The diagnosis of enthesitis in clinical practice is difficult and usually based on conventional radiographic findings, which are not helpful in most cases.1 We previously reported that ultrasound (US) was sensitive in detecting peculiar pathological features of enthesitis around the heel.2 Furthermore, we have continued to study the efficacy of ultrasonographic diagnosis of enthesitis of other tendon and ligament insertion sites.

Sixteen patients (10 male, six female, mean age 45.6 years) with a diagnosis of seronegative arthropathy were recruited from the population for the study. Their mean disease duration was 6.3 years. They had seronegative arthropathy and knee enthesopathy without typical conventional radiographic evidence. An HDI 3000 ATL US machine (Advanced …

https://ard.bmj.com/content/annrheumdis/63/2/213.full.pdf

Ultrasound detection of knee patellar enthesitis: a comparison with magnetic resonance imaging

Etanercept, a soluble tumour necrosis factor α (TNFα) receptor fusion protein, may be combined with methotrexate (MTX) in severe rheumatoid arthritis (RA).1 Etanercept is generally given to patients treated with MTX who have an inadequate response. However, MTX could be introduced to patients who have already been treated with etanercept and who initially had a good response but subsequently a secondary failure. It was decided to evaluate, in an open prospective study, the clinical, biological, and functional benefit of the secondary addition of MTX in patients with RA with an inadequate response to etanercept alone.

A cohort of 93 patients with active and severe RA was observed for a mean duration of 8 months (range 1–20). The group comprised 75 women, 18 men, with an average age of 49.5 years (range 17–75), and positive rheumatoid factor …

https://ard.bmj.com/content/annrheumdis/63/2/209.full.pdf

Secondary addition of methotrexate to partial responders to etanercept alone is effective in severe rheumatoid arthritis

Juvenile temporal arteritis (JTA) is a rare benign vascular lesion limited to the branches of the external carotid artery, first recognised by Lie et al .1 Histological features of JTA include vasculitis (without giant cells and granulomas), lymphocytes infiltrate, and fibrous intimal proliferation.1 Despite frequent local arterial thrombosis associated with the lesion, no study on the coagulation pathway has been undertaken until now. We present an exceptional case of JTA occurring in a man in association with activated protein C resistance.

A 34 year old male smoker (12 cigarettes/day), without past medical history, consulted in January 2001 for right headache associated with swellings of both temples. Temporal regions were painful when he wanted to brush his hair. No visual or systemic symptoms occurred. Physical examination showed no pulse of the right temporal artery and a pulse of the …

https://ard.bmj.com/content/annrheumdis/63/2/215.full.pdf

Juvenile temporal arteritis and activated protein C resistance.

Scalp necrosis as a manifestation of temporal arteritis An 85-year-old man with a history of hypertension and glaucoma was referred to us with a 2-month history of pain and skin necrosis on both temporoparietal regions (Fig. 1), which had been diagnosed as herpes zoster. The patient reported occasional fever below 38 C, asthenia, jaw claudication, pain on swallowing, weakness of scapular and pelvic waists, an unspecified weight loss, and general malaise. The physical examination showed extensive bilateral necrosis with serpiginous borders and a dirty and sphacelus appearance. The necrotic area was spontaneously highly painful and even more painful on palpation. The ophthalmologic examination was normal. The analytical study showed an elevated erythrocyte sedimentation rate (ESR) (70 mm in 1 h) and normochromic normocytic anemia. Temporal arteritis was suspected and a biopsy of the temporal artery confirmed the diagnosis (Fig. 2). Treatment was started with boluses of 6-methylprednisolone (500 mg · 3) and continued with oral steroids and oral methotrexate. The evolution was favorable. The areas of necrosis were debrided and were treated daily with antimicrobial cream to achieve granulation tissue and enable the area to be covered with skin grafts. The patient died soon after fromanacutemyocardial infarction. Temporal arteritis, giant cell arteritis, or Horton’s arteritis is characterized by a multisystem granulomatous vasculitis of the medium and large vessels, preferentially involving the external carotid area and, most frequently, the temporal artery. It is a rare disease, which appears in approximately 25 of every 100,000 individuals. It almost exclusively affects individualsagedover55years, females,andthewhitepopulation,althoughcaseshavebeenreportedinyoungpeople. It clinically manifests as cephalea, associated or not with a temporal artery of thickened, nodular appearance that is pulsatile and painful to palpation. It is usually accompanied by fever, general malaise, fatigue, anorexia, weight loss, jaw and tongue claudication, and musculoskeletal and ophthalmologic symptoms. It can also be associated with polymyalgia rheumatica syndrome. Cases of myocardial infarction, aorta dissection, strokes, and other infarctions of visceralorganshavebeenreportedinthesepatients. The diagnosis is simple in an elderly patient with the classic complex of fever, cephalea, and anemia with an increased ESR, and is confirmed by a biopsy of the temporal artery. Recent studieshaveproposedmagnetic resonanceangiography as a noninvasive method to aid in the clinical diagnosis and to select the optimal site for taking the biopsy, given that the involvementofthearteryisnotuniform. Pathology reveals a granulomatous arteritis that involves the inner layer with abundant multinucleated giant cells. It is associated with a proliferation of fibroblasts and muscle cells of the intima, with small changes in the middle layer, 466 Figure 1 Skin necrosis in both temporoparietal regions. The necrotic area shows serpiginous borders and a dirty and sphacelus appearance

Scalp necrosis as a manifestation of temporal arteritis.

Juvenile temporal arteritis: A clinicopathological multicentric experience.

[Juvenile temporal arteritis: a benign disease].

Artérite temporale juvénile : une maladie bénigne

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[Juvenile temporal arteritis: a benign disease].

Artérite temporale juvénile : une maladie bénigne