Abnormal Erythrocyte Sedimentation Rate Research Articles

Assessment of visual and blood-related parameters among children with sickle cell anaemia at Murtala Muhammad Specialist Hospital in Kano, Nigeria.

Sickle cell disease (SCD) is a prevalent genetic disease worldwide and particularly in Nigeria. Retinopathy is a known complication of SCD, underscoring the need to assess visual parameters in children. This study aimed to evaluate the visual acuity (VA), color vision (CV), packed cell volume (PCV), and erythrocyte sedimentation rate (ESR) of Sickle cell anemic (SCA) patients attending the Sickle cell counseling unit of Murtala Muhammad Specialist Hospital (MMSH) in Kano. It was a descriptive cross-sectional study consisting of 60 participants, including 30 SCA patients and 30 healthy controls without systemic or ocular diseases, aged between 8 and 14 years. Visual acuity, CV, PCV, and ESR were assessed using Snellen Chart, Ishihara chart, Hematocrit test, and Westergren Method respectively. Data were analyzed using SPSS version 22.0. Statistical significance was set at P < 0.05. Both SCA patients and controls demonstrated limited knowledge about VA, CV, and ESR tests, and a significant percentage had never undergone these tests. SCA patients exhibited mild to moderate visual impairment (VI) in both eyes, while controls had no VI. Abnormally low PCV and ESR values were observed in all SCA patients, whereas controls had normal values. Gender differences were observed in ESR levels, with females showing higher levels. Significant differences were found between controls and SCA patients in terms of VA, ESR, and PCV values. There was a general lack of awareness regarding the importance of VA and CV tests in the community. Visual impairment and abnormal PCV and ESR values were exclusive to the SCA patients, indicating their association with the disease.

Baseline Characteristics and Clinical Presentation of Biopsy-Proven Giant Cell Arteritis in White Compared with Black Patients.

Giant cell arteritis (GCA) is the most prevalent systemic vasculitis in the elderly and can lead to permanent vision loss if left untreated. Most earlier studies have evaluated GCA in primarily white populations, and GCA was traditionally thought to occur at nearly negligible frequency in black populations. Our previous study showed that GCA may occur at similar rates in white and black patients, but little is known about the presentation of GCA in black patients. The purpose of this study is to examine baseline presentation of biopsy-proven GCA (BP-GCA) in a tertiary care center-based population with a sizeable proportion of black patients. Retrospective study from a single academic institution of a previously described cohort of BP-GCA. Presenting symptoms, laboratory findings, and GCA Calculator Risk score were compared in black and white patients with BP-GCA. Among 85 patients with biopsy-proven GCA, 71 (84%) were white and 12 (14%) were black. White patients had higher rates of elevated platelet count (34% vs 0%, P = 0.04), whereas black patients had higher rates of diabetes mellitus (67% vs 12%, P < 0.001). There were no statistically significant differences in age, gender, biopsy classification (active vs healed arteritis), cranial symptoms, visual symptoms/ophthalmic findings, rates of abnormal erythrocyte sedimentation rate or C-reactive protein, unintentional weight loss, polymyalgia rheumatica, or GCA risk calculator score. Presenting features of GCA were similar between white and black patients in our cohort, except for rates of abnormal platelet level and diabetes. Physicians should feel comfortable relying on the usual clinical features for the diagnosis of GCA independent of race.

Overview of erythrocyte sedimentation rate examination results of farmers aged 30-40 years in Manunggal Karya Village Sub-district of Randangan District of Pohuwato

This research aimed to give an overview of the erythrocyte sedimentation rate (ESR) examination results of farmers aged 30-40 years in Manunggal Karya Village, sub-district of Randangan, Pohuwato.&#x0D; This research method used a quantitative research approach with the type of research being descriptive research. Samples in this study were 29 samples using the simple random sampling technique as well as conducting interview and examination of erythrocyte sedimentation rate of the farmers.&#x0D; The results of this study concerning the erythrocyte sedimentation rate examination of farmers aged 30-40 years in Manunggal Karya Village, sub-district of Randangan showed that the percentage of normal ESR results was 62.1% and the percentage of abnormal ESR results was 37.9%. Based on the risk factors that affect the ESR value, by the medical history of the farmers, the percentage of normal ESR results by 62.1% and the percentage of abnormal ESR results was 37.9%; by the length of work, farmers with a working period of &gt;10 years had normal ESR results of 62.1% and the abnormal ESR results of 37.9%.&#x0D;

Systemic sclerosis patients with negative antinuclear antibodies have distinctive clinical manifestations: amulticenter CRDC cohort in China.

