Rheumatologic Complaints Research Articles

5175 A Rare Case of Type B Insulin Resistance Syndrome

Abstract Disclosure: S. Fatima: None. A. Champion: None. S. Ward: None. Q. Aziz: None. K.E. Izuora: None. Introduction: Severe insulin resistance may be defined as a severely diminished response to insulin’s biological effects and is characterized by substantial hyperinsulinemia and impaired glucose response to endogenous and exogenous insulin. We hereby present a rare case of Type B Insulin Resistance Syndrome (TBIRS). Case:40-years old female with history of systemic lupus erythematosus (SLE), diabetes mellitus was admitted with multiple rheumatologic complaints, including arthralgias, oral ulcers, skin rash, and hair loss secondary to SLE flare. Endocrinology was consulted for diabetes management. Her HbA1c had increased from 7.3% to 11.6% in 3 months despite taking Glargine 45 units daily, Lispro 15 units pre-meals and metformin. She noticed 80 lbs weight loss for past 6 months. Her BMI was 26 and exam showed acanthosis of neck, armpits, groin, hair loss on scalp, multiple genital ulcers, and facial rash. She was noted to have refractory hyperglycemia despite high insulin doses. By 14th day of hospitalization, she was on 287 units of insulin (3.4units/kg) daily. We suspected TBIRS in the setting of SLE. Metformin and pioglitazone were started. Further testing showed insulin level 152mIU/ml (2.6-14.9mIU/ml), C-peptide 1.7 ng/ml (1.1-4.4 ng/ml), islet-cell antibody negative, GAD-65 antibody <5 u/ml, insulin antibody 6.5 uU/ml, IGF-1 14 (79-259 ng/ml), adiponectin 13.3 (2.4-17.9 ug/ml), testosterone 7 (8-60 ng/dl), free testosterone <0.2 (0-4.2 pg/ml), total cholesterol 200 mg/dl (<200 mg/dl), triglycerides 85 mg/dl (<150 mg/dl), LDL 154 mg/dl (<100 mg/dl), HDL 29 mg/dl (>60 mg/dl). She was transferred to National Institute of Health for further care. She was confirmed to have TBIRS by insulin receptor antibody testing, started on regular insulin U500 initially, and then switched to IV insulin drip requiring up to 1700 units of insulin per hour. She received methylprednisolone, cyclophosphamide (2 doses), rituximab (2 doses), hydroxychloroquine and IV immunoglobulin. Her stay was complicated by hemophagocytic lymphohistiocytosis. She was discharged on U-500 Regular insulin, 1000 units with breakfast and 500 units with lunch, Prednisone 60 mg daily and Hydroxychloroquine. Two months later she was found unresponsive at home secondary to hypoglycemic seizures. She required dextrose drip and was discharged on Glargine 16 units and Lispro 6 units with meals. Conclusion: TBIRS is caused by a highly specific polyclonal autoantibody against the cell surface insulin receptor that decreases the cellular insulin response and causes refractory hyperglycemia. About 100 cases have been reported in literature. 60% of the cases are associated with SLE. The goal of therapy is to reverse the hypercatabolic state with high doses of insulin and to eliminate the autoantibodies with immunosuppressive therapy. The most common cause of mortality is hypoglycemia. Presentation: 6/3/2024

Rheumatological complaints in H syndrome: from inflammatory profiling to target treatment in a case study

BackgroundH Syndrome is a rare genetic condition caused by biallelic pathogenic variants in the SLC29A3 gene. It is characterized by a wide range of clinical manifestations, many of which are related to the immune-rheumatological field. These include scleroderma-like skin changes, deforming arthritis, and enlarged lymph nodes. The condition also features cardiac and endocrine defects, as well as hearing loss, for which the immune pathogenesis appears less clear. Immunomodulatory medications have been shown to improve many symptoms in recent experiences.Case presentationA 21-year-old girl was referred to our institute after being diagnosed with H syndrome. Her medical history was characterized by the development of finger and toe deformities, which developed since the first years of life and progressively worsened with clinodactyly. At 6 years of age, she was diagnosed with diabetes mellitus without typical autoantibodies and with bilateral sensorineural hearing loss. She also complained of frequent episodes of lymphadenopathy, sometimes with colliquation and growth retardation due to pancreatic insufficiency. It wasn’t until the genetic diagnosis of H syndrome that the continual increase in acute phase reactants was noticed, suggesting that an immunological pathogenesis may be the source of her problems. During her visit to our institute, she reported serious pain in both feet and hands and difficulty walking due to knee arthritis and muscle contractures. Conventional therapy with steroid injection in affected joints and methotrexate only led to partial improvement. After a thorough assessment of her inflammatory profile showing a high interferon score, the girl received treatment with baricitinib. Furthermore, based on recent data showing that SLC29A3 deficiency results in interferon production because of Toll-like Receptor 7 activation in lysosomes, hydroxychloroquine was also added. The combination of the two drugs resulted for the first time in a rapid and persistent normalization of inflammatory markers, paralleled by a dramatic improvement in symptoms.ConclusionsWe describe the results of inhibiting IFN inflammation in H syndrome and discuss how JAK inhibitors and antimalarials might represent a mechanistically based treatment for this orphan drug disorder.

