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Biomedical subjects

D Roig-Escofet

Publications and source records attributed to D Roig-Escofet.

At least 19 recordsLinked to original sources

Lipoma arborescens of the knee.

Lipoma arborescens is a rare intraarticular lesion characterized by diffuse replacement of the subsynovial tissue by mature fat cells, producing villous transformation of the synovium. The etiology of this benign condition is unknown. The most typical site of involvement is the knee, most notably at the suprapatellar pouch, although other joints can be affected. Symptoms consist of gradual joint swelling, variable pain, motion range restriction, and intermittent joint effusions or bleeding. We report a case of lipoma arborescens and discuss the clinical features, diagnosis, and treatment of this disorder based on a literature review. Although it is rare, lipoma arborescens should be included in the differential diagnosis of patients with chronic joint swelling or hemarthrosis.

Follow-Up Studies

Evaluation of circulating type I procollagen propeptides in patients with Paget's disease of bone.

We evaluated circulating aminoterminal and carboxyterminal propeptides of type I procollagen and total alkaline phosphatase levels in eighty consecutive patients affected by Paget's disease of bone. We compared the biochemical data with the extent of bone disease calculated on the basis of the bone scintigraphic indices. Serum aminoterminal propeptide of type I procollagen levels were high in 77% of patients, serum carboxyterminal propeptide of type I procollagen levels in 22% and serum total alkaline phosphatase levels in 76%. We found significant correlations between the three markers studied. The three biochemical markers correlated significantly with the bone scintigraphic activity indices, but the highest correlation coefficient was between the aminoterminal propeptide and total alkaline phosphatase. We conclude that there is a discrepancy between serum levels of the propeptides studied in relation to Paget's disease of bone. The sensitivity of the carboxyterminal propeptide of type I procollagen in this disease is low. In contrast the aminoterminal propeptide may be as sensitive a marker for the evaluation of this disorder as total alkaline phosphatase, and in addition may be more specific.

Aged

Sudden cochlear hearing loss in a patient with Behçet's disease.

A Behçet's disease patient developed sudden cochlear hearing loss during a flare of her disease. Prednisone and cyclosporin therapy was ineffective, probably because it was initiated late. Sensorineural hearing loss is a rare but underrecognized complication of various forms of vasculitis such as Wegener's granulomatosis, polyarteritis nodosa, giant cell arteritis and Behçet's disease. Its importance lies in the need for an early diagnosis, since prompt treatment with steroids and immunosuppressive agents may lead to restoration of hearing.

Behcet Syndrome

Salivary testosterone in postmenopausal women with rheumatoid arthritis.

OBJECTIVE: To study changes in testosterone concentrations in saliva and total testosterone, free testosterone, and sex hormone binding globulin (SHBG) concentrations in serum in 2 groups of postmenopausal women with rheumatoid arthritis (RA), one group with glucocorticoid treatment and the other without it. METHODS: The above mentioned hormonal levels were measured in 20 postmenopausal women with RA undergoing glucocorticoid treatment, in 24 postmenopausal women with RA without treatment, and in 36 postmenopausal women without RA. RESULTS: We observed significantly lower levels of total testosterone in serum, SHBG in serum, testosterone in saliva, and the free testosterone index in the group of patients with RA undergoing glucocorticoid treatment compared to the group without treatment. We did not observe changes in free testosterone concentrations in serum of the groups studied, which is believed due to its lower specificity. CONCLUSION: Testosterone in saliva is a useful indicator for monitoring androgenic status in women with RA.

Aged

High serum prolactin levels in men with rheumatoid arthritis.

OBJECTIVE: High prolactin (PRL) levels have been reported in systemic lupus erythematosus, Reiter's syndrome, and psoriatic arthritis. However, results of PRL investigations in rheumatoid arthritis (RA) are contradictory. We evaluated the PRL status in men with RA and the possible effect on bone mineral density (BMD). METHODS: We studied 91 men with RA and 68 controls. PRL serum levels were analyzed under standardized conditions. Sex hormones (testosterone, androstenedione, and DHEAS) were also studied. BMD was analyzed at L2-L4 and the femoral neck by Hologic QDR1000. Comparative tests, linear correlations, and multiple regression analysis were performed. RESULTS: Serum PRL levels were significantly higher in men with RA (249+/-162 mU/l) than in controls (189+/-85 mU/l) (p=0.0015). High PRL levels were significantly correlated with the duration of RA (r=0.23; p=0.01) and with functional stage according to the Steinbrocker classification (r=0.24; p=0.01). High PRL concentrations were not correlated with the low levels of androgens observed in males with RA. Femoral BMD showed a negative correlation with PRL concentrations (r=0.20; p=0.04). Nevertheless, PRL was not a significant determinant of BMD. CONCLUSION: Men with RA have high serum PRL levels and concentrations increase with longer disease evolution and worse functional stage. Prolactin levels do not have a direct effect on BMD.

