Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2014
Fibromyalgia often coexists and overlaps with other syndromes such as chronic fatigue, irritable ... more Fibromyalgia often coexists and overlaps with other syndromes such as chronic fatigue, irritable bowel syndrome, and interstitial cystitis. Chronic stress has been implicated in the pathogenesis of these illnesses. The sympathetic nervous system is a key element of the stress response system. Sympathetic dysfunction has been reported in these syndromes, raising the possibility that such dysautonomia could be their common clustering underlying pathogenesis. The objective of this study was to carry out a review of all published comparative case-control studies investigating sympathetic nervous system performance in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. Online databases PubMed and EMBASE were accessed using the following key words: autonomic (OR) sympathetic (AND) fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. All entries up to December 10th 2012 were reviewed by 2 independent investiga...
Ultrasound is a simple, non invasive and accessible imaging technique that allows the evaluation ... more Ultrasound is a simple, non invasive and accessible imaging technique that allows the evaluation of the musculoskeletal system in real time, with the advantage of examining the joints in a dynamic way and with the aid of Doppler power, local inflammatory phenomena can be evaluated, without submitting the patient to radiation. It has the disadvantage of being operator dependant, which has to have a wide knowledge of the physical principles of ultrasonography, has to be familiar with the sonographic anatomy and musculoskeletal anatomy, but even more it is important that he has the ability to recognize the sonographic phenomena that can present as decoys, nominated artifacts. This knowledge is desirable to the specialist in musculoskeletal conditions, so that ecographic studies can be interpreted and recognizing artifacts and avoiding wrong diagnosis and unnecessary procedures. In the present review, the basic principles of ecography are analyzed, the normal sonographic anatomy of the ...
BACKGROUND Spread of complex regional pain syndrome (CRPS) outside the affected limb is a well-re... more BACKGROUND Spread of complex regional pain syndrome (CRPS) outside the affected limb is a well-recognized phenomenon; nevertheless, the actual evolution from CRPS to fibromyalgia is poorly documented. Similar mechanisms have been recently put forward to explain the development of CRPS and fibromyalgia including dorsal root ganglia (DRG) hyperexcitability and small fiber neuropathy. OBJECTIVES The aims of this study were to describe 3 cases with typical CRPS evolving to full-blown fibromyalgia and to discuss the potential pathogenetic mechanisms linking these debilitating illnesses. METHODS This was a review of medical records and PubMed search on the relationship between CRPS-fibromyalgia with DRG and small nerve fiber neuropathy. RESULTS Our 3 cases displayed over time orderly evolution from CRPS to fibromyalgia. Dorsal root ganglion hyperexcitability and small fiber neuropathy have been recently demonstrated in CRPS and in fibromyalgia. Dorsal root ganglia contain the small nerve fiber cell bodies surrounded by glial cells. After trauma, DRG perineuronal glial cells produce diverse proinflammatory mediators. Macrophages, lymphocytes, and satellite glial cells may drive the immune response to more rostrally and caudally located DRG and other spinal cord sites. Dorsal root ganglion metabolic changes may lead to small nerve fiber degeneration. This mechanism may explain the development of widespread pain and autonomic dysfunction. CONCLUSIONS Clinicians should be aware that CRPS can evolve to full-blown fibromyalgia. Spreading of neuroinflammation through DRG glial cell activation could theoretically explain the transformation from regional to generalized complex pain syndrome.
This paper emphasizes the anatomical substrate of several foot conditions that are seldom discuss... more This paper emphasizes the anatomical substrate of several foot conditions that are seldom discussed in this context. These include the insertional and non-insertional Achilles tendinopathies, plantar fas-ciopathy, inferior and posterior heel spurs, foot compartment syndromes, intermetatarsal bursitis and Morton's neuroma. It is a rather superficial anatomical review of an organ that remains largely neglected by rheumatologists. It is our hope that the cases discussed and the cross examination by instructors and participants will stimulate study of the foot and the attention it deserves.
Objective. To characterize the ultrasound (US) pattern of joint involvement in primary Sjögren’s ... more Objective. To characterize the ultrasound (US) pattern of joint involvement in primary Sjögren’s syndrome (pSS).Methods. Seventeen patients with pSS, 18 with secondary Sjögren’s syndrome (sSS), and 17 healthy controls underwent US examinations of various articular regions. Synovitis (synovial hypertrophy/joint effusion), power Doppler (PD) signals, and erosions were assessed.Results. In patients with pSS, synovitis was found in the metacarpophalangeal joints (MCP, 76%), wrists (76%), and knees (76%), while the proximal interphalangeal joints, elbows, and ankles were mostly unscathed. Intra-articular PD signals were occasionally detected in wrists (12%), elbows (6%), and knees (6%). Erosions were evident in the wrists of three (18%) patients with pSS, one of these also having anti-cyclic citrullinated peptide (anti-CCP) antibodies. While US synovitis does not discriminate between sSS and pSS, demonstration of bone erosions in the 2nd MCP joints showed 28.8% sensitivity and 100% speci...