Detection of joint involvement in patients with systemic lupus erythematosus using musculoskeletal ultrasound and its correlation with disease activity

BackgroundMusculoskeletal symptoms are common and could be the first presenting symptom in up to 50% of systemic lupus erythematosus patients, and they affect more than 95% of patients during the clinical course. The present study aimed to assess joint involvement in the wrists, hands, and knees of SLE patients using musculoskeletal ultrasonography and to correlate these findings with disease activity.The study enrolled 40 Patients with SLE who were attending the Immunology outpatient clinic and internal medicine department of Beni-Suef University Hospital and 20 age and sex nearly matched healthy controls who have no rheumatological complaints. Participants had a comprehensive physical examination, series of laboratory tests, functional assessment by Health Assessment Questionnaire score, disease activity assessment of by European Consensus Lupus Activity score, and radiological examination by high-resolution Ultrasound machine called (LOGIC P 9) using a gray-scale US mode (13–18 MHz) with Power Doppler to detect joint synovitis, synovial hypertrophy, bone erosions and or tenosynovitis.ResultsThere was a statistically significant prevalence of US abnormality of knee joints in both asymptomatic and symptomatic cases versus controls contrary to the wrist and hand US abnormality. The presence of SLE increases the risk of US abnormalities in knee joints 28 times more than controls also increasing the age of the patient one year increase the probability of getting abnormal findings in the knee joint by 1.156 times. While the only independent variable that can affect US abnormal findings in the wrist joint is the increase in Systolic Blood Pressure 1 mmHg with 1.06 times.ConclusionMusculoskeletal Ultrasound with applied Power Doppler is a good tool for the detection of early affection of joints either in symptomatic or asymptomatic SLE patients.

HLA-DRB1 Polymorphisms and Rheumatologic Manifestations in Chronic Hepatitis C.

Hepatitis C has been associated with rheumatologic manifestations (HCV-related RM). Clinically, HCV-related RM may be indistinguishable from the symptoms that occur in diffuse connective tissue diseases (DCTD-related RM), making the differential diagnosis difficult. Host genetic factors, such as the Human Leukocyte Antigens (HLA) polymorphisms were associated with HCV infection, however, there are no studies that discriminate between HCVrelated RM and DCTD-related RM. This study focused on verifying associations between HLADRB1 and RM in patients with chronic hepatitis C, aiming to distinguish between DCTD-related RM and HCV-related RM. The participants were 152 individuals, of both sexes, aged between 18 and 80 years, and affected by chronic hepatitis C. The patients underwent rheumatologic physical examination and HLA-class II (HLA-DRB1) typing was performed by PCR-SSO (Polymerase Chain Reactionsequence Specific Oligonucleotides). A significant number of patients with rheumatologic complaints (73%) not attributed to other causes was observed. DRB1*08 allele seems to confer protection against RM in chronic hepatitis C. There is no susceptibility association between HLA-DRB1 alleles and RM. The absence of association between HLA-DRB1 and the rheumatologic manifestations studied suggests that the pathophysiological pathways of DCTD-related RM and HCV-related RM are distinct.

Prevalence, Clinical Manifestations, and Treatment Pattern of Patients with Rheumatoid Arthritis Attending the Rheumatology Clinic at Tikur Anbessa Specialized Hospital, Ethiopia: A Cross-Sectional Study.