The presence of circulating antinuclear antibodies (ANAs) is ahallmark of immune dysregulation in patients with systemic sclerosis (SSc). Avariety of ANAs are associated with unique sets of disease manifestations and are widely used in clinical practice in SSc. This study aimed to investigate the clinical features of SSc patients negative for ANAs in aChinese Rheumatism Data Center (CRDC) multicenter cohort in China. Patients were prospectively recruited between April 2008 and June 2019 from 154 clinical centers nationwide, and all cases fulfilled the 2013 ACR/EULAR classification criteria for systemic sclerosis. Results for antinuclear antibodies were intensively collected. Demographic, clinical, and laboratory data were compared between ANA-positive SSc patients and those negative for ANAs. Antinuclear antibodies were detected in 2129 of 2809patients enrolled in the study; 4.2% of patients were negative. There were more males among ANA-negative SSc patients (29/60 vs. 294/1746, p < 0.001). The incidence of certain critical organ involvement, including gastroesophageal reflux (5.6% vs. 18.5%, p = 0.002), interstitial lung disease (65.2% vs. 77.9%, p = 0.015), and pulmonary arterial hypertension (11.5% vs. 29.0%, p = 0.006) was significantly lower in ANA-negative patients than in ANA-positive patients. The proportion of abnormal erythrocyte sedimentation rate (32.4% vs. 47.6%, p = 0.013) and IgG elevation (14.3% vs. 37.0%, p = 0.003), an indicator of disease activity, was significantly lower in ANA-negative patients than in ANA-positive patients. Antinuclear antibodies are strongly associated with the clinical manifestations of systemic sclerosis, with ANA-negative SSc patients tending to exhibit relatively milder disease.

Evaluation of Demographic, Clinical and Laboratory Features of Patients with Systemic Lupus Erythematosus in Kermanshah

Background: Systemic lupus erythematosus (SLE) is a worldwide autoimmune disease. The disease has different etiologies, clinical and laboratory symptoms between different geographical and racial groups, and sufficient knowledge of the type of symptoms in each region can play a proper role in diagnosis and treatment. Objectives: This study was performed to evaluate demographic, clinical and laboratory features of patients with systemic lupus erythematosus in Kermanshah. Methods: This study is descriptive, analytical and cross-sectional. The files of 150 patients with lupus during 2016 - 2018 in Imam Reza hospital in Kermanshah were reviewed. Results: Data analysis showed that patients at the time of referral were with musculoskeletal symptoms 37.3% (56 individuals), cutaneous-mucosal 32% (48 individuals), constitutional 51.3% (77 individuals), renal 62% (93 individuals), cardiac 6.7% (10 individuals), neurological manifestations 17.3% (26 individuals), pulmonary involvement 37.3% (56 individuals), and Hematological 71.3% (107 individuals). The anti-nuclear antibody (ANA) in 60% (90 individuals), anti-double strand DNA Antibody (anti-ds DNA) in 35.4% (53 individuals), C-reactive protein (CRP) in 44.6% (67 individuals), lower level of normal C3 and C4 in 33.3% (50 individuals) and 11.3% (17 individuals), respectively, lupus anticoagulant in 13.3% (20 individuals), antibody citrullinated peptide anti-cyclic (anti-CCP) in 14.9% (22 individuals), anticardiolipin IgM and IgG, in 6% (9 individuals) and 9.3% (14 individuals) of patients respectively were observed. Also, anemia was observed in 34% (51 individuals), leukopenia in 22% (33 individuals), and thrombocytopenia in 30.7% (46 individuals). Abnormal ESR (erythrocyte sedimentation rate) was seen in 59.3% (89 individuals) of patients. Leukopenia in men and positive CRP in women were more common (P = 0.014, P = 0.004). Conclusions: Despite the diverse clinical and laboratory manifestations of SLE in different racial and geographical groups, paying attention to these differences in each region can effectively diagnose the disease. As in this study, hematological manifestations had a higher percentage in the population of lupus patients in Kermanshah.