Background The presence of subclinical inflammation promotes the progression of morphostructural ... more Background The presence of subclinical inflammation promotes the progression of morphostructural joint damage in RA patients. Currently, clinical remission is based on the count of swollen and painful joints associated with acute phase reactants. Adding an image technique like grey scale (GS) US and power Doppler (PD) increases the capability to detect active synovitis. There are no studies on the association between active synovitis as defined by PD and more specific markers of inflammation like cytokines in patients with RA in clinical remission Objectives To identify subclinical synovitis in patients with RA in clinical remission using US and to characterize the biological profile of this group of patients by determining inflammatory cytokines Methods RA patients in clinical remission according to ACR/EULAR criteria were enrolled. Clinical evaluation was performed and DAS28 calculated. Cytokines (IL1b, 10, 6. 5, 2, 4, 8, GMCS, TNFa, IFNg,) were determined using ELISA kit (Human ultrasensitive cytokine 10 -plex panel [Invitrogen, CA, USA]). GS and PD ultrasound was assessed in 7 joints according to Backhaus et al (2). Esaote MyLab ® 25 ultrasound machine with 12-18 MHz linear probe was used. Results 21 patients were included. Clinical and demographic data are shown in the table. N=21 Age (years) 44.81 (25–69) Disease duration (months) 100.76 (28–353) Duration in clinical remission (months) 12.15 (1–43) DAS28 1.35 (0.99–2.42) Rheumatoid factor (positive) 95% (n=20) antiCCP (positive) 52% (n=11) GS synovitis was found in 95%, and tenosynovitis in 9.5%. PD was detected in 57%. There was no association between DAS28 and duration in clinical remission, disease duration and US-defined active synovitis (p=0.84, 0.309 and 0.762 respectively). Pro-inflammatory cytokines levels were elevated in patients with less than 6 months and in those with 13 to 24 months in clinical remission. Nevertheless, there was no correlation with US-defined synovitis (p=NS) Conclusions US detected a high percentage of subclinical synovitis in RA patients in clinical remission. Cytokine levels did not correlate with DAS 28 or ultrasound-defined active synovitis. References Brown AK, Conaghan P, Karim Z, et al. An explanation for the apparent dissociation between clinical remission and continues structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008; 58(10): 2958-2967 Backhaus M, Ohrndorf S, Kellner H, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum 2009; 61(9): 1194-1201 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4855
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2014
Fibromyalgia often coexists and overlaps with other syndromes such as chronic fatigue, irritable ... more Fibromyalgia often coexists and overlaps with other syndromes such as chronic fatigue, irritable bowel syndrome, and interstitial cystitis. Chronic stress has been implicated in the pathogenesis of these illnesses. The sympathetic nervous system is a key element of the stress response system. Sympathetic dysfunction has been reported in these syndromes, raising the possibility that such dysautonomia could be their common clustering underlying pathogenesis. The objective of this study was to carry out a review of all published comparative case-control studies investigating sympathetic nervous system performance in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. Online databases PubMed and EMBASE were accessed using the following key words: autonomic (OR) sympathetic (AND) fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. All entries up to December 10th 2012 were reviewed by 2 independent investiga...
Ultrasound is a simple, non invasive and accessible imaging technique that allows the evaluation ... more Ultrasound is a simple, non invasive and accessible imaging technique that allows the evaluation of the musculoskeletal system in real time, with the advantage of examining the joints in a dynamic way and with the aid of Doppler power, local inflammatory phenomena can be evaluated, without submitting the patient to radiation. It has the disadvantage of being operator dependant, which has to have a wide knowledge of the physical principles of ultrasonography, has to be familiar with the sonographic anatomy and musculoskeletal anatomy, but even more it is important that he has the ability to recognize the sonographic phenomena that can present as decoys, nominated artifacts. This knowledge is desirable to the specialist in musculoskeletal conditions, so that ecographic studies can be interpreted and recognizing artifacts and avoiding wrong diagnosis and unnecessary procedures. In the present review, the basic principles of ecography are analyzed, the normal sonographic anatomy of the ...