BackgroundRheumatoid arthritis (RA) is an a chronic inflammatory disease characterized by symmetric polyarticular inflammation that can lead to progressive joint damage. It is said to be rare among black Africans, even though there have been limited reports from some African countries and no study has been done on RA in Ethiopia. This study determined the prevalence, clinical features, and treatment of rheumatoid arthritis in Tikur Anbessa Specialized Hospital (TASH).MethodsA cross-sectional study design was conducted on diagnosed patients with RA attending the rheumatology clinic at TASH from November 2018 to February 2019. Data was collected through patient interviews and chart reviews. The dataset was subjected to descriptive statistical analysis using the Statistical Package for Social Sciences (SPSS) version 25.ResultsA total of 1116 patients attended a rheumatologic clinic with rheumatologic complaints. The prevalence of rheumatoid arthritis was 18.5% (206/1116). Females were mostly affected (F:M 4.6:1). One hundred nineteen (57.8%) were between 35 and 64 years of age. The seropositivity for rheumatoid factor was 47.1%. Almost all patients had morning stiffness (89.8%) and joint pain (97.1%), with the majority (74.8%) having both small and large joint involvement. Nearly half of the patients, 99 (48.1%), had a joint deformity. Comorbid conditions seen in this study were hypertension (17%), overweight in 43 (20.9%), and obesity in 8 (3.9%). Methotrexate was the most prescribed agent (82.5%), both as monotherapy and along with other medications, but 139 (67.5%) of them were on prednisolone, which 2/3 (122) of patients took for 6 months in duration.ConclusionRA accounted for nearly one-fifth of the patients coming to the rheumatology clinics, with females affected more, which is similar to reports from some African countries. Disease-modifying anti-rheumatic drugs are the most prescribed agents, but most patients are on a prolonged dose of prednisolone.

0825 A Case of Familial Restless Legs Syndrome and Raynaud's Phenomenon

Abstract Introduction Restless legs syndrome (RLS) is a common sensory-motor disorder that frequently leads to sleep disturbances and reduced quality of life. Raynaud's phenomenon (RP) is characterized by episodes of reduced blood flow mainly to the fingers due to vasospasms, with subsequent pain and discoloration, usually triggered by cold exposure or by stress. We present an interesting case report of co-occurrence and familial transmission of RLS and RP which has not been reported previously. Report of Cases: A 64-year-old woman presented for evaluation of long-standing RLS. She had a history of RP, osteoarthritis (OA), and recurrent late pregnancy losses. The patient, and one brother and a sister had RLS and RP. She had another sister and two maternal first cousins with RLS. Her mother suffered from neither and her father and his brother both had RP. She has a daughter who also has RLS. The patient's mother was treated with Diethylstilbestrol (DES) and had five pregnancy losses. The patient also had 3 miscarriages and the patient's daughter miscarried her first pregnancy as well. The patient first experienced RLS symptoms at the age of 12 and has been treated with several medications since then, most recently clonazepam. Since she was taken off clonazepam, she experienced a worsening of RLS and was subsequently started on Pregabalin up to 300 mg at bedtime but without significant relief. She was then started on pramipexole, titrated up to 0.375 mg which resulted in significant improvement of RLS symptoms. Her RP symptoms were infrequent, occurring every few months and not bothersome. She did not report rheumatological complaints other than chronic OA from lifelong sports. Conclusion This case report suggests a possible shared genetic abnormality in the transmission of both RLS and RP in this family. This genetic association may be related to a vascular dysfunction common to both disorders. The co-occurrence of frequent miscarriages (although could be related to DES), in association with the presence of RLS and RP, may also suggest an underlying auto-immune disorder. Further genetic research is needed to confirm above findings with the potential uncovering of new therapeutic targets for RLS. Support (If Any) None.

Anti-dense fine speckled (DFS) antibody: its staining pattern in indirect immunofluorescence and its clinical relevance.