Concordance or Discordance between ESR (erythrocyte sedimentation rate) and hs‐CRP (high sensitivity C‐reactive protein): Are both tests necessary for patient diagnosis?

Introduction Erythrocyte sedimentation rate (ESR) and high-sensitivity C- reactive protein (hs-CRP) are screening tests for inflammation and are often ordered simultaneously. Our study investigated concordance between ESR and hs-CRP to optimize patient diagnosis. Methods A retrospective review was conducted on ESR and hs-CRP tests performed simultaneously in the same clinical encounter during a 10-month period at Alaska Regional Hospital. Kappa statistics and correlation coefficients were calculated to evaluate the level of concordance between ESR and hs-CRP tests. Logistic regression models and Receiver Operator Characteristic (ROC) curves were constructed to evaluate the ability of each screening test to predict the other screening test. Results ESR and hs-CRP were elevated in 54% and 76% of the patient population (N=860) respectively. Among patients with abnormal ESR, 93% also had abnormal hs-CRP, whereas among patients with abnormal hs-CRP, 66% also had abnormal ESR. ESR and hs-CRP tests agreed in 70% of cases. Kappa statistics indicated a fair to moderate level of agreement between dichotomous ESR and hs-CRP tests, with significant differences among patients with and without non-infectious organ diseases, but no other demographic or clinical characteristics. The correlation coefficient between continuous ESR and hs-CRP was nearly 0.40, with no statistically significant correlation among patients with connective tissue/musculoskeletal/autoimmune diseases or diabetes. Finally, hs-CRP and ESR were predictive of each other based on logistic regression and ROC analyses. Conclusion hs-CRP identified the majority of inflammatory conditions and should be included in the first line of testing when the clinical indication clearly suggests an inflammatory process.

Evaluation of Prognostic Factors Associated with Postoperative Complications Following Pulmonary Hydatid Cyst Surgery.

Background:Hydatid cysts are one of the serious complications following echinococcus infection. The liver and the lungs are the most affected organs, respectively. The severity of the disease is associated with the increase in the number and the size of the cysts, cysts rupture, and systemic effects. The aim of this study is to evaluate prognostic factors that are associated with the increased incidence of postoperative complications following pulmonary hydatid cyst surgery.Methods:Patients referred to Madani hospital from 2014-2018, presenting pulmonary hydatid cysts were included in this study. All the patients were evaluated based on the following parameters: age, gender, location and size of the cysts, rupture status of the cysts (intact or perforated), type of surgical intervention (capitonnage or segmentectomy) and Erythrocyte Sedimentation Rate (ESR). The factors were then compared with postoperative complications. Statistical analysis of the data obtained was conducted using R-softwareResults:Of 76 patients enrolled in our study, 52.63% were males and 47.36% were female. Air leak complication was reported in 13.15% of the patients and 3.94% of the patients were presented with pleural effusion. Postoperative complications were significantly associated with the perforated (ruptured) cysts p= 0.001, segmentectomy p= 0.013, giant hydatid cysts p= 0.007 and ESR p= 0.014. However, the side of the lung was not significantly related to postoperative complications.Conclusion:Our study reports that perforated cysts, increased size, segmentectomy and abnormal ESR are likely to increase postoperative complications following pulmonary hydatid cysts surgery. Prospective studies with perioperative parameters and greater sample size can help to deduce better inferences.

Evaluation of platelet count, erythrocyte sedimentation rate and C-reactive protein levels in paediatric patients with inflammatory and infectious disease.

