Evaluation of dystrophic calcification in juvenile dermatomyositis and systemic sclerosis
Resumen
Background: Dystrophic calcification is associated with juvenile dermatomyositis and progressive systemic sclerosis. The clinical diagnosis is established with detection of subcutaneous and petrous nodules.
Conventional x-ray methods may evidence calcium deposits; however, in the case of incipient deposits x-ray may be insufficient. There are studies that use Tc99-MPD labeled bone scintigraphy to identify dystrophic calcification.
Objectives: Estimate the frequency of dystrophic calcification in patients with juvenile dermatomyositis and progressive systemic sclerosis and CREST syndrome, and the concordance between the diagnosis of dystrophic calcification obtained by physical exploration and that obtained by scintigraphy.
Patients and methods: A comparative, observational, and transverse study conducted in patients of one and the another gender, between 5 and 17 years of age, with diagnosis of juvenile dermatomyositis, progressive systemic sclerosis, and CREST syndrome to detect dystrophic calcification by physical exploration and scintigraphy. Fisher’s exact test was performed to evaluate the association between the two diagnostic methods, and the Kappa test was used for the level of concordance and analysis of distribution by group and extent of dystrophic calcification. The sensitivity and specificity of scintigraphy in detecting dystrophic calcification in soft tissues, bony protrusions, costal arches and vertebrae were also estimated.
Results: The overall incidence of calcinosis was 80%. In 16 patients dystrophic calcification was detected by dermatological physical exploration
and in 9 patients by scintigraphy. No association or concordance was found between the findings from physical exploration and scintigraphic findings. The latter have 37.5% sensitivity for detection of dystrophic calcification in soft tissues and 43.8% in bony protrusions, and are suitable for detection in costal arches.
Conclusions: Dermatological exploration and scintigraphy are complementary tools for detecting dystrophic calcification.
Citas
Gutierrez A Jr, Wetter DA. Calcinosis cutis in autoimmune connective tissue diseases. Dermatol Ther 2012;25:195-20.
Walsh JS, Fairley JA. Calcifying disorders of the skin. J Am Acad Dermatol 1995;33:693-706.
Boulman N, Slobodin G, Rozenbaum M, Rosner I. Calcinosis in rheumatic diseases. Semin Arthritis Rheum 2005;34:805-
Reiter N, El-Shabrawi L, Leinweber B, Berghold A, Aberer E. Calcinosis cutis: part I. Diagnostic pathway. J Am Acad Dermatol 2011;65:1-12.
Agarwal V, Sachdev A, Dabra AK. Calcinosis in juvenile dermatomyositis. Radiology 2007;242:307-11.
Robertson LP, Marshall RW, Hickling P. Treatment of cutaneous calcinosis in limited systemic sclerosis with minocycline. Ann Rheum Dis 2003;62:267-69.
Chauhan NS, Sharma YP. A child with skin nodules and extensive soft tissue calcification. Br J Radiol 2012;85:193-95.
Nunley JR, Jones LME. Calcinosis cutis. E Medicine Specialties 2009:1-18. http://www.emedicine.com/derm/topic66.
html
Bowyer SL, Blane CE, Sullivan DB, Cassidy JT. Childhood dermatomyositis: factors predicting functional outcome and development of dystrophic calcification. J Pediatr 1983;103:882-88.
Pachman LM, Abbott K, Sinacore JM, et al. Duration of illness is an important variable for untreated children with juvenile dermatomyositis. J Pediatr 2006;148:247-53.
Blane CE, White SJ, Braunstein EM, Bowyer SL, Sullivan DB. Patterns of calcification in childhood dermatomyositis. Am J Roentgenol 1984;142:397-400.
Fishel B, Diamant S, Papo I, Yaron M. CT assessment of alcinosis in a patient with dermatomyositis. Clin Rheumatol
;5:242–4.
Cairoli E, Garra V, Bruzzone MJ, Gambini JP. Extensive calcinosis in juvenile dermatomyositis. Acta Reumatol Port
;36:180-81
Palossari K, Vuotila J, Takalo R, et al. Contrast-enhanced dynamic and static MRI correlates with quantitative 99cT labeled nanocolloid scintigraphy. Study of early rheumatoid arthritis patients. Rheumatol 2004;43:1364-73.
Wu Y, Seto H, Shimizu M. Extensive soft-tissue involvement of dermatomyositis detected by whole-body scintigraphy with 99mTC-MDP and 201Tl-chloride. Ann Nucl Med 1006;10:127-30.
Bar- Server Z, Mukamel M, Harel L, Hardoff R. Scintigraphic evaluation of calcinosis in juvenile dermatomyositis with Tc-99m MDP. Clin Nucl Med 2000;25:1013-16.
Colamussi P, Prandin N, Cittanti C, Feggil L, Giganti M. Scintigraphy in rheumatic diseases. Best Pract Res Clin Rheumatol 2004;18:909-26.
Peller P, Ho V, Kransdorf MJ. Extraosseus Tc99 MDP uptake: a pathophysiological approach. Radiographic 1993;13:715-34
Derechos de autor 2015 Acta Pediátrica de México
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