Background: Dense fine speckled (DFS) pattern is defined by very intense, heterogeneous speckled staining of nucleoplasms of interphase HEp-2 cells and chromosomal areas of metaphase cells. The association of Anti-DFS70 and rheumatologic signs, symptoms, and diagnosis were evaluated.Methods: One-hundred-eight anti-DFS70 positives who got consecutively admitted to the Rheumatology clinic between January and June 2020 were analyzed. The clinical and laboratory findings of positives for anti-DFS70 antibody were compared with those with DFS pattern ANA IFA staining rates. Also, anti-DFS70 positivity rates and their correlation with the DFS staining pattern were analyzed retrospectively in 1016 CTD patients.Results: The most common complaint was joint pain seen in 77 (71.3%) and the most common laboratory abnormality was RF-positivity observed in 10/108 (9.3%) who had anti-DFS70 positivity. The most common ANA staining pattern was DFS (72/108; 66.7%); one-third had other than DFS. No statistical significance was found for the association of any of the rheumatological complaints and laboratory findings with the DFS staining pattern. ANA analysis was performed in a total of 964/1016 (94.88%) CTD patients and 44 (4.56%) of these positive for anti-DFS70. The correlation coefficient showed good correlations between the DFS pattern staining and anti-DFS70 antibody positivity (r=+0.773, p<0.001).Conclusions: Anti-DFS70-positives have a low rate of CTD. A low anti-DFS70 positivity rate was observed in patients with CTD. As such, it can be considered that anti-DFS70 does not predict CTD or even excludes it.

Specialized dermatological-rheumatological patient management improves diagnostic outcome and patient journey in psoriasis and psoriatic arthritis: a four-year analysis

BackgroundManagement of psoriasis patients with arthralgia suffering from suspected psoriatic arthritis (PsA) requires an interdisciplinary approach involving dermatologists and rheumatologists. The aim of the study was to analyze the specialized dermatological-rheumatological management of these patients before and after foundation of a PsA center.MethodsA retrospective cohort study of all dermatological-rheumatological consultations during two periods was conducted. Period one, from April 1st, 2016 to February 28th, 2018 versus period two, from March 1st, 2018 to January 31st, 2020, after foundation of a PsA center. Clinical data on patient characteristics including psoriasis subtypes, clinical symptoms and signs, disease activity scores, classification criteria and comorbidities as well as patient journey were extracted and analyzed.ResultsFour hundred four consultations were studied. Close collaboration in a PsA center lead to a relevantly shortened patient journey concerning rheumatological complaints: period 1: median (IQR): 36.0 (10.0–126.0) months, period 2: median (IQR): 24.0 (6.0–60.0) months. Established scores and classification criteria such as GEPARD or CASPAR did not assist in diagnosis of PsA. Arthralgia (p = 0.0407), swollen joints (p = 0.0151), morning stiffness (p = 0.0451) and dactylitis (p = 0.0086) helped to distinguish between osteoarthritis and PsA.ConclusionsClinical signs and symptoms, scores and classification criteria usually assessed were less helpful than expected in diagnosis of PsA. Close collaboration in a specialized PsA center yielded the fastest way of diagnosis.

ROMATOLOJİK HASTALIKLARDA HİDRADENİTİS SÜPÜRATİVA’NIN ÖNEMİ

Objective: Hidradenitis suppurativa (HS) is a recurrent chronic inflammatory disease of the apocrine glands. It is more common in women, especially after puberty. The primary locations affected are the axillary, inguinal, perianal, and perineal regions, with a painful nodüle and a complex of symptoms ranging from abscesses to sinus formation and hypertrophic scars. Obesity and metabolic syndrome, especially spondyloarthritis, autoinflammatory diseases and some autoimmune diseases are more common in HS patients. In this study, we aimed to determine the etiologic factors, demographic and clinical characteristics of patients with HS who were attending our rheumatology clinic. Material and Methods: This study was performed retrospectively in the Department of Rheumatology between January 2017 and December 2018. Eleven patients diagnosed with HS and over 18 years of age were included in the study. Epidemiological, clinical, and laboratory findings, along with treatment information file records of patients, were obtained through examinations. Results: Of 11 patients diagnosed with HS, 10 were male and one was female. The mean age of the patients was 40.9 years (minumum 22, maximum 57). When evaluated for concomitant rheumatologic diseases, four cases of spondyloarthritis, three of Behcet’s disease, one of Familial Mediterranean Fever, one of rheumatoid arthritis, one of gout and one of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) were diagnosed. Conclusion: HS may be associated with rheumatic diseases. Therefore, a differential diagnosis should be made in patients followed up with the diagnosis of HS in the case of rheumatologic complaints.&nbsp;&nbsp;

Clinical and immunological characteristics of 56 patients with systemic lupus erythematosusin Uganda.