Inflammatory and infectious diseases are the major causes of morbidity and mortality. The identification of markers for the assessment of disease activity and response to treatment can improve long-term prognosis. The aim of this study was to evaluate platelet count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) among children with inflammatory and infectious disease. This cross-sectional study was conducted in the paediatric immunology and infectious units of Shahid Madani Hospital of Khorramabad. One hundred fifty children, half boys and half girls, with diagnoses of infectious and inflammatory diseases were included in the study. Platelet count, ESR and CRP were measured at the time of hospitalization and thereafter (recovery phase). A questionnaire including demographic information, diagnosis and paraclinical data was completed. At the time of hospitalization, all 150 children had abnormal ESR, 110 (73.3%) had abnormal CRP and 12 (92%) had alterations in platelet count. At the time of discharge, one patient (0.7%) had normal ESR, 132 (88%) had normal CRP and 140 patients (93.3%) had normal platelet count. At the time of discharge, we found a significant difference between the levels of CRP and platelets in girls. This study showed that CRP level is useful during treatment follow-up. Changes in platelet count are likely to be more prevalent in girls.

Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study

ObjectiveTo identify the key diagnostic features and causes of fever of unknown origin (FUO) in Japanese patients.DesignMulticentre prospective study.SettingSixteen hospitals affiliated with the Japanese Society of Hospital General Medicine, covering...

Protozoa Infections and Celiac disease: Relationship and hematological study among children under five years

The aims of this study was concerned on the evaluation the etiology of diarrhea (parasitic (E. histolytica and G. lamblia) and Celiac disease in children under five years and its effectiveness on the some laboratory investigations which is the complete blood picture (CBP), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), the sero-prevalence of celiac disease; in which two types of autoantibodies was studied, anti-gliadin (IgG and IgA), and anti-tissutransglutaminase (IgG and IgA); A total of 67 children with diarrhea have been diagnostic, E. histolytica recorded the largest group 36 sample followed by G. lamblia 23 sample, and Sero-positive celiac disease only 8 children. the E. histolytica was mostly at 4-5 years (36.1%) and G. lamblia was mostly in age 1-2 and 2-3 years (30.4%). we found that most of neutrophilia and eosinophilia cases were in E. histolytica and G. lamblia. Hemoglobin concentration show a significant decrease in patients with diarrhea. Abnormal ESR and CRP titer reading has been in shows higher mean values with E. histolytica and Sero-positive celiac disease then followed by G. lamblia.

Platelet Function Tests and Inflammatory Markers for the Differentiation of Primary Thrombocytosis and Secondary Thrombocytosis.

Background:The prognosis and management of primary thrombocytosis (PT) and secondary thrombocytosis (ST) are different. This study aims to evaluate the role of platelet function tests by light transmission platelet aggregometry (LTA), plasma von Willebrand factor antigen (vWF:Ag), ristocetin cofactor activity (vWF:RCo) and inflammatory markers [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] for the differentiation between PT and ST. Methods:This prospective study was carried out in patients with platelet counts greater than 450 x 109/L. Primary outcomes were the sensitivity and specificity of platelet function tests by LTA for the differentiation of PT and ST. Secondary outcomes were sensitivity and specificity of ESR, CRP, vWF:Ag, and vWF:RCo for the differentiation of PT and ST. Results:Fifty-two patients were enrolled onto the study of which 26 (50%) had PT. The sensitivity and specificity of epinephrine, collagen, and arachidonic acid (AA) induced abnormal LTA for the differentiation of PT from ST were sensitivity of 50%, 38.5%, 26.9% and specificity of 88.5%, 100%, 100% respectively. The sensitivity and specificity of abnormal ESR, CRP, and either abnormal ESR or CRP in the differentiation of ST from PT were sensitivity of 88.5%, 80.8%, 100% and specificity of 65.4%, 61.5%, 46.2% respectively. The sensitivity and specificity of low vWF:Ag and vWF:RCo in the differentiation of PT from ST were sensitivity of 7.69%, 42.3% and specificity of 100%, 88.5% respectively. Conclusions:Abnormal platelet function determined by LTA with collagen, AA, epinephrine had high specificity ratings enabling the differentiation between PT and ST. vWF:RCo, ESR and CRP levels could be helpful in differentiating between PT and ST.

