Revista Colombiana de Reumatología (English Edition)最新文献

Introduction

Anti-tumor necrosis factor-alpha (TNF-α) treatments have been available for over two decades to treat inflammatory arthropathies (IA). Most of these disorders are common among women of reproductive age, which emphasizes the need to evaluate their safety in pregnancy.

Objective

This study aims to scrutinize neonatal and pregnancy outcomes in pregnant IA patients treated with adalimumab.

Materials and methods

The current cross-sectional work was conducted by reviewing the medical files of pregnant IA patients (n = 30) receiving adalimumab referred to Golestan Hospital in Ahvaz (Iran) from 2014 to 2017, followed by extracting demographic profiles as well as neonatal and pregnancy outcomes.

Results

Noteworthy among the findings were PsA (n = 13), RA (n = 5), IBD (n = 4), AS (n = 3), uveitis (n = 2), Behcet's disease (n = 2), and panuveitis (n = 1). The mean age of subjects, duration of illness, and duration of treatment were estimated at 29.53 ± 5.88, 2.85 ± 1.15, and 1.96 ± .90 years, respectively. No delivery outcome was found for 27 (90%) cases, and delivery outcomes observed in three (10%) patients were abortion (n = 2) and preterm complications (n = 1). No neonatal complication was found for 28 (93.3%) cases and neonatal IUGR outcome was reported in 2 (6.7%) cases. Cesarean section was a delivery method in 7 (23.3%) cases and natural method in 21 (70%) cases. There were no significant differences for the prevalence of cesarean section and neonatal outcomes based on the type of disease, but differences were observed for the outcome of delivery based on the type of disease.

Conclusion

According to our findings, definitive conclusions on the safety of adalimumab during pregnancy were impossible and there is a need for further research with a larger sample size.

Sjögren’s Syndrome (SS) is an autoimmune pathology with glandular and/or extraglandular compromise, secondary to the infiltration of lymphoid cells. The clinical course varies depending on genetic susceptibility, comorbidities, patient’s age, and environmental risk factors. Lymphoid proliferation and differentiation are key factors in the progression of SS to haematological malignancies or amyloidosis. Amyloidosis is a secondary entity to the aberrant accumulation of soluble plasma proteins, derived from chronic infectious, inflammatory, neoplastic and haematolymphoid processes. The clinical manifestations vary and depend on the constitutive protein and the age of the patient; and may have glandular or extraglandular, local, or systemic compromise. Among the affected organs, pulmonary involvement poses a diagnostic and therapeutic challenge due to its variable course and clinical manifestation. The following is a case report of a woman over 70 years old, with SS and amyloidosis with glandular and extra glandular manifestations at pulmonary level.

Introduction/Objective

To describe the safety and response to treatment with RTX, estimating its impact on the health state utility (HSU) of patients with refractory lupus nephritis (LN) treated in referral centres in several cities in Colombia.

Materials and methods

A registry-based follow-up study. Patients aged between 16 and 75 years, who were refractory to first-line management and had ISN / RPS class III-IV (+/- V) LN, were included. Our primary outcome was total or partial response to treatment; secondary outcomes were HSU measured with the EQ-5D-3 L, and safety of treatment with RTX. The impact analysis of response to RTX on HSU were performed by mean difference estimated by robust regression.

Results

Forty-six patients (44 women) were included, with a median age of 34 years (IQR = 13), the median SDI was 1 (IQR = 1) and the median activity measured by SLEDAI was 4.5 (IQR = 5.9). Response to RTX was observed in 27 (58.7%) patients. Adjusted for SLEDAI and co-interventions, the patients who responded to RTX obtained a higher mean HSU by 0.162 (95% CI 0.006–0.317). Which is equivalent to 1.9 (95% CI 0.2–3.8) more months lived in ideal health conditions for each year with refractory LN. In 54.3% of the patients, RTX had adequate safety.

Conclusion

From the patient's perspective, the response to treatment with RTX in patients with refractory LN implies a significant impact on their quality of life.

Approximately forty percent of patients with autoimmune diseases suffer from interstitial lung disease (ILD). There are currently no specific screening guidelines for these patients. ILD causes substantial morbidity and mortality; early recognition and diagnosis are essential to avoid treatment delays. The gold standard for management incorporates a multidisciplinary approach (MMD) with input from various specialties, such as pulmonary, rheumatology, radiology, and pathology, to reach a consensus regarding diagnosis and treatment. In this article, we will discuss the most common forms of ILD that affect patients with autoimmune diseases, as well as how to promptly and effectively diagnose and treat these conditions.

An increasing number of musculoskeletal clinical manifestations, the onset of diseases and rheumatological manifestations have been seen in the paediatric population surviving COVID-19, however, the medical literature on the subject is limited.