BACKGROUND Spread of complex regional pain syndrome (CRPS) outside the affected limb is a well-re... more BACKGROUND Spread of complex regional pain syndrome (CRPS) outside the affected limb is a well-recognized phenomenon; nevertheless, the actual evolution from CRPS to fibromyalgia is poorly documented. Similar mechanisms have been recently put forward to explain the development of CRPS and fibromyalgia including dorsal root ganglia (DRG) hyperexcitability and small fiber neuropathy. OBJECTIVES The aims of this study were to describe 3 cases with typical CRPS evolving to full-blown fibromyalgia and to discuss the potential pathogenetic mechanisms linking these debilitating illnesses. METHODS This was a review of medical records and PubMed search on the relationship between CRPS-fibromyalgia with DRG and small nerve fiber neuropathy. RESULTS Our 3 cases displayed over time orderly evolution from CRPS to fibromyalgia. Dorsal root ganglion hyperexcitability and small fiber neuropathy have been recently demonstrated in CRPS and in fibromyalgia. Dorsal root ganglia contain the small nerve fiber cell bodies surrounded by glial cells. After trauma, DRG perineuronal glial cells produce diverse proinflammatory mediators. Macrophages, lymphocytes, and satellite glial cells may drive the immune response to more rostrally and caudally located DRG and other spinal cord sites. Dorsal root ganglion metabolic changes may lead to small nerve fiber degeneration. This mechanism may explain the development of widespread pain and autonomic dysfunction. CONCLUSIONS Clinicians should be aware that CRPS can evolve to full-blown fibromyalgia. Spreading of neuroinflammation through DRG glial cell activation could theoretically explain the transformation from regional to generalized complex pain syndrome.
This paper emphasizes the anatomical substrate of several foot conditions that are seldom discuss... more This paper emphasizes the anatomical substrate of several foot conditions that are seldom discussed in this context. These include the insertional and non-insertional Achilles tendinopathies, plantar fas-ciopathy, inferior and posterior heel spurs, foot compartment syndromes, intermetatarsal bursitis and Morton's neuroma. It is a rather superficial anatomical review of an organ that remains largely neglected by rheumatologists. It is our hope that the cases discussed and the cross examination by instructors and participants will stimulate study of the foot and the attention it deserves.
Objective. To characterize the ultrasound (US) pattern of joint involvement in primary Sjögren’s ... more Objective. To characterize the ultrasound (US) pattern of joint involvement in primary Sjögren’s syndrome (pSS).Methods. Seventeen patients with pSS, 18 with secondary Sjögren’s syndrome (sSS), and 17 healthy controls underwent US examinations of various articular regions. Synovitis (synovial hypertrophy/joint effusion), power Doppler (PD) signals, and erosions were assessed.Results. In patients with pSS, synovitis was found in the metacarpophalangeal joints (MCP, 76%), wrists (76%), and knees (76%), while the proximal interphalangeal joints, elbows, and ankles were mostly unscathed. Intra-articular PD signals were occasionally detected in wrists (12%), elbows (6%), and knees (6%). Erosions were evident in the wrists of three (18%) patients with pSS, one of these also having anti-cyclic citrullinated peptide (anti-CCP) antibodies. While US synovitis does not discriminate between sSS and pSS, demonstration of bone erosions in the 2nd MCP joints showed 28.8% sensitivity and 100% speci...
Background The presence of subclinical inflammation promotes the progression of morphostructural ... more Background The presence of subclinical inflammation promotes the progression of morphostructural joint damage in RA patients. Currently, clinical remission is based on the count of swollen and painful joints associated with acute phase reactants. Adding an image technique like grey scale (GS) US and power Doppler (PD) increases the capability to detect active synovitis. There are no studies on the association between active synovitis as defined by PD and more specific markers of inflammation like cytokines in patients with RA in clinical remission Objectives To identify subclinical synovitis in patients with RA in clinical remission using US and to characterize the biological profile of this group of patients by determining inflammatory cytokines Methods RA patients in clinical remission according to ACR/EULAR criteria were enrolled. Clinical evaluation was performed and DAS28 calculated. Cytokines (IL1b, 10, 6. 5, 2, 4, 8, GMCS, TNFa, IFNg,) were determined using ELISA kit (Human ultrasensitive cytokine 10 -plex panel [Invitrogen, CA, USA]). GS and PD ultrasound was assessed in 7 joints according to Backhaus et al (2). Esaote MyLab ® 25 ultrasound machine with 12-18 MHz linear probe was used. Results 21 patients were included. Clinical and demographic data are shown in the table. N=21 Age (years) 44.81 (25–69) Disease duration (months) 100.76 (28–353) Duration in clinical remission (months) 12.15 (1–43) DAS28 1.35 (0.99–2.42) Rheumatoid factor (positive) 95% (n=20) antiCCP (positive) 52% (n=11) GS synovitis was found in 95%, and tenosynovitis in 9.5%. PD was detected in 57%. There was no association between DAS28 and duration in clinical remission, disease duration and US-defined active synovitis (p=0.84, 0.309 and 0.762 respectively). Pro-inflammatory cytokines levels were elevated in patients with less than 6 months and in those with 13 to 24 months in clinical remission. Nevertheless, there was no correlation with US-defined synovitis (p=NS) Conclusions US detected a high percentage of subclinical synovitis in RA patients in clinical remission. Cytokine levels did not correlate with DAS 28 or ultrasound-defined active synovitis. References Brown AK, Conaghan P, Karim Z, et al. An explanation for the apparent dissociation between clinical remission and continues structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008; 58(10): 2958-2967 Backhaus M, Ohrndorf S, Kellner H, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum 2009; 61(9): 1194-1201 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4855
Uploads
Papers by Angelica Vargas