Publications (4)10.77 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Dactylitis and calcaneitis developed in a patient with untreated sarcoidosis of the skin and lungs. Radiographs showed a defect in the second phalanx of the left middle finger. Radiographs of the feet were normal, but magnetic resonance imaging demonstrated a defect in the left calcaneus. Methylprednisolone therapy (1 g per day for three consecutive days) induced a dramatic improvement within 48 hours. Low-dose oral glucocorticoid therapy was given subsequently. One year later, a recurrent episode of dactylitis responded promptly to the same regimen. Maintenance therapy was given, and no further recurrences were noted during the four-year follow-up. Sarcoid bone lesions are uncommon and arise selectively in the small bones of the hands and feet. Involvement of the calcaneus is exceedingly rare, and its treatment is not standardized. In our patient, glucocorticoid therapy combined with methotrexate and hydroxychloroquine were effective in controlling the disease.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose. To evaluate the efficacy of upper cervical spine surgery in symptomatic atlanto-axial instability due to rheumatoid arthritis (RA). Material and methods. Thirty RA patients (29 women and one man) with a mean age of 56 years were studied retrospectively. Symptomatic forward slippage of the atlas on the axis with a synovial pannus surrounding the odontoid and magnetic resonance imaging evidence of spinal cord compression was present in all 30 patients; 18 patients had vertical translocation of the odontoid and 14 had basilar impression. Surgery, performed between 1991 and 1997, consisted in occipito-cervical fusion in 18 patients and atlanto-axial fusion in 12. Cotrel-Dubousset instrumentation was performed in all 30 patients. Results. Mean follow-up was four and a half years. All patients were satisfied with the procedure and exhibited marked functional gains and objective neurological improvement (by one class in the Ranawat scheme). Stable fusion was documented in all 30 patients. Conclusion. Cervical instrumentation and bone grafting seems to provide functional and neurological gains in carefully selected RA patients with atlanto-axial instability and spinal cord compression. Long term follow-up suggests that the benefits are sustained and that morbidity is low.