The objective is to explore the available evidence on musculoskeletal symptoms and autoimmune diseases in the paediatric population with post-COVID syndrome.

Scoping systematic review in PubMed and Scopus through search strategies. Observational and experimental studies are included in populations under 21 years of age with and without autoimmune diseases, without time limit in English and Spanish.

The 28 documents included: case reports (n = 6), cross-sectional studies (n = 5), prospective cohort studies (n = 5), retrospective cohort (n = 6), case series (n = 6), ambidirectional section (n = 1), randomized controlled trial (n = 1), and longitudinal section study (n = 1). The total study population was 56,738 patients. The most frequent symptoms presented in long COVID-19 are myalgias and arthralgias. The evidence showing a relationship between SARS-CoV-2 infection in the development of musculoskeletal symptoms and autoimmune diseases in the convalescent period is limited.

As a conclusion, myalgias and arthralgias are the most frequent symptoms in long COVID. Patients with SARS-CoV-2 infection and a history of rheumatic disease who are undergoing immunomodulatory treatment do not have a dangerous risk of developing severe presentations and/or complications of the disease.

Interstitial lung disease in lupus is an entity that occurs infrequently and tends to progress slowly in most cases. Despite this, the therapeutic approach for moderate to severe cases is largely unknown because most of the evidence comes from case reports, many of which predate the advent of today’s known treatments for lupus. Additionally, little progress has been made in understanding its pathophysiology and current concepts come from other connective tissue diseases such as systemic sclerosis or are grouped within the group of interstitial pneumonias with autoimmune characteristics. This, to an extent, has been an obstacle for research in this field, and to date there is no unified diagnostic and therapeutic approach. Therefore we conducted a state-of-the-art search of the best evidence available to date, in terms of diagnostic methods and emerging therapies, to offer the clinician a practical vision for a comprehensive approach.

Introduction/Objective

The purpose of this study was to evaluate patients in clinical remission of psoriasis for at least for one year, who maintained therapeutic goals after initiating optimization of biologic therapy.

Materials and methods

A descriptive, observational study was conducted on patients with a diagnosis of moderate–severe psoriasis in treatment with biologic therapy who were started on optimization of biologic therapy.

Results

A total of 29 patients started therapeutic optimization, of these, 27 patients were in the target range with absolute PASI less than 3. Only one patient failed therapeutic optimization with final PASI 3.6 and there was a case of a patient who lost continuity of management due to an accident and had a final PASI 3.8. Most of the patients were male, with an average age of 53 years, married, employed, residing in urban areas, with psoriasis of more than ten years of evolution, without associated morbidities, and without previous biologic treatment, the most frequently used being etanercept and adalimumab.

Conclusion

Optimizing biologic therapy in patients with moderate–severe psoriasis may be viable. We seek to share this experience to propose a protocol to reduce the possibility of adverse events due to the prolonged use of this type of therapy, preserving clinical response and reducing costs to the health system.

Scleromyxoedema is a cutaneous fibromucinosis of unknown aetiology. It is associated with haematological dyscrasias and quite diverse manifestations. Pulmonary vascular involvement is rare and requires a differential diagnosis approach with systemic sclerosis. The case of a patient with scleromyxoedema with an extracutaneous pulmonary manifestation is described.

Introduction

Anti-synthetase syndrome is a recently characterized entity whose morbidity and mortality are mainly determined by interstitial lung involvement. For this reason, it is considered important to identify the association between the presence of anti-synthetase antibodies and the presence and putatively, the development of a specific radiological pattern of interstitial lung disease.

Objective

To determine the association between the antibodies present at the time of diagnosis of anti-synthetase syndrome and the presence of interstitial lung disease.

Materials and methods

Systematic review of the literature and meta-analysis. The search strategy was carried out in: EMBASE, LILACS, PUBMED, CENTRAL (Cochrane), and Grey Literature. The primary outcomes were the detection of the different radiological patterns of interstitial lung disease, and the reported specific anti-synthetase antibody.

Results

One hundred seventy-six patients were identified; Jo-1 in combination with NSIP was the most frequent pattern. Quantitative analysis suggests that PL-7 expression is associated with the presence of UIP and NSIP. For obstructive pneumonitis, a relationship was observed with the presence of anti EJ, while the expression of PL-7 was negatively associated. Also, EJ had a negative association with the presence of NSIP. The observed associations were corroborated with the subgroup analysis carried out using the two retrospective observational studies identified.

Conclusion

Despite the limitations, PL-7 and EJ showed significant associations with the presence of specific patterns of interstitial lung disease. Jo-1 did not have a significant specific association. Studies of higher methodological quality are required to generate recommendations that affect clinical practice.