Factors Influencing Sputum Smear and Culture Conversion Time among Patients with Pulmonary Tuberculosis

Introduction: Pulmonary tuberculosis is a contagious bacterial infection that involves the lungs and it may spread to other organs. Sputum smear and culture conversion are important indicators for the effectiveness of treatment and the infectivity of the patient. The present study aims to find sputum smear and culture conversion time and the factors that influence the conversion time among tuberculosis patients at National Tuberculosis Centre in Nepal.&#x0D; Methods: A total of 54 patients, who were diagnosed with laboratory confirmed pulmonary tuberculosis and under antitubercular therapy were monitored for sputum smear and culture conversion time. The blood specimens from each patient were processed for hemoglobin, platelets, erythrocyte sedimentation rate and blood glucose levels. Patient’s clinical history, risk factors that prolong conversion time and sociodemographic information were also collected by direct interview.&#x0D; Results: The mean sputum smear and culture conversion were found to be 54.4 days and 45.5 days respectively. Old age, smoking habit, low body mass index value, Treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate values were found to be associated with long sputum conversion time. Radiographic involvement of only left lungs, presence of fewer symptoms, aged between 15-45 years, having normal weight, without smoking habit and being married, were found to be associated with short sputum conversion time.&#x0D; Conclusions: The sputum microscopy, old age, smoking habit, low body mass index value, treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate value had been found to be significantly associated with long sputum conversion time.

Variation in diagnostic test requests and outcomes: a preliminary metric for OpenPathology.net

Efforts to reduce healthcare costs have led to the development of metrics to identify unwarranted variation in care. Previous work assessing diagnostic tests is limited, despite their substantial contribution to expenditure. We explored C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) tests ordered across Oxfordshire NHS General Practices, and the proportion of tests that yielded an abnormal result, and identified practices that had a proportion of abnormal CRP and ESR results 3 standard deviations below the mean. We estimated the adjusted average proportion of abnormal CRP and ESR tests that yielded abnormal results from each practice, after adjusting for differences in practice populations. These proportions were plotted against the total CRP and ESR requests per practice. We constructed funnel plots to identify practices 3 standard deviations below the mean proportion of abnormal CRP and ESR tests. We analysed 143,745 CRP and 30,758 ESR requests from 69 practices. Twelve (17%) and 7 (10%) practices were more than 3 standard deviations below the mean for CRP and ESR testing respectively. Two practices (3%) were below the 99.8% limit for both CRP and ESR ordering. Variation in the proportion of tests with an abnormal result shows promise for auditing variation in care.

Do Elevated Inflammatory Markers Associate With Infection in Revision Shoulder Arthroplasty?

Background Serologic erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) measurements, which have been successfully utilized in the lower extremity, are thought to lack adequate sensitivity in the diagnosis of infection after shoulder arthroplasty. The purpose of this study is to determine the diagnostic performance of preoperative white blood cell (WBC) count, ESR, and CRP in the diagnosis of infection in the setting of revision shoulder arthroplasty with the gold standard of infection being defined as a later diagnosis of infection. Patients and methods A national insurance database between the years of 2007 and 2015 (PearlDiver, Warsaw, IN) was queried for those patients who underwent revision shoulder arthroplasty using a combination of procedural (common procedural terminology codes 23472 and 23474) and diagnostic codes (International Classification of Diseases [ICD]-9 code 81.97 and equivalent ICD-10 codes). This database contains demographics, laboratory data, and complication data to allow identification of patients with an infection within 1 year postoperatively. Results The database contained 1392 patients who met criteria. Among these, the best diagnostic performance was with a combined test which was positive if CRP, ESR, or WBC was positive with a sensitivity of 7% to 42%, a specificity of 92%, a positive predictive value of 8% to 45%, a negative predictive value of 91%, and an accuracy of 84% to 85%. On multivariate analyses, predictors included an abnormal ESR (odds ratio 2.4, P = .05) and male gender (3.8, &lt;.001). Conclusions Those patients with an abnormal preoperative ESR have significantly increased odds of a subsequent infection following revision shoulder arthroplasty. ESR, CRP, and WBC in combination are specific but insensitive. Level of Evidence: Diagnostic, Level III

