A. Zunino's research while affiliated with Hospital Dr. Jose Maria Cullen and other places

No existen datos exactos relativos a la prevalencia de tofos en pulpejos como manifestación inicial de la gota. El objetivo de este estudio es describir la población de pacientes con gota y evaluar la presencia de tofos en pulpejos de dedos de manos, pies y articulaciones interfalángicas distales, comparando los datos clínicos entre los pacientes con y sin tofos. Se reclutaron 161 pacientes con gota. Si bien los pacientes con tofos en pulpejos (12 pacientes) tenían mayor edad que aquellos sin tofos en esta localización, tenían mayor tiempo de evolución de la gota, mayor número de ellos tenían compromiso renal y menor porcentaje de enfermedades asociadas, ninguno de estos datos alcanzó significancia estadística.

Objective: To describe the principal characteristics of spondyloarthritis in the Argentina population. Material and methods: A descriptive transversal study was carried out with information obtained between March and December 2007 and stored online at the Spondyloarthropathy Records website of the Spanish Society for Rheumatology (REGISPONSER). Eleven Argentine Centers participated and they all adopted similar criteria to assess patients and data were collected in the same database. Results: A total of 405 patients with spondyloarthritis (SpA) were included: 238 were males (59%) with an average age ± standard deviation 48.1 ± 15.7 years and an average disease progress of 10.9 ± 9.5 years. The majority was diagnosed with psoriatic arthritis (PsA) (46.7%), followed by ankylosing spondylitis (AS) (30.3%) and undifferentiated spondyloarthritis (U-SpA) (12.4%). Average age at onset was 38.4 ± 16.6 years and time until diagnosis was 7.5 ± 8.6 years. The most common initial symptoms were peripheral arthritis (66%), lumbago (54%) and sacroiliitis (39%). 43% of these patients presented dactylitis and 10% uveitis during the disease progress. TNF inhibitor treatment was administered in 10.4% of the patients. Average BASDAI score was 4 ± 2.5 and BASFI 3.3 ± 2.9. Patients with ankylosing spondylitis were younger, showed a higher incapacity for work, felt more pain and presented more axial disorders and more evidence of radiologic damage than psoriatic arthritis patients. Conclusion. Argentina spondyloarthritis patients presented classical characteristics of axial and peripheral disorders and extraarticular symptoms were common.

This report describes the coexistence of three patients with rheumatic diseases (systemic lupus erythematosus, rheumatoid arthritis, and dermatomyositis) and infections because of Histoplasma capsulatum. Connective tissue diseases and histoplasmosis share several clinical findings. Therefore, histoplasmosis could be misdiagnosed as connective tissue disease or a flare of these diseases. Such cases highlight the importance of awareness of histoplasmosis in immunocompromised patients, particularly in those originating from endemic areas.

Extensive cutaneous necrosis (ECN) associated with antiphospholipid antibodies is a rare presentation. We describe 2 patients with ECN and high titers of anticardiolipin antibodies. The mechanism by which these antibodies act has not been established and there is still controversy regarding treatment of these patients without established guidelines. In the few documented cases the use of pulse steroid therapy, anticoagulants, fibrinolytic agents, plasmapheresis, or a combination of them has shown some benefit. Early recognition and treatment of the antiphospholipid syndrome may limit the extent of thrombotic complications that can result in tissue necrosis.

A 46-year-old man simultaneously developed chronic seronegative non destructive oligoarthritis and chronic watery diarrhoea. Biopsies from the colorectal mucosa showed a thickened subepithelial collagen layer consistent with collagenous colitis. Collagenous colitis should be added to the list of causes of enteropathic arthritis.