Idiopathic hypertrophic osteoarthropathy misdiagnosed as juvenile idiopathic arthritis. Case study.
Background
Pachydermoperiostosis (or primary hypertrophic osteoarthropathy) is a rare genetic disease that usually begins in childhood or adolescence, is characterized by certain clinical signs (pachydermia, periostosis, drum sticks) that gradually progress over many years until the disease stabilizes. Currently, there are 2 genes in which mutations are associated with the development of pachydermoperiostosis - HPGD and SLCO2A1. The functions of these genes are not fully understood, but their influence on the metabolism of prostaglandin E2 is known.
Case presentation
We present a case of a 20-year-old patient mistakenly diagnosed as juvenile idiopathic arthritis. Symptoms on admission to the hospital: pain accompanied by swelling in the hands and feet, arthralgias in the talocrural joints, knees with slight swelling, paresthesia in the extremities, hyperhidrosis, fatigue. Clinical and paraclinical examinations confirmed the diagnosis of pachydermoperiostosis.
Conclusions
Pachydermoperiostosis should be considered as a differential diagnosis when a patient presents with hypertrophic osteoarthropathy and acromegalic features.
The joint ultrasound markers in the early diagnosis of psoriatic arthritis
Objectives
Early establishment of arthritis in PsA based on clinical data and ultrasound examination.
Material and methods
The study was conducted between 2019-2023, in the rheumatology and arthrology departments of the Timofei Moşneaga Republican Clinical Hospital, or treated in outpatient. In order to meet the requirements of the study, 100 people were examined, including 70 patients with PsA.
Results
In patients with PsA the most common changes were an increase in the amount of intra-articular fluid and the proliferation of the synovial membrane. In total, fluid was detected in 293 out of 3,232 joints (9.1%).
Conclusions
Ultrasound is a highly informative method in detecting a wide range of morphological changes in the joints of patients with PsA. The highest index of sensitivity appeared when inflammatory fluid, cartilage changes, osteophytes and tenosynovitis were detected.
Osteitis condensans ilii – difficulty in diagnosis and management. Clinical case study
Introduction
Osteitis condensans ilii (OCI) is a condition characterized by benign sclerosis of the iliac bone in the portion adjacent to the sacroiliac joints, which is radiologically manifested by triangular opacities at the level of this portion. Among the clinical manifestations, localized low back or lumbosacral pain is often attested, which is found in the gestational or post-partum period. The pain may worsen during physical exertion or during menstruation and may be accompanied by myalgia.
Material and methods
The epidemiological, clinical and paraclinical data were used to highlight this study, followed by the conclusions of multidisciplinary specialists, retrieved from the inpatient medical records of 3 women with OCI, who were admitted for diagnosis and treatment.
Results
3 cases of imaging-determined OCI will be presented, which were initially diagnosed with seronegative spondyloarthritis (SpA). Through them, we would determine the varieties between the OIC forms and their differential diagnosis with SpA. The results of the lab tests do not reveal specific changes, so the markers of inflammation (C-reactive protein, erythrocyte sedimentation rate) were normal. Also, unlike SpA, the marker HLA-B27 is in most cases negative.
Conclusions
According to the results of the presented clinical cases, OCI is often confused with sacroiliitis, which leads to misdiagnosing and erroneous treatment tactics. Thus, in order to establish a true diagnosis, it is necessary to collect a detailed history, perform a comprehensive objective examination, which includes the character of the pain and its triggers, the lack of inflammatory lab markers and the radiological presence of the sclerosis areas at the level of the iliac bone, not involving the sacroiliac joints.