1/11. The comparison between Behcet's disease and spondyloarthritides: does Behcet's disease belong to the spondyloarthropathy complex? This study was to clarify whether Behcet's disease (BD) could be classified into the spondyloarthropathy (SpA) complex. It was undertaken on 58 patients with BD (BD group), 56 patients with SpA (SpA group), and 3 patients who concurrently satisfied the criteria for BD and SpA (BDSpA group). The clinical parameters and known susceptible hla antigens were compared between BD group and SpA group. In addition, 3 patients in BDSpA group were reviewed. The prevalence of definitive sacroiliitis (SI) in BD group and SpA group was 46.4% and 5.2%, respectively. However, none had a definitive SI in healthy controls. Enthesitis was observed in 3.4% of BD group and in 50% of SpA group. The patterns of eye involvement were different between these two groups. HLA-B27 was negative in all 49 patients of BD group, whereas it was positive in 67.9% of SpA group. The prevalence of HLA-B51 was 51.7% in BD group, and that in SpA group was 21.4%. One patient in BDSpA group was considered to have concurrent BD and ankylosing spondylitis (AS). Another patient was closer to AS, and the third to BD. Conclusively, it seems that BD could not be classified into the SpA complex. ( info) |
2/11. Efficacy of etanercept for treatment of Crohn's related spondyloarthritis but not colitis. The seronegative spondyloarthropathies (SpAs) are associated both with clinical and subclinical colitis. Recently biological blockade with the tumour necrosis factor alpha (TNFalpha) antagonists infliximab and etanercept has been shown to be effective in the treatment of SpA. However, only infliximab is efficacious in the treatment of colitis in patients with Crohn's SpA. We report on two patients with SpA and associated Crohn's disease treated with etanercept whose arthritis showed an excellent response with complete resolution of spinal pathology, whereas their Crohn's disease persisted or flared. These findings suggest that the effect of TNFalpha blockade in SpA differs between the joint and the bowel. ( info) |
| familial mediterranean fever (FMF) is characterized by an autosomal inheritance pattern, Mediterranean ancestry, and history of recurrent fever. We present a 30-year-old Turkish man with FMF and accompanying seronegative spondyloarthropathy. His diagnose depended on the clinical course of his disease: recurrent fever accompanied by abdominal pain attacks together with a positive family history and his ethnic origin and sacroiliitis. We review the common manifestations of FMF and remind physicians that sacroiliac joint involvement must be kept in mind in presence of articular symptoms in a FMF patient. ( info) |
4/11. Juvenile spondyloarthritis and severe cardiac involvement in a female patient. heart involvement is a recognized complication in 10-20% of all adults with spondyloarthritis. Until now only 8 cases of cardiac involvement in juvenile spondyloarthritis (JS) have been reported, all male patients. We describe the first female patient with JS, in whom progressive cardiac involvement developed, and summarize the pediatric JS cases with cardiac involvement. ( info) |
5/11. Long-term results of occipitothoracic fusion surgery in RA patients with destruction of the cervical spine. OBJECTIVE: This is a retrospective study of the outcome of occipitothoracic fusion surgery in rheumatoid arthritis (RA) patients with destruction of the cervical spine, designed to assess the efficacy of halo vest before surgery, the postoperative outcome, and the activities-of-daily living (ADL) problems associated with surgical management. There have been no reports regarding these issues, including surgical effect on subjacent vertebrae. methods: This study included 20 RA patients with destruction of the cervical spine. All patients underwent preoperative halo vest followed by occipitothoracic fusion with an average follow-up of 5 years. The long-term clinical outcomes were analyzed using a modified Ranawat classification. RESULTS: Before halo application, the neurologic status was assessed as IIIC in 15 patients and IIIB in 5 patients. After halo application, the neurologic status improved in all patients: IIIA in 12 patients and IIIB in 8 patients. After surgery, the neurologic status did not improve in six of the eight IIIB patients but improved to IIIA in two patients. Of the 12 IIIA patients, the neurologic status improved to II in 6 patients but did not improve in the other 6 patients. patient satisfaction was excellent for 14 patients, good for 3 patients, and fair for only 3 patients (1 had difficulty drinking, another had back pain, and the last had low back pain associated with a compression fracture of the lumbar spine). CONCLUSIONS: We have performed occipitothoracic fusion surgery in RA patients with destruction of the cervical spine. Preoperative halo vest was very effective for improving the neurologic status, for the general condition, and for an optimal sagittal alignment. Occipitothoracic fusion using unit rods gave satisfactory long-term clinical results compared with the prognosis of patients in whom the disease follows its natural course. ( info) |
