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M T Clavaguera

Publications and source records attributed to M T Clavaguera.

12 recordsLinked to original sources
PubMed2001

Musculoskeletal manifestations in polymyalgia rheumatica and temporal arteritis.

OBJECTIVE: To evaluate the incidence and characteristics of musculoskeletal manifestations in polymyalgia rheumatica (PMR) and temporal arteritis (TA). METHODS: The records of 163 cases of PMR or TA diagnosed over a 15 year period in one area of Spain were reviewed for the presence and type of musculoskeletal manifestations. RESULTS: Of 163 patients, 90 had isolated PMR and 73 had TA. Eighteen of the 90 patients (20%) with isolated PMR developed distal peripheral arthritis either at diagnosis or during the course of the disease. When it occurred, synovitis was mild, monoarticular or pauci-articular, asymmetrical, transient, and not destructive. Other distal manifestations observed in these patients were carpal tunnel syndrome and distal extremity swelling with pitting oedema. In all cases these manifestations occurred in conjunction with active PMR. As expected, PMR was the most frequent musculoskeletal manifestation in patients with TA, occurring in 56% of cases. On the contrary, only 11% of patients with TA developed peripheral arthritis. An important finding was that peripheral arthritis in these patients appears to be linked only temporally to the presence of simultaneous PMR and is not observed in its absence. Distal extremity swelling or defined polyarthritis were not observed. CONCLUSION: The spectrum of distal musculoskeletal manifestations of PMR in our series is similar to that reported in other populations. By contrast, distal musculoskeletal symptoms are uncommon in TA. The almost complete absence of distal musculoskeletal manifestations in patients with pure TA suggests different mechanisms of disease in PMR and TA, supporting the view of two separate conditions or one common disease in which host susceptibility influences the clinical expression.

Aged↗
PubMed2000

Lack of association between infection and onset of polymyalgia rheumatica.

OBJECTIVE: The etiology of giant cell arteritis (GCA) is unknown, but its sudden onset and the wide variation in incidence reported from various parts of the world suggest a genetic predisposition and/or the influence of environmental factors, such as infectious agents or a seasonal effect. We analyzed the influence of season on GCA in our area over the period 1985-97, as well as the possible association between infection and onset. METHODS: Retrospective study of 143 cases of GCA diagnosed from 1985 to 1997. To evaluate seasonal variation in disease onset, the month of onset of the first symptoms related to GCA was used to calculate season-specific incidence rates. Differences between season incidence rates were assessed by chi-square test. To test for an association between infection and GCA onset, we considered only infections that occurred within 2 months before the onset of disease. Because of the difficulty in determining whether an infection was present using only the clinical and laboratory data recorded in patients' medical charts, we categorized the likelihood of patients having infection into 3 groups: no infection, probable infection, and definite infection. RESULTS: Between 1985 and 1997 (both years included), a total of 143 patients (88 women, 55 men) were diagnosed with GCA. Of these, 85 had isolated polymyalgia rheumatica (PMR), 22 had temporal arteritis (TA) without PMR, and 36 had PMR associated with TA. The main clinical features in our population were similar to those reported in other studies. We found no seasonal variation in disease onset during the 13 year period. Moreover, only one (0.7%) of 143 patients was categorized as a probable infection, whereas definite infection was not observed in any case. From these results, the hypothesis of an infectious cause for GCA seems highly improbable. CONCLUSION: We were unable to observe a seasonal pattern or an association between infection and the onset of GCA.

Aged↗
PubMed1999

Longterm therapy in polymyalgia rheumatica: effect of coexistent temporal arteritis.

OBJECTIVE: To analyze the clinical course and duration of therapy in a series of 104 patients with polymyalgia rheumatica (PMR), identifying factors that influence prolonged steroid use and relapses. METHODS: Retrospective study of 104 cases of PMR diagnosed from 1985 to 1995. Patients were followed from time of diagnosis until either their death or December 31, 1995. To assess the effects of the coexistence of temporal arteritis (TA) on outcome in PMR, patients were grouped according to the absence or presence of arteritis. Kaplan-Meier survival analysis was performed to evaluate the duration of therapy, the incidence of prolonged remissions and relapses, and the average time to relapse. The log-rank test was used to test for significant differences between groups. Multivariate Cox proportional hazards regression models were used to identify variables associated with the occurrence of these events. RESULTS: Of 104 patients, 69 had pure PMR and 35 had both PMR and TA. Although some patients had limited disease requiring limited corticosteroid (CS) therapy (usually about 2 years), a significant number of patients had sustained disease requiring longterm treatment. Patients with simultaneous arteritis tended to have a longer duration of therapy, but no increased risk of relapse. By multivariate analysis, increasing age at diagnosis, female sex, higher baseline erythrocyte sedimentation rate, and lower daily CS dose were significant risk factors associated with long duration of therapy. No clinical feature predicted patients who were more likely to relapse. CONCLUSION: Although there was great individual patient variation, we found that typically CS therapy lasted at least 2 years. Our findings allow the identification of patients who are particularly predisposed to need prolonged and higher dose cumulative steroid therapy and merit preventive strategies to decrease the incidence of steroid related adverse events.

Adrenal Cortex Hormones↗
PubMed1998

Bone and skeletal muscle metastases from gastric adenocarcinoma: unusual radiographic, CT and scintigraphic features.

Skeletal metastatic lesions arising from gastric cancer are uncommon and usually of the osteolytic type. In order to gain a better understanding of its radiological spectrum, we report two atypical cases of skeletal metastases from gastric adenocarcinoma presenting with unusual radiographic, CT and scintigraphic features. In one patient multiple ossifying skeletal muscle metastases and bone metastases with spiculated periosteal reaction occurred as a presenting manifestation of the malignant disease. The other patient developed widespread osteosclerotic metastases with a superscan pattern on bone scintigraphy.

Adenocarcinoma↗
PubMed1998

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↗
PubMed1997

Posterior tibial tendon dysfunction as a cause of acquired flatfoot in the adult: value of magnetic resonance imaging.

Dysfunction of the posterior tibial tendon is the most common cause of acquired flatfoot in adults; despite this, the condition is not commonly recognized. We report three cases with flatfoot secondary to spontaneous tendon rupture, in whom magnetic resonance imaging (MRI) was a helpful non-invasive technique to confirm the suspected diagnosis. This disabling entity, and the usefulness of MRI in the diagnosis and planning the appropriate treatment, are reviewed.

Diagnosis, Differential↗