Revista Colombiana de Reumatología (English Edition)最新文献

Transient osteoporosis of pregnancy is a pathology of low prevalence and difficult diagnosis that mainly affects pregnant women in the third trimester of pregnancy. It is characterized by mechanical joint pain, more frequent in the lower limbs, radiological osteopenia, and bone oedema on magnetic resonance imaging (MRI). A series of 4 cases is presented in pregnant women between 26 weeks of gestation and the early puerperium with symptoms of coxalgia and/or knee pain. The treatment was based on conservative measures: analgesics that are allowed during pregnancy and non-weight bearing on the joints, and the possibility of corticosteroid infiltration into the joint. Bisphosphonates can be added in the puerperium. All cases resolved within a maximum of 9 months, without subsequent sequelae.

Interstitial lung disease refers to a group of disorders generally characterized by progressive scarring of lung tissue due to a wide variety of causes and associated with a plethora of symptoms. Patients with this diagnosis can be asymptomatic or present severe symptoms that could lead to death. Its signs and symptoms are the same in patients with concomitant connective tissue disease and those without. Genetics and immunity play essential roles in patients with interstitial lung disease and idiopathic inflammatory myopathy. Alterations in genes and excessive production of specific cytokines can lead to the development of interstitial lung disease. Interstitial lung disease can have several complications, including chronic respiratory distress and infections, and can worsen the prognosis of patients with idiopathic inflammatory myopathy. Here, we present a narrative review describing the epidemiology, pathophysiology, clinical manifestations, risk factors, and complications of the population with interstitial lung disease and idiopathic inflammatory myopathy.

Introduction

Capillaroscopy is a non-invasive tool used to evaluate microcirculation and determine whether a Raynaud's phenomenon is primary or secondary. Capillaroscopic changes are well-described in systemic sclerosis; however, these alterations have been less studied in other autoimmune diseases.

Objective

The aim of this study is to determine videocapillaroscopic alterations in lupus, and its association with clinical manifestations.

Materials and methods

A cross-sectional study with analytical intention was performed. Videocapillaroscopy and medical evaluations were performed on 76 patients with lupus, according to SLICC 2012 classificatory criteria, from January to June 2019. Chi², Fisher, and Mann–Whitney U tests were used to evaluate association, and the prevalence ratios (PR) were determined. A multivariate analysis was performed.

Results

Seventy-one (93.4%) of the patients were female with a median age of 33.5 years (interquartile range [IQR]: 27–44.8); the median lupus duration was 84 months (IQR: 30–168). The main clinical manifestations were articular, cutaneous, hematological, and Raynaud's phenomenon. A non-specific pattern was found in 43 patients (56.6%), and a systemic sclerosis-like pattern was found in 7 patients (9.2%). In bivariate and multivariate analyses, Raynaud episodes occurring more than once a week (PR 1.24; 95% CI: 1.13–1.33) were more frequent in patients with a sclerosis-like or a non-specific pattern.

Conclusion

Lupus patients frequently have videocapillaroscopic alterations with non-specific and systemic sclerosis like patterns, which are more common in patients with Raynaud's phenomenon that occurs more than once a week. Due to the study's design, it is impossible to determine causality.

Introduction

Relapses are common in patients with ANCA-associated vasculitis (AAV), which results in a significant burden of morbidity, mortality, impact on quality of life, disability, and cost. However, evidence in the Colombian population is scarce.

Objective

The objective of this study was to estimate the relapse-free survival during the first year and describe clinical and serological variables of patients with AAV in a specialized centre for rheumatic diseases in Colombia.

Materials and methods

A retrospective follow-up study was conducted on a cohort based on medical records of patients over 18 years old with confirmed diagnosis of AAV by the treating rheumatologist and who had achieved remission. Information on AAV relapse and clinical, immunoserological, and treatment-related characteristics was extracted. The relapse-free survival function during the first year was estimated.

Results

A total of 56 patients were included, 69.9% of whom were women, with a median age of 60 (IQR = 48−63). According to the clinical phenotype, 64.3% were classified as granulomatosis with polyangiitis (GPA), 23.2% as microscopic polyangiitis (MPA), and 12.5% as eosinophilic granulomatosis with polyangiitis (EGPA). According to the European Vasculitis Study Group (EUVAS) classification, 39.3% had generalized AAV at debut, 23.2% had localized AAV, 21.4% had severe renal AAV, and 16.1% had systemic AAV. The median Five Factor Score (FFS) was 1 (IQR = 0−2). The cumulative relapse-free survival at one year was 82.2%.

Conclusions

The relapse-free survival observed in this cohort was similar to other reports in clinical studies and AAV registries.

Introduction

Transthoracic echocardiography is a useful noninvasive tool in the assessment of cardiac involvement in patients with systemic lupus erythematosus.

Objective

We aimed to investigate the main echocardiographic alterations in patients with a diagnosis of systemic lupus erythematosus and to describe the relationship between various disease factors and echocardiographic findings.

Materials and methods

We performed a retrospective review of patients with a diagnosis of SLE between 2016 and 2020 at a referral centre. All 98 patients were included, 87% were female, the mean age for the whole population was 35 years (IQR 27.0- 49.7), 40% had a recent diagnosis, 55% with previous or new diagnosis of arterial hypertension, 37% were using steroids at admission.