Evaluation of efficacy of septic screen in diagnosis of early onset sepsis

Background: Clinical features of sepsis are non-specific in all neonates and a high index of suspicion is required for the timely diagnosis of sepsis. Although blood culture is the gold standard for the diagnosis of sepsis, reports are available after 48-72 h. Therefore, a practical septic screen for the diagnosis of sepsis is needed. Objectives: To study the maternal and neonatal risk factors for early onset neonatal sepsis and to evaluate the efficacy of septic screen in diagnosis of same. Methods: Total 51 inborn were selected on basis of presence of maternal and neonatal risk factors, clinical features consistent with infection. The following investigations were done: Total leukocyte count, absolute neutrophil count, immature/total Neutrophil (I/T) ratio, haematocrit, platelet count, C-reactive protein (CRP) (after 6 h), gastric lavage, Micro erythrocyte sedimentation rate (ESR), chest X-ray (after 6 h). Blood culture was sent for any neonate with septic screen positive or those developing clinical sepsis within 72 h of birth and were correlated with the gold standard test (BACTEC). Results: Our study consisted of 51 inborn babies with 61% males and 39% females, 41% preterm &lt;37 weeks of gestation and 59% term, 64.7% low birth weight &lt;2500 g and 33% with history of premature rupture of membrane (PROM). Amongst 51 babies, 41.2% had leucocytosis, 15.7% with leucopenia, 21.6% had thrombocytopenia and 23.9% had anaemia. 86.3% had abnormal CRP, 33.3% had abnormal Micro ESR, and 54.9% had abnormal I/T ratio. Out of 51 babies, 17 (33.3%) were culture positive. Out of 17 culture proven sepsis, 64.7% were preterm, 88.8% were LBW &lt;2500 g and 64.7% had history of PROM. Out of 17 culture proven cases, 75% had leucopenia, 70% had abnormal I/T ratio. 58.8% had abnormal Micro ESR, 86% were CRP positive which suggest that leucopenia, CRP and Micro ESR are good septic screen markers. Gastric aspirate is less significant. Conclusion: PROM, prematurity and low birth weight, especially, very low birth weight are the common high risk factors for early onset sepsis. Amongst septic profile, leucopenia, CRP and Micro ESR are associated with culture proven sepsis.

Minimal disease activity and anti-tumor necrosis factor therapy in psoriatic arthritis.

A state of minimal disease activity (MDA) was defined and validated as target for treatment in psoriatic arthritis (PsA). We aimed to identify disease characteristics, outcome, and predictors of MDA in patients treated with tumor necrosis factor α (TNFα) blockers. Patients fulfilling the Classification of Psoriatic Arthritis criteria treated with TNFα blockers were followed every 3-6 months. Patients were considered in MDA when they meet at least 5 of the 7 criteria. Sustained MDA was defined as an MDA state lasting ≥12 months. Patients achieving MDA were compared to non-MDA patients. A proportional odds discrete time survival analysis model was applied, adjusting for sex, age, PsA duration, abnormal erythrocyte sedimentation rate (ESR) and clinically damaged joint count at each visit to identify predictors for MDA. Of the 306 patients treated with TNFα blockers identified from our database, 23 patients were in an MDA state when treatment was commenced; 57 were taking TNFα blockers prior to enrollment. Therefore, 226 subjects were in a non-MDA state and constituted the study population. One hundred forty-five patients of 226 patients (64%) achieved MDA within a mean ± SD duration of 1.30 ± 1.68 years. The mean ± SD duration of MDA was 3.46 ± 2.25 years. At total of 17 patients withdrew from therapy and remained in an MDA state. Male sex (odds ratio [OR] 1.65, 95% confidence interval [95% CI] 1.08-2.53; P = 0.02) and normal ESR (OR 2.27, 95% CI 1.22-4.17; P = 0.009) increased the odds for achieving MDA. MDA is achieved in 64% of patients treated with TNFα blockers in a clinical setting. Male sex and normal ESR are predictors for MDA. On withdrawal or reduction in treatment, 11.6% of patients maintained MDA state.