Adult

Termination of disease-modifying drugs in psoriatic arthritis: study of 109 courses of treatment.

Our aim is to study the termination of disease-modifying anti-rheumatic drugs (DMARDs) in psoriatic arthritis (PsA) and the causes of withdrawal. We have reviewed the prospective protocols of patients with PsA and collected the data on treatments and causes of withdrawal. Fifty-four out of 96 patients (48 male and 48 female) have undergone one or more courses of DMARD (n = 109). The life-table analysis shows a survival rate of 6 months for gold sodium thiomalate (GOLD) and sulphasalazine (SSZ), and 16 months for methotrexate (MTX). The Mantel-Haenszel test finds statistical differences between GOLD and MTX. There are no differences between MTX and SSZ or between GOLD and SSZ. The absence of differences for MTX and SSZ could be explained by the heterogeneity of both groups. The most common cause of withdrawal for GOLD and SSZ are adverse effects.

Antirheumatic Agents

Tertiary hyperparathyroidism after long-term phosphate supplementation in adult-onset hypophosphataemic osteomalacia.

We report the development of tertiary hyperparathyrodism in a patient with a sporadic form of adult-onset hypophosphataemic osteomalacia who had been treated with vitamin D or calcitriol and large doses of phosphate. This observation suggests that even with concomitant vitamin D or calcitriol therapy, long-term oral phosphate supplementation may lead to the development of hypercalcaemic hyperparathyrodism. Caution is recommended when relatively large doses of phosphate are used to treat hypophosphataemic osteomalacia of diverse causes.

Calcitriol

[Bone mineral density in female patients with systemic lupus erythematosus treated with high glucocorticoid doses].

OBJECTIVE: To study the bone mineral density (BMD) in premenopausal women with systemic lupus erythematosus receiving glucocorticoids (GL) and at 6 months, when the dose of GL was decreased to a level below half of the initial dose. METHODS: Twelve premenopausal women with SLE were prospectively studied after initiating prednisone therapy at a dose > or = 0.5 mg/kg/day. A densitometric study was performed (Hologic 1000 QDR) of the lumbar spine and femoral neck. Levels of osteocalcine (BGP), catacalcine (PDN-21), testosterone in plasma and saliva, and dehydroepiandrosterone sulphate (DHEAS) were measured. Measurements were repeated after 6 months. RESULTS: The initial mean dose of prednisone was 40 +/- 10.2 mg/day (0.66 mg/kg/day) with an accumulated dose of 27.6 +/- 23 g. Lumbar and femoral BMD were 1 +/- 0.13 and 0.831 +/- 0.07 g/cm2, respectively. A significant increase was observed in BGP an adrogen levels studied after a 6 months when the dose of GL was decreased to a mean dose of 13.9 +/- 7.5 mg/day (0.23 mg/kg/day), whereas no differences were found in BMD values. In none of the two phases of the study were osteoporosis, correlations between BMD and BGP, between PDN-21 and androgens or with the accumulated or punctual doses of GL documented. CONCLUSIONS: No decrease in BMD was observed after 6 months of therapy with high doses of GL. In contrast, an increase in BGP and androgenic status was observed when the GL dose was decreased.

Adult

Loss of bone mineral density in premenopausal women with systemic lupus erythematosus.

OBJECTIVE: To evaluate bone mineral density (BMD) in premenopausal patients with systemic lupus erythematosus (SLE). METHODS: We measured BMD by dual energy x ray absorptiometry at lumbar vertebrae L2-4 and at the right femoral neck in 74 premenopausal white patients (mean age 30.8 years) with SLE who were receiving glucocorticoid therapy, and in a control group. RESULTS: The mean cumulative dose of prednisone was 32.5 (SD 28) g. The mean dose at the time of absorptiometry was 13.7 (6.9) mg. BMD was significantly reduced at the spine and at the femoral neck in SLE patients when compared with the control group: L2-4 = 0.943 (0.1) g/cm2 v 1.038 (0.1) g/cm2 (p < 0.001); femoral neck = 0.766 (0.09) g/cm2 v 0.864 (0.1) g/cm2 (p < 0.001). Nine patients (12.1%), but none of the control group, had a BMD less than the reference range. CONCLUSION: BMD in premenopausal patients with SLE was less than that in a control group and less than the reference range of values defining the presence of osteoporosis in 12.1%. We did not find a relationship between BMD and either cumulative or baseline dose of corticosteroid therapy.

