1989 Volume XIV, 4, 4º Trimestre - Acta Reumatológica Portuguesa ...

218 A. TRAVERSO, A. SPITALERI, T. MANCA, A BALDARI, F. CATALANI, A. SHENONE, I. DE MARTINI
rheumatoid arthritis, which had already been diagnosed in 1974. The symptoms
disappeared after 20 days treatment with Indomethacin.
About 6 months later he was readmitted complaining of hyposthenia in the
upper limbs and there was a further worsennig of the general clinical picture.
A clinical examination revealed muscular hypotrophy of the scapular girdle
and of the hand muscles, widespread reduction in the articular mobility and, in
particular, difficulty in flexing the lower limbs.
The patients also had difficulty in swallowing and coordinating his tongue
movements.
The neurological examination revealed widespread hypotrophy of the tongue,
which presented fasciculations, dysphonia with open rhinolalia, hyposthenia
(force=2) of the four limbs and an advanced degree of hypotropia of the
scapular girdle and of the upper limbs (both proximal and distal tract).
There were also rare fasciculations of the biceps and triceps and reduced
OTR of the upper limbs. There also seemed to be slight hypotrophy of the
right rectus femoris muscle; Patellar jerk was bilaterally vivacious.
There was no evidence of any alterations in either the superficial or the
sensitivity in depth, or in coordination, and the "fundus oculi" was normal.
Besides, the following tests evidenced abnormalities:
E.S.R = 50at 1st hour.
C.R.P.=+++
A.L.P. = 131
R.A. Test = 1/80
Waaler Rose = 160 U.I.
E.C.G. = There was total arhytmia, as a result of a. f., frequent ventricular
ectopias. Diffuse alterations in repolarization probably caused by previous
ischemic attacks.
THORAX Radiographic = RIGHT: signs of pachi-pleuritis with obliteration
of the rib-phrenic sinus. LEFT: obliteration of the rib-phrenic sinus and
disventilatory striae of the pulmonary base. Increased cardiac transverse diameters.
Sclerosis and ectasia of the aorthic arch.
RADIOGRAPHS
1) Cervical spine: reduction of the physiologic lordosis with spondilo-arthritis
and osteophitosis. Diffuse reduction of the interspinal spaces and reducted
flexing.
2) Dorsal spine: spondiloarthrosis and yielding of D12
3) trophic paralysis in the area of the spinal with disk lesions of Ll, L2, L3,
L4 and L5. Widespread reduced bobne density.
4) Hands: signs of serious bilateral rheumatoid arthristis, with marginal
erosions, narrowing of articular spaces, subluxation of first right metacarpophalangeal
joint and destruction in the wrists, particulary in the radiocarpal
joint (Fig. 1).
ELECTROMYOGRAPHY: signs of peripheral neurological damage at the
brachial biceps bilaterally, at the left brachial triceps and at the right tibial
ACTA REUMATOLÓGICA PORTUGUESA