Immunoglobulin G subclass analysis in psoriatic arthritis.

The occurrence of monoclonal gammopathy of undetermined significance (MGUS) is common in chronic immune mediated disorders. This increased monoclonal antibody production could result from chronic stimulation of lymphocytes, with the immunoglobulin G (IgG) subtype accounting for the majority of cases in psoriatic arthritis (PsA). We aimed to identify IgG subclass profiles in patients with PsA and to determine association with specific disease characteristics. Serum samples from 221 patients with PsA from a single cohort were analyzed for their serum IgG subclass levels. All patients fulfilled the ClASsification for Psoriatic ARthritis (CASPAR) criteria and were followed at 6-month to 12-month intervals according to a standard protocol. MGUS was defined as the occurrence of a discrete band in the gammaglobulin region on at least 2 separate serum protein electrophoresis tests performed 6 months apart. Patients with high abnormal IgG subclass levels were compared to patients with normal levels using descriptive tests. Elevations of IgG1-4 were common in PsA, with ∼20%-49% of patients having elevations of each subclass, IgG2 being the most common subclass abnormality. However, no clinical-serological correlation was found in the group with abnormal IgG2 levels. Of the 38 patients with MGUS, elevations in IgG1 were most common. Patients with an abnormal IgG1 subclass level were more likely to have a discrete band in the gammaglobulin region, higher prevalence of MGUS, and abnormal erythrocyte sedimentation rate or C-reactive protein levels. Determination of the IgG subclass concentration in PsA did not seem to add any significant value in identifying specific disease manifestations. However, this study provides insight into the pathological process leading to MGUS in PsA.

Systemic aspects of soft tissue rheumatic disorders (STRDs).

To determine the markers of systemic inflammation in soft tissue rheumatic disorders (STRDs). Case series. Rheumatology Clinic, Yazd, Iran, from November 2010 to December 2011. Patients aged 20 years or above with known diagnosis of STRD according to clinical criteria and/ or paraclinical investigations for at least 3 weeks duration were longitudinally followed. Patients with diagnosis of rheumatoid arthritis, hypothyroidism, or any other known systemic conditions (other than diabetes mellitus) were excluded. After careful and detailed history taking, laboratory tests indicating systemic inflammation including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and routine screening rheumatologic tests were assessed. Of the 90 patients, 75% were female and 25% were male and 28 (31.1%) of patients had diabetes mellitus. Fifty six (62%) and 49 (54%) of all studies cases had some degrees of morning stiffness and remarkable fatigue respectively. Twenty two (24%) had elevated CRP and 5 (5.5%) had abnormal ESR. Rheumatoid factor (RF) and anti-CCP was positive in 5 (5.5%) and 12 (13.3%) of patients accordingly. Three (3.3%) patients suffered from anemia of chronic disease. Mean ESR was 48 ± 7.34 (hl) and mean CRP was 10.06 ± 1.96 mg/dl. Mean RF was 10.8 ± 1.64 U/ml and mean anti- CCP was 18.5 ± 2.71 U/ml. Mean hemoglobin was between 10.4 ± 1.01 g/dl. Features of subtle systemic inflammation are positive in some cases of soft tissue rheumatism.