Results

Among the echocardiographic findings, 64.3% had valvular disease, 63% had pericardial involvement, 25.5% systolic function compromise, 27.5% some degree of diastolic dysfunction, 13% ventricular hypertrophy, 46% left atrial enlargement, 87% right ventricular systolic dysfunction, 24.5% some probability of pulmonary hypertension, 3% non-infectious vegetations. The presence of lupus activity was associated with a higher percentage of abnormal echocardiographic findings. There was no significant relationship between disease duration and cardiac abnormalities, anti-DNA and positive antiphospholipid antibodies were more frequently observed in the cardiac involvement group.

Conclusion

We consider that echocardiography should be part of the routine evaluation in patients with lupus. Right ventricular systolic dysfunction, pericardial involvement and non-significant valvular disease were the most frequently reported abnormalities.

Introduction

The enthesis is one of the target organs in patients with spondyloarthritis (SpA), since inflammation of it, known as enthesitis, can be observed, which in many patients with spondyloarthritis could go unnoticed.

Objective

To find the relationship between the MASEI index (MAdrid Sonographic Enthesitis Index) in entheses and other indices/serological activity markers (such as BASDAI, DAPSA or ASDAS and ESR, CRP) in spondyloarthritis patients.

Materials and methods

Observational, descriptive, and cross-sectional study. Data were collected from patients with SpA who underwent musculoskeletal ultrasound using the MASEI index and who were treated in our clinics from May 2021 to September 2021. As appropriate, the variables evaluated were described using frequency and central tendency/dispersion measures. First, we tested the normality of all the variables using a Shapiro–Wilk test. Then we studied the correlation of parametric and non-parametric numerical variables, using Pearson's and Spearman's coefficients. We used the T-Student, Mann–Whitney U, and chi-square tests for the categorical variables.

Results

We analyzed 24 patients with SpA (with a mean age of 50.50 ± 10.63 years), 8 women and 16 men. The variables have the following average levels: ASDAS 2.35 (±1.09); BASDAI (for those with axial involvement) 4.54 (±2.93); DAPSA (for psoriatic arthritis) 10.98 (±6.85), and total MASEI 19.88 (±14.77). We found a correlation between the total MASEI and the following variables: ASDAS (Pearson coefficient = .696), BASDAI (Spearman coefficient = .823), and DAPSA (Pearson coefficient = .823).

Conclusion

Patients with spondyloarthritis with more significant disease activity measured by ASDAS, BASDAI/DAPSA, and the serological markers of inflammation CRP and ESR present a higher total MASEI than patients who are controlled.

Introduction

Rheumatoid arthritis (RA) is a high-cost disease, which allows patients to be classified into early or established phase approaches.

Objective

The purpose of this work was to perform a cost-effectiveness analysis comparing both phases with patient data at a 6-month time horizon from a third-party payer perspective.

Materials and methods

The population was delimited. The costs and effectiveness of each of the phases were estimated. A decision tree-type economic evaluation model was developed, and the Incremental Cost-Effectiveness Ratio (ICER) was calculated with the respective sensitivity analyses, both deterministic and probabilistic.

Results

In terms of costs, it was found that for effectiveness in goals, the cost was 85% higher in the established than in the early phase. Similarly, for non-target effectiveness, the cost was 77% higher in the established than in the early phase. On the other hand, the effectiveness results were better in the early phase compared to the established phase. Regarding the ICER, it was determined that the early phase approach saves $2,326,389 COP_cte (colombian pesos current currency) per patient in goals at 6 months of treatment, compared to the established phase approach.

Conclusion

The clinical approach to early-stage rheumatoid arthritis is a less costly and more effective alternative vs. the established phase, as it generates savings for the third-party payer over a 6-month time horizon, from a third-party payer perspective.

Introduction/Objective

Patients with psoriatic arthritis (PsA) have a significant prevalence of metabolic syndrome (MS), however studies conducted in Latin America describing comorbidities of PsA patients are still scarce. The aim of the present work was to estimate the prevalence of MS in patients attending PsA clinics in tertiary university centers in the south region of Brazil and to evaluate the achievement of the minimal disease activity criteria among those with and without MS.

Materials and methods

A cross-sectional study was conducted; patients were recruited in two university hospitals and data collected during a routine clinic visit. The prevalence of MS was estimated using the National Cholesterol Education Programme's Adult Treatment Panel III (NCEP/ATP III). The prevalence of patients achieving the MDA criteria was compared between individuals with and without MS using Chi-square test.

Results

One hundred and five patients with PsA were evaluated, 81 in center A (Rio Grande do Sul) and 24 in center B (Paraná); 54.3% were female (N = 57), the average age was 55.7 (SD 11.6) years and the median time of diagnosis in years was 7.4 (.16–42.2). A total of 51.9% (N = 54) were diagnosed with MS., hypertension was found in 51.4% (N = 54) and obesity in 38.1% (N = 40) of the sample. There was no statistically significant association between MS and MDA.

Conclusion

Patients followed in PsA clinics in university tertiary centers in the south of Brazil have a significant prevalence of MS. This work emphasizes the importance of the screening and treatment of comorbidities in PsA.