Revista Colombiana de Reumatología (English Edition)最新文献

Recent advances in deciphering the genetic architecture of RA-ILD support the hypothesis of RA-ILD as a complex disease with a heterogeneous phenotype encompassing at least the usual interstitial pneumonia (UIP) and non-UIP high-resolution CT patterns. The results of genetic studies support the hypothesis of a common genetic background between idiopathic pulmonary fibrosis (IPF) and RA-ILD, and more specifically RA-UIP, a subset of the disease associated with a poor prognosis. Overall, these findings suggest the existence of shared pathogenic pathways between IPF and RA-ILD providing new opportunities for future intervention in RA-ILD, particularly with drugs that have been shown to be active in IPF.

Introduction

Arthroplasty is a commonly used surgical procedure for the functional recovery of patients with impaired mobility and displacement. The post-surgical process implies dealing with pain and anxiety, a situation that must be addressed during hospitalization by the nursing staff, to guarantee pertinent and effective care that favours the processes of rehabilitation and patient satisfaction.

Objective

To identify the relationship between satisfaction with nursing care and the presence of anxiety and pain in women who underwent arthroplasty.

Materials and method

Cross-sectional quantitative, with 63 patients undergoing arthroplasty at the Dr. Jorge Von Ahn National Hospital of Orthopaedics and Rehabilitation in León, Guatemala. The variables level of anxiety, pain, and satisfaction with nursing care were measured. Data were analysed with non-parametric statistics using Spearman’s coefficient correlation test. International ethical considerations and informed consent were taken into account.

Results

The variable satisfaction with nursing care was related to low level of anxiety and null relationship with pain and the sociodemographic variables sex, age, ethnicity, level of education, and days of stay.

Conclusion

It is necessary to implement therapeutic nursing strategies that continue to humanize the hospital stay and recovery processes, and to conduct mixed studies that deepen the relationship between satisfaction with nursing care variables and anxiety and non-associated sociodemographic variables.

Introduction

Granulomatosis with polyangiitis (GPA) and pyoderma gangrenosum are rare and difficult-to-diagnose pathologies with severe manifestations and a high burden of morbidity. GPA is a necrotizing systemic vasculitis of small vessels, while pyoderma gangrenosum is an inflammatory skin disease.

Objectives

The aim of this study is to describe the comprehensive clinical-pathological study process necessary to accurately identify these conditions and establish an effective treatment plan.

Materials and methods

A retrospective study was conducted on a case of a patient with cutaneous lesions suspected of pyoderma gangrenosum. Clinical data, including symptoms, laboratory tests, biopsies, and imaging results, were collected. A multidisciplinary review of the findings was carried out to reach an accurate diagnosis. The treatment consisted of administering methotrexate.

Results

Following the comprehensive clinical-pathological study, the diagnosis of granulomatosis with polyangiitis associated with pyoderma gangrenosum-like lesions was confirmed. The patient responded favourably to methotrexate treatment, and the cutaneous lesions completely resolved after one year.

Conclusions

This case illustrates the difficulty in diagnosing granulomatosis with polyangiitis and pyoderma gangrenosum, highlighting the importance of a multidisciplinary approach in their management. The comprehensive clinical-pathological study and appropriate treatment led to successful resolution of the patient’s lesions. It is crucial to promote collaboration among different medical specialties to improve the diagnosis and treatment of these rare and highly morbid diseases.

Introduction

: Fibromyalgia (FM) is a chronic pain condition that represents a public health problem. It greatly impacts quality of life and affects the psychosocial dimension beyond physical aspects. However, there are insufficient studies aimed at determining the suffering levels of this population and its related factors to propose more comprehensive interventions.

Objective

To determine the levels of suffering and its associated factors in patients with FM treated at the Colombian Institute of Pain.

Materials and methods

A quantitative, analytical observational, and cross-sectional study with a correlational design was carried out. Convenience