Objective To describe the cohort of patients with inflammatory rheumatic diseases (IRD) hospitalized due to SARS-CoV-2 infection in our hospital and to determine the increased risk of severe coronavirus disease regarding no IRD patients. Methods Retrospective single-center observational study of patients with IRD actively monitored in the Department of Rheumatology who were hospitalized due to COVID- 19. Results 41 (1,8%) out of 2,315 patients admitted due to severe SARS-CoV-2 pneumonia suffered from an IRD. The admission Odds ratio (OR) for IRD patients was 1.87 against the general population, and it was higher in patients with Sjögren’s syndrome, vasculitis and systemic lupus erythematosus. Twenty-seven patients were receiving treatment for IRD with corticosteroids, 23 with conventional DMARDs, 12 with biologics (7 rituximab, 4 anti-TNF and 1 abatacept) and 1 with JAK inhibitors. Ten deaths were registered among patients with IRD. A higher hospitalization rate and a higher number of deaths were observed in patients treated with rituximab (OR=12.8) but not in patients treated with anti-TNF (OR=0.9). Conclusion Patients with IRD, especially autoimmune diseases and patients treated with rituximab, may be at higher risk of severe pneumonia due to SARS-Cov 2, compared to the general population. More studies are needed to analyze this association further in order to help managing these patients during the pandemic.

PurposeTo analyse trends in hip fracture (HF) rates in patients with rheumatoid arthritis (RA) over an extended time period (17 years).MethodsThis observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalisations of patients with RA and HF that were reported from 1999 to 2015 were analysed. Codes were selected using the Ninth International Classification of Diseases, Clinical Modification: ICD-9-CM: RA 714.0 to 714.9 and HF 820.0 to 820.3. The crude and age-adjusted incidence rate of HF was calculated by age and sex strata over the last 17 years. General lineal models were used to analyse trends.ResultsBetween 1999 and 2015, 6656 HFs occurred in patients with RA of all ages (84.25% women, mean age 77.5 and 15.75% men, mean age 76.37). The age-adjusted osteoporotic HF rate was 221.85/100 000 RA persons/ year (women 227.97; men 179.06). The HF incidence rate increased yearly by 3.1% (95% CI 2.1 to 4.0) during the 1999–2015 period (p<0.001) and was more pronounced in men (3.5% (95% CI 2.1 to 4.9)) than in women (3.1% (95% CI 2.3 to 4.1)). The female to male ratio decreased from 1.54 in 1999 to 1.14 in 2015. The average length of hospital stays (ALHS) decreased (p<0.001) from 16.76 days (SD 15.3) in 1999 to 10.78 days (SD 7.72) in 2015. Age at the time of hospitalisation increased (p<0.001) from 75.3 years (SD 9.33) in 1999 to 79.92 years (SD 9.47) in 2015. There was a total of 326 (4.9%) deaths during admission, 247 (4.4%) in women and 79 (7.5%) in men (p<0.001).ConclusionIn Spain, despite the advances that have taken place in controlling disease activity and in treating osteoporosis, the incidence rate of HF increased in both male and female patients with RA.

BackgroundPyomyositis (PM) is an acute pyogenic bacterial infection of skeletal muscle that may arise from haematogenous spread (primary PM) or by contiguity (secondary PM). Although PM is more common in tropical countries, its incidence is increasing in other areas due to the high number of immunocompromised patients, who have a poor prognosis and elevated mortality.ObjectivesTo describe epidemiological characteristics, clinical spectrum, laboratory and microbiological findings, therapeutic and outcome of patients with PM treated at a Spanish tertiary hospital.MethodsWe performed a retrospective study of patients diagnosed with PM admitted to our hospital between January 1991 and October 2014. The data were obtained by reviewing their medical records.ResultsA total of 41 cases were included, most of them males (73.1%), with a mean age at diagnosis being 46 years (range: 1-84). The mean time from onset of symptoms to diagnosis was 2.3 weeks (range: 1-16). The most common clinical manifestations were pain (92.5%), fever (72.5%) and local swelling (67.5%). Large muscle groups were more frequently affected, especially lower limbs (70.7%), and 15 patients (36.6%) developed multifocal involvement. Leucocytosis was found in 64.8% and neutrophilia in 72.9%. The mean values of ESR and CRP were 91.5 mm/h and 158.3 mg/dL respectively, and CPK levels were increased in 5/18 cases. Imaging test were performed in 40 patients (ultrasonography 26, CT 29, MRI 8) and demonstrated muscle abscesses in 73.2%. Nine cases (22%) corresponded to secondary PM and the most commonly associated infections were cellulitis, arthritis and osteomyelitis. Underlying diseases most frequently found were HIV-1 infection in 12 cases, chronic C hepatitis in 10 cases (coinfection with HIV-1 in 7) and diabetes mellitus (DM) type 2 in 5 cases (12.2%). There was a previous diagnosis of autoimmune disease (AD) in 14,6% (2 rheumatoid arthritis, 1 lupus/Sjögren overlap, 1 p-ANCA vasculitis,1 Addison's disease and 1 DM type 1) and intravenous drugs abuse in 24.4%. Aspirate of muscle abscesses was performed in 37 cases, being positive for Staphylococcus aureus in 67.5%, Streptococcus sp. in 10.8% and polymicrobial infection in 16.2%. Blood cultures were positive in 17/35 patients and the most frequently isolated pathogen was S. aureus. Information regarding treatment was available in 38 cases, 50% of them receiving combinations of 2 intravenous antibiotics, the most common being cloxacillin + gentamicin, with median treatment duration of 4 weeks (range: 1-19). Drainage was performed in 32/41 (7 percutaneous, 25 surgical). Associated mortality was 19.5%, mainly due to septic shock. The most frequent complications were pneumonia (12.2%), endocarditis (4.9%), septic thrombophlebitis (4.9%) and myonecrosis (4.9%).ConclusionsPM is a serious, potentially life-threatening infection that primarily affects large muscle groups. Most patients have a predisposing factor; the most frequent in our patients were HIV infection, chronic C hepatitis, DM type 2, AD and intravenou...

SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome was first described by Chamot et al in 1987. 1 It is characterized by the presence of osteoarticular lesions (typically osteitis and hyperostosis of the anterior chest wall) and dermatological involvement (palmoplantar pustulosis, acne conglobata and hidradenitis suppurativa). 2 A wide range of manifestations have been associated with this disease, including lesions in other organs or systems, which poses a major challenge to diagnosis. However, pleural involvement has been seldom described as part of the clinical spectrum of this entity.We report a case of a patient with SAPHO syndrome who suffered repetitive episodes of pleural effusion. | C A S E REP ORTIn 2009, a 70-year-old man was diagnosed with SAPHO syndrome based on the presence of palmoplantar pustulosis, folliculitis and chronic sternoclavicular osteitis. Bone scintigraphy revealed a strong focal osteogenic reaction at the proximal epiphysis of both clavicles and the sternochondral joints, known as the "bull-horn" sign (Figure 1). Human leukocyte antigen (HLA)-B7 was positive and there was no evidence of acute or chronic sacroiliitis on magnetic resonance imaging. The autoimmune laboratory findings (rheumatoid factor [RF], anti-citrullinated protein antibodies [ACPA], antinuclear antibodies [ANA], extractable nuclear antigen antibodies [ENA], antineutrophil cytoplasmic antibodies [ANCA], complement, immunoglobulins [Igs], cryoglobulins and IgG4) and genetic test (HLA-B51 and CW6) were within normal limits. Due to the osteoarticular manifestations, the patient was being treated with subcutaneous methotrexate (20 mg per week) since 2010. In 2013, he developed a non-productive cough, dyspnea and chest pain before his admission to our hospital, where a right pleural effusion was demonstrated (Figure 2). The laboratory findings (hemogram, biochemistry and arterial blood gas sampling) were normal, except for an elevated C-reactive protein level of 265.6 mg/L. Pleural fluid had a serofibrinous appearance with lymphocytic exudate, with the following features: pH 7.45, lactate dehydrogenase (LDH) 426 UI/L, proteins 3.7 g/dL, glucose (Glc) 131 mg/dL, adenosine deaminase (ADA) 7.3 U/L, hematocrit (hct) 0.9%, leukocytes 2760/μL (neutrophils 540/μL, lymphocytes 2040/μL). Cytological and microbiological analyses of the pleural effusion were negative; there was no history of exposure to asbestos. Computed tomography (CT) and bronchoscopy with bronchoalveolar lavage (BAL) did not identify an underlying cause. CT showed a passive partial atelectasis of the right lower lobe. Pulmonary function tests showed a restrictive pattern. A video-assisted thoracoscopic surgery (VATS) biopsy of the right pleura only showed a non-specific chronic inflammation.The pleural effusion spontaneously disappeared over a 3-month period, and the patient remained pulmonary asymptomatic without a specific treatment for the following 4 years.In 2017, he was admitted again to our hospital complaining of shortness of breath; a ches...

Paraneoplastic polyarthritis is an inflammatory arthritis, is usually seronegative, and has a temporal and pathophysiological relationship with an underlying malignancy. Although head and neck tumors may be a cause of paraneoplastic polyarthritis, its association with tongue carcinoma has not been previously reported. We present the case of a 69-year-old man who was a former smoker and presented with polyarthritis since 2 months in the wrists, proximal interphalangeal joints, knees, and elbows, with increased levels of acute-phase reactants; negativity for rheumatoid factor, anticitrullinated cyclic peptide antibody, and antinuclear antibody; and negative results for crystals and microorganisms in the synovial fluid. Cervical computed tomography and posterior rhinoscopy were performed, which detected an asymptomatic lesion on the base of the tongue, whose biopsy was compatible with nonkeratinizing squamous cell carcinoma. Polyarthritis did not respond to glucocorticoids at medium doses (oral prednisone 20 mg/day) but progressively resolved after the initiation of antineoplastic therapy.