lower compared to the healthy control group (p<0.001). In comparison to the healthy control group, FM patients had considerably decreased TT and NT levels. DIS levels were significantly higher in FM patients than in controls (p<0.001).</p><p><strong>Conclusions: </strong>Reactive oxygen species have several negative impacts on the human body. As a result of the measurements we analyzed, the relationship between FM and oxidative stress should be studied in terms of disease progression and may help improve the treatment process.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"75 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ReumatismoPub Date : 2023-09-18DOI: 10.4081/reumatismo.2023.1584
G El Hasbani, M Del Pilar Morel, B Tandoh, J F Vargas, R Crusio
{"title":"Adrenal hemorrhage and non-ST elevation myocardial infarction: an antiphospholipid syndrome dilemma.","authors":"G El Hasbani, M Del Pilar Morel, B Tandoh, J F Vargas, R Crusio","doi":"10.4081/reumatismo.2023.1584","DOIUrl":"https://doi.org/10.4081/reumatismo.2023.1584","url":null,"abstract":"<p><p>Antiphospholipid syndrome (APS) can affect different organ systems, including the heart and adrenal glands. Despite being known for its prothrombotic characteristics, APS can have serious bleeding complications. Occasionally, thrombotic and bleeding episodes can present simultaneously in an APS patient. Whenever these events co-occur, resuming anticoagulation becomes a topic of debate. As such, we present the case of a 43-year-old male with triple positive antiphospholipid antibodies, indicating APS, who presented with chest pain. Anticoagulants were switched one month before presentation from warfarin to a direct oral anticoagulant, rivaroxaban. Non-ST elevation myocardial infarction, as well as new-onset left-sided adrenal hemorrhage, were diagnosed. The patient developed adrenal insufficiency; therefore, corticosteroids were administered, and warfarin was resumed to prevent further thrombotic episodes.</p>","PeriodicalId":21222,"journal":{"name":"Reumatismo","volume":"75 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10672544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}