ObjectivesThe prevalence and burden of SLE in Africa are poorly understood. This health-facility-based retrospective study aimed to describe the frequency and the clinical and immunological characteristics of SLE in Uganda.MethodsWe reviewed clinical notes of patients presenting with rheumatological complaints in two large rheumatology outpatient clinics in Uganda between January 2014 and December 2019.ResultsOf the 1019 charts reviewed, 5.5% (56) of the patients had confirmed SLE, with a median age of 29 (range: 14–65) years. The male-to-female ratio was ∼1:10, and 19.6% (11/56) of the patients had SLE and RA overlap syndrome. Patients presented with joint pains or swellings (n = 39, 69.6%), typical photosensitive malar rash (n = 34, 60.7%), oral ulceration (n = 23, 41.1%), anaemia (n = 14, 25.0%), hair loss and polyserositis (n = 12, 21.4% each), constitutional symptoms (n = 10, 17.9%), RP (n = 4, 7.1%) or LN (n = 3, 5.4%). ANA and anti-dsDNA autoantibodies were both positive in 25 (75.8%) of the 33 patients with available results. ANA titres were ≥1:160, with a median titre of 1:160 (range: 1:160 to 1:3200). Six patients had titres ≥1:320. The median dsDNA level was 80 (range: 40–283) IU. Ten patients had results of C3 and C4 complement protein levels and, of these, 4 patients had low C3 levels and 3 had low C4 levels.ConclusionSLE is uncommon among patients presenting with rheumatological complains in Uganda. SLE overlaps with RA in our setting, and a majority of patients present to care with complications.

Homeopathic Treatment of Rheumatoid Arthritis: An Open, Observational Trial

Abstract Background Rheumatological complaints including rheumatoid arthritis (RA) are frequently encountered conditions in homeopathy practice. On account of progressive destruction and disability of the joints, and troublesome side effects and dissatisfaction with the mainstream therapies, homeopathy remains one of the most sought-after therapies; however, it remained under-researched systematically. Aim of this trial was to evaluate the possible role of homeopathic treatment in RA by determining changes in severity of complaints and quality of life. Materials and Methods An open observational trial was performed on 50 patients suffering from RA (classified as per 2010 ACR/EULAR criteria) at National Institute of Homoeopathy, Kolkata and were assessed over 4 months of treatment. Disease Activity Score-28 (DAS28) and Rheumatoid Arthritis Disease Activity Index (RADAI) were used as the primary and secondary outcome measures respectively. Individualised medicines were prescribed on the basis of homeopathic principles. Results Six patients dropped out; 44 completed the trial. Intention-to-treat sample (n = 50) was analysed in the end. There were statistically significant reductions in both DAS28 score (6.8 ± 1.0 vs. 6.1 ± 1.2; mean reduction 0.7, 95% CI: 0.4–0.9, p &lt; 0.001) and RADAI score (6.6 ± 1.8 vs. 5.2 ± 1.9; mean reduction 1.4, 95% CI: 1.0–1.9, p &lt; 0.001) over 4 months of individualised homeopathic treatment. Conclusion Individualised homeopathic medicines seemed to produce promising treatment effects by reducing DAS28 and RADAI scores significantly over 4 months. Further randomised trials are warranted with enhanced methodological rigor (Trial registration: CTRI/2017/06/008848).

Severe skin disease in lupus associated with hemophagocytic lymphohistiocytosis: case reports and review of the literature

BackgroundHemophagocytic lymphohistiocytosis (HLH) is a severe clinical entity associated with high mortality in the adult population. HLH has been associated with infections, malignancy and autoimmune conditions such as Systemic Lupus Erythematosus (SLE), however this is often in the context of a disease flare. Currently, there are limited reports of inaugural SLE manifesting as HLH with a lack of consensus on treatment and management of these patients.Case presentationHere, we present two rare case reports of severe cutaneous manifestation of lupus associated with HLH. Both patients presented with sinister clinical courses with primarily rheumatologic complaints including malaise, arthralgia, and myalgia with biochemical abnormalities. Both patients were diagnosed with HLH as a result of first presentation from cutaneous lupus. A comprehensive literature review using the PubMed database with cases comprising keywords of HLH and SLE up to September 2017 was conducted, with an emphasis on inaugural cutaneous SLE cases.ConclusionsUltimately, we highlight that a keen clinical acumen is required as misdiagnosis may lead to insufficient treatment with adverse clinical outcomes with the unique presentation of HLH from inaugural cases of SLE.