Pyogenic Flexor Tenosynovitis of the Finger due to Kingella Kingae

To the Editors: Pyogenic flexor tenosynovitis (PFT) is a closed-space infection of the sheath of the fingers’ tendons.1–3 Most of the time, the flexor sheath infection occurs after an injury to the finger, such as deep cut or penetrating trauma.1,3,4 When bacteria penetrate into the sheath, the body has only limited ability to fight off these infections because there is no blood supply to the lubricating synovial fluid within the tendon sheath, rendering the body’s immune system ineffective.1,3,5,6 Most infections are caused by native skin flora, and Staphylococcus aureus is the most common organism.3,4,6,7 Many other microorganisms may be responsible for PFT especially after cat bites, dog bites or even human bites.7 The purpose of this article is to report the first case, to our knowledge, of PFT caused by Kingella kingae in a young child. A 16-month-old Caucasian girl was brought to the emergency department of our hospital complaining of swelling and limited movement of the right ring finger. At the admission, the child was afebrile and the ring finger was slightly swollen, with a red area at the level of the proximal phalanx. The finger was held in extension and spontaneous movements were limited. Laboratory results showed a white blood cell count of 16,000 cells/mm3, an elevated C-reactive protein (28 mg/dL) and an abnormal erythrocyte sedimentation rate (25 mm/h). Magnetic resonance imaging demonstrated a collection in the flexor tendon sheath with moderate soft tissue reaction suggestive of tenosynovitis (Fig. 1). The child underwent surgery to clean out the flexor tendon sheath, accomplished by making 2 small incisions, 1 at the palm and the other near the tip of the finger. At the opening of the sheath, there was an abundant liquid and saline fluid was then washed through the sheath. K. kingae-specific real-time polymerase chain reaction was positive using synovial tendon sheath fluid. The patient was treated with intravenous antibiotics (cefuroxime) initially and switched to oral treatment after 3 days for 10 additional days. The child recovered full mobility of the affected finger.FIGURE 1: 3D SPACE inversion recovery T2 axial (A) and sagittal (B) reconstructions showing collection in the flexor tendon sheath with moderate soft tissue reaction (arrows) suggestive of tenosynovitis.Pyogenic flexor tenosynovitis is an aggressive closed-space infection of the digital flexor sheaths,2,3,7 which is uncommon in children.4 This condition necessitates urgent diagnosis and surgical care,2,8–10 as delay in diagnosis can result in a worse prognosis.8–10 Since the 1980s, the reported number of cases of K. kingae’s osteoarticular infections has markedly increased mainly owing to utilization of molecular methods.11–17 Many studies have demonstrated that K. kingae has become the major bacterial cause of osteoarticular infections in children between 6 and 48 months of age.12–15 However, its role in causing PFT has never been documented, and the present case is the first to be reported. Osteoarticular infections due to this microorganism are characterized by a mild-to-moderate clinical and biologic inflammatory response. Therefore, infected children may present few signs evocative of osteoarticular infections.12,18 Our patient had mild symptoms. PFT due to K. kingae seems to have a less aggressive presentation and course than PFT caused by Staphylococcus aureus or Streptococcus spp. Dimitri Ceroni, MD Pediatric Orthopedic Service Laura Merlini, MD Pediatric Radiology Service Davide Salvo, MD Pierre Lascombes, Professor Victor Dubois-Ferrière, MD Pediatric Orthopedic Service Children's Hospital Geneva Geneva, Switzerland

Percutaneous Vertebral Body Cement Augmentation for Back Pain Related to Occult Osteomyelitis/Diskitis

Although complications related to vertebroplasty or kyphoplasty are few, we treated 2 patients with vertebroplasty or kyphoplasty for pain, presumed to be due to vertebral compression fractures, which were subsequently found to be due to occult osteomyelitis/diskitis. The onset of their infections appeared to have preceded their vertebral body augmentation procedures and was possibly due to prior interventional procedures for histories of back pain.An 86-year-old woman had had 3 prior kyphoplasty procedures for fractures at T10, T11, and L1. She reported continued severe pain, and subsequent magnetic resonance imaging was misinterpreted for another fracture at T12, resulting in her fourth kyphoplasty. She became septic and had some improvement with antibiotics, but she declined specialty care and died. A 74-year-old man with chronic back pain had recently undergone lumbar facet joint injections. Computed tomography and subsequent bone scan found uptake at both L2 and L3. Despite abnormal erythrocyte sedimentation rate and C-reactive protein level and normal radiographic vertebral height, he underwent a vertebroplasty. His pain increased, and subsequent workup found L2-3 diskitis. He recovered with antibiotics and specialty care. Similar to prior reports of spondylodiskitis, both patients had multiple medical comorbidities.This article emphasizes the need for clinical reevaluation and scrutiny in the interpretation of imaging studies, including for infection in patients with continued pain after spinal procedures. The differential diagnosis of infectious etiology is an important consideration prior to vertebral cement augmentation for presumed fragility fracture.