6/11. Crystal arthropathy of the lumbar spine: a series of six cases and a review of the literature. There have been very few reports in the literature of gout and pseudogout of the spine. We describe six patients who presented with acute sciatica attributable to spinal stenosis with cyst formation in the facet joints. Cytopathological studies confirmed the diagnosis of crystal arthropathy in each case.Specific formation of a synovial cyst was identified pre-operatively by MRI in five patients. In the sixth, the diagnosis was made incidentally during decompressive surgery. Surgical decompression alone was undertaken in four patients. In one with an associated degenerative spondylolisthesis, an additional intertransverse fusion was performed. Another patient had previously undergone a spinal fusion adjacent to the involved spinal segment, and spinal stabilisation was undertaken as well as a decompression.In addition to standard histological examination material was sent for examination under polarised light which revealed deposition of urate or calcium pyrophosphate dihydrate crystals in all cases.It is not possible to diagnose gout and pseudogout of the spine by standard examination of a fixed specimen. However, examining dry specimens under polarised light suggests that crystal arthropathy is a significant aetiological factor in the development of symptomatic spinal stenosis associated with cyst formation in a facet joint. ( info) |
7/11. Tophaceous gout in the cervical spine. gout is a common metabolic disorder typically affecting the distal joints of the appendicular skeleton. Involvement of the axial skeleton, particularly the facet joints and posterior column of the cervical spine, is rare. This case report highlights such a presentation in a 76-year old female who presented with cervical spine pain following a fall. Her radiological findings were suggestive of a destructive metastatic process. Histological diagnosis confirmed tophaceous gout. ( info) |
8/11. Lumbar facet joint infection associated with epidural and paraspinal abscess: a case report with review of the literature. A case of lumbar facet joint infection associated with epidural and paraspinal abscess is presented. A 57-year-old man was hospitalized with severe low back pain that radiated into the bilateral buttocks and legs. The patient had a temperature of 37.3 degrees C, and the biochemical inflammatory parameters were elevated. Initially on admission, we administered antibiotics intravenously. However, pain increased, fever elevated gradually, and bladder-bowel disturbance appeared. magnetic resonance imaging (MRI) showed effusion in the widened facet joint, paraspinal muscles, and epidural space, which compressed the theca severely. We performed an immediate surgical debridement combined with thorough antibiotic therapy and achieved excellent results. MRI was useful for precise diagnosis and operative planning. ( info) |
9/11. Very early spondyloarthritis: where the inflammation in the sacroiliac joints starts. Involvement of the sacroiliac joints (SIJ) is a major and characteristic feature of the spondyloarthritides (SpA). In early ankylosing spondylitis and undifferentiated SpA (uSpA) sacroiliitis is the most common early clinical finding and the presumed first manifestation of the disease. magnetic resonance imaging has proved useful for visualising inflammation in the SIJ in adults and children. Recently, initial localisation of the inflammation in the SIJ has been described in some detail, but it has not been completely defined to date--either in imaging or in histopathological studies. This is mainly owing to the lack of data in very early disease and the lack of follow up studies. Here we present a patient with early disease, which may augment our understanding of this stage of SpA. ( info) |
| The deficiency of homogentisic acid oxidase, an enzyme that is mainly found in hepatocytes, is associated with alkaptonuria and ochronosis. We report a patient with clinical and radiologic findings of ochronotic arthropathy in whom alkaptonuria disappeared and the progressive course of the disease stopped after liver transplantation for hepatitis b-related cirrhosis. ( info) |