Adolescent

Sex hormone status and bone mineral density in men with rheumatoid arthritis.

OBJECTIVE: Sex hormone status has been proposed as an important determinant of low bone mineral density (BMD) in both men and women. Our objective was to study the relationship between sex hormones and BMD in patients with rheumatoid arthritis (RA), and how steroid therapy affects both. METHODS: We studied 99 men with RA to assess their BMD and sex hormone status. A comparative group of 68 age paired men was used. We made comparative tests, linear correlations, and multiple regression analysis. RESULTS: We found significant reductions in lumbar BMD (p = 0.0005), femoral BMD (p < 0.0005), salivary testosterone (p = 0.01), androstenedione (p = 0.007), and dehydroepiandrosterone sulfate (DHEAS) (p = 0.03) in patients with RA. In contrast, serum testosterone concentrations were normal. Salivary testosterone showed correlation with femoral BMD (r = 0.36; p < 0.001). By multiple regression analysis, weight, serum testosterone concentrations, and the cumulative dose of corticosteroids were significant predictors of lumbar BMD (r = 0.41; p = 0.001). Weight, age, androstenedione concentrations, and the cumulative dose of corticosteroids were the significant predictors of femoral BMD (r = 0.79; p < 0.0005). CONCLUSION: We confirm there is reduced BMD in men with RA; corticosteroids contribute, but are not the only factor in the pathogenesis of low BMD in patients with RA; we found decreased levels of androstenedione, DHEAS, and salivary testosterone in men with RA; and salivary testosterone, as with free testosterone, is correlated with BMD in patients with RA, with lower levels contributing to low BMD.

Adrenal Cortex Hormones

Prevalence of antiphospholipid antibodies in patients with ankylosing spondylitis.

OBJECTIVE: To establish the prevalence of antiphospholipid antibodies (aPL) in a group of patients with ankylosing spondylitis (AS). The relation of the antibodies with different clinical and analytical features was studied. METHODS: Eighty-four patients with AS (71 men) and 40 age and sex matched controls were studied. aPL determinations included: anticardiolipin antibodies (aCL) of the IgM, IgG, and IgA classes, the presence of lupus anticoagulant (LAC), and a false positive serologic test for syphilis. Comparisons between variables were done by Student t test, Mann-Whitney test and Chi squared test. Correlations between aPL and clinical variables were performed by Pearson coefficients. RESULTS: Twenty-four patients with AS (29%) has positive IgG aCL, compared with only 2 cases in the control group (5%) (p < 0.002). There were no differences in other aPL determinations between patients and controls. There was no correlation between the presence of aCL (IgG, IgM, or IgA) and LAC and the different aspects of the disease. Two patients fulfilled the criteria for antiphospholipid syndrome. CONCLUSION: Our results indicate the presence of IgG aCL in patients with AS higher than in the normal population but their relation with thrombosis and other systemic manifestations seems weak.

Adult

Bone mineral density in patients with temporal arteritis and polymyalgia rheumatica.

OBJECTIVE: To assess the influence of corticosteroids in the mineral content of patients with giant cell arteritis (GCA), 56 patients, 28 with polymyalgia rheumatica (PMR) and 28 with temporal arteritis (TA) were studied. METHODS: The bone mineral density (BMD) in the lumbar spine and the femoral neck was measured by dual photon X-ray absorptiometry. A control group (48 people) comparable in age and sex was also evaluated. RESULTS: Compared with the controls, the patients with GCA had lower values of BMD in the femoral neck (men: p < 0.03; women: p < 0.001). In the lumbar spine differences were significant in women (p < 0.05) but not in men (p < 0.1). Multiple regression analysis showed that the BMD at L2-L4 in men correlated with height and weight and was inversely related to the cumulative dose of corticosteroids and the duration of treatment. The BMD at L2-L4 in women correlated with height and weight, but not with corticosteroids. Multiple regression analysis in men showed that age and the total dose of corticosteroids were significant independent predictors of femoral BMD. In women BMD in the femoral neck was correlated with age and weight, but not with corticosteroid treatment. CONCLUSION: The total dose and duration of corticosteroid treatment have been shown to be determinant factors of bone mass in patients with GCA who received corticosteroids.

Absorptiometry, Photon