Antı-β2 Glycoprotein I Antibodies in Children with Rheumatologic Disorders.

Anti-beta-2-glycoprotein I antibodies (anti-β2GPI) which are the main antiphospholipid antibodies that characterize the autoimmune "antiphospholipid syndrome" are pathogenic and are contributing to thrombosis. We aimed to evaluate the presence and the diagnostic importance of these antibodies in children with different rheumatologic diseases with or without thrombosis risk. A total of 100 children with different rheumatologic diseases evaluated retrospectively. The mean anti-β2GPI IgG (p=0.108), IgA (p=0.547), and IgM (p=0.807) levels showed no statistically significant difference between different diagnosis groups. But anti-β2GPI IgA and IgM levels were higher in SLE patient group. The mean anti-β2GPI IgG (p=0.375), IgA (p=0.811), and IgM (p=0.276) levels were not also showed difference between disease groups with/without predisposition to thrombosis even though concentrations were higher in thrombosis group. In children with rheumatological complaints, anti-β2GPI antibody measurements should not be the first diagnostic criteria if vasculitis is not thought as the primary defect underlying the clinical symptoms.

Perfil clínico-epidemiológico de pacientes infectados pelo HTLV-1 em Belém/Pará

ResumoObjetivoInvestigar o perfil clínico-epidemiológico de pacientes portadores do HTLV-1 em Belém, no Estado do Pará, Brasil, descrevendo as características de indivíduos infectados e atendidos no Laboratório de Clínica e Epidemiologia de Doenças Endêmicas (LCEDE) do Núcleo de Medicina Tropical (NMT) da Universidade Federal do Pará (UFPA).MetodologiaFoi um estudo descritivo de corte transversal, com coleta em prontuários de pacientes infectados pelo HTLV-1, matriculados no LCEDE do NMT da UFPA entre os anos 2000 a 2012. Foi aplicada a análise descritiva pelo programa Epi Info 3.2.5.ResultadosDos 182 prontuários, 35,2% eram do sexo masculino, e 64,8%, do sexo feminino. Houve predomínio de indivíduos casados (47,8%). A maioria (73,6%) tinha procedência do município de Belém-PA. Dentre os pacientes sintomáticos, 51% apresentavam sintomas neurológicos, 21%, queixas dermatológicas, 18%, queixas reumatológicas, e 10%, queixas autonômicas. Com relação aos pacientes com sintomas neurológicos, 16 (39,0%) foram diagnosticados com PET/MAH.ConclusõesHouve o predomínio do sexo feminino, na faixa etária entre 40 e 49 anos, casado, trabalho informal, procedentes de Belém, com queixas neurológicas e com retorno regular as consultas médicas.

A Case of Newly Diagnosed Chronic Myelomonocytic Leukemia with Rheumatoid Arthritis Presentation

We describe a case of newly diagnosed chronic myelomonocytic leukemia that presented with predominantly rheumatologic symptoms. In addition to the deletion of chromosome 12p, marrow cytogenetics also revealed a unique translocation, t(x:4). This finding was not a constitutive abnormality. We report this unusual chromosomal abnormality and hypothesize about the potential immunogenicity of the gene product and its relation to the patient’s rheumatologic complaints.

Employment of a needs assessment survey to shape a novel web-based pediatric rheumatology curriculum for primary care providers

BackgroundPediatric rheumatology faces many challenges due to the shortage of board certified physicians in the field and the imbalance in their geographic distribution. This shortage has required primary care physicians and adult rheumatologists to assume the care of children with rheumatologic diseases, though these physicians report significant discomfort doing so. We are addressing this issue through the development of a novel web-based curriculum aimed at primary care physicians.MethodsWe pursued a needs assessment survey of Vanderbilt pediatric residency graduates (1981–2010) working in primary care. Our goals were to understand their perceptions of what the needs are and what educational interventions would be most effective.ResultsOf 152 surveys sent successfully via Survey Monkey, we received 28 responses (18.4%). Responses suggest there to be a discrepancy between physicians’ general assessment of their training and their self-reported ability to recognize specific diseases. Nearly 80% of respondents felt that additional education in pediatric rheumatology would improve their ability to co-manage children with the rheumatologist. Action plans for common rheumatologic complaints and potential emergencies were thought to be of potential benefit by a majority of respondents.ConclusionsWe will utilize our survey results to develop a learner centered curriculum to have the highest positive impact in assisting primary care providers in caring for children with rheumatologic diseases.

AB0355 Anti-CCP antibodies in patients with rheumatologic complaints without rheumatoid arthritis: A prospective cohort in a tertiary care center

BackgroundThe presence of anti-CCP antibodies has been shown to be highly specific for rheumatoid arthritis (RA). Testing for anti-CCP antibodies has grown in popularity and has become widely available. Testing...

Clinical and laboratory features, complications and treatment outcome of brucellosis in childhood and review of the literature

Brucellosis, whether in an endemic region or not, remains a diagnostic puzzle due to occasional misleading unusual presentations and non-specific symptoms. The aim of this study was to evaluate the clinical and laboratory findings, complications and treatment outcome of brucellosis in children in southeastern Anatolia, Turkey. This study focuses on the frequency of clinical and laboratory findings and complications in cases with brucellosis. Of 22 patients, 8 (36.3%) were female and 14 (63.7%) were male. Fever, malaise, lack of appetite, arthralgia, and night sweating were the main presenting symptoms overall. Hematologic complications (n=13, 59.1%) were most common, followed by skeletal (n=7, 31.8%) and cutaneous system (n=1, 4.5%). Brucellosis may affect any organ system and imitate a variety of clinical entities. Diagnosis of brucellosis should be considered whenever there is a febrile illness associated with rheumatological complaints. Consequently, early recognition of the infection, prolonged antibiotic treatment and careful long-term follow-up should improve the patient outcome.

Clinical manifestations in individuals with recent diagnosis of HTLV type I infection

Background Human T-lymphotropic virus type 1 (HTLV-1) is known to cause HTLV-associated myelopathy (HAM)/tropical spastic paraparesis and adult T cell leukemia. A growing body of evidence links HTLV-1 infection with an increasing spectrum of disease, including uveitis, periodontal disease, arthropathy, sicca syndrome, and neurologic deficits. Objectives Despite recent findings, the natural history of HTLV-1 infection remains poorly defined. This study was designed to better characterize initial clinical and neurological findings in individuals diagnosed with HTLV-1 infection. Study design We conducted a cross-sectional study of 71 individuals recently diagnosed with HTLV-1 and 71 uninfected age- and sex-matched blood donors in Salvador, Brazil. Subjects were administered a standardized questionnaire and underwent physical exam. Results HTLV-1 infected subjects were significantly more likely than controls to report complaints of hand and foot numbness (OR = 5.3; 95% CI: 1.8–15.3; p = 0.002 and OR = 4.0; 95% CI: 1.3–12; p = 0.013 respectively), difficulty running (OR = 4.0; 95% CI: 1.1–14.2; p = 0.032), nocturia (OR = 5.0; 95% CI: 1.1–22.8; p = 0.038), arthralgia (OR = 3.3; 95% CI: 1.4–7.7; p = 0.006), and photophobia (OR = 3.3; 95% CI: 1.4–7.7; p = 0.006). Conclusions Neurologic, ocular and rheumatologic complaints may be the first manifestations of HTLV-1 infection. Therefore, all patients presenting with initial diagnosis should be rigorously screened for these symptoms.

Effects of celecoxib in young rats: Histopathological changes in tissues and alterations of oxidative stress/antioxidant defense system

Celecoxib is increasingly being used in children with rheumatologic complaints. Although the particular concerns about the safety of the drug, there are only a small number of published studies in children. This study was performed to investigate the effects of celecoxib on oxidative stress and antioxidant enzyme activities as well as celecoxib-induced changes in liver, kidneys and stomach of young rats. Four weeks-old Wistar albino, female rats were used. Celecoxib was given by gavage for 14 days. Control rats received only vehicle. Blood and organs were taken under pentobarbital anesthesia. Plasma malondialdehyde levels were increased by treatment. Catalase activity was increased, while glutathione peroxidase activity was decreased. Superoxide dismutase and glucose-6-phosphate dehydrogenase activities was not changed by treatment. The reduced glutathione content of kidneys were higher, while there was no significant difference in liver content, as compared with controls. Significant changes were observed in serum parameters of rats treated with celecoxib. Histopathological evaluation of organs was done by an experienced pathologist unaware of the treatment. Results of the present study indicated the alterations of oxidant/antioxidant status and histopathological changes in tissues of young rats treated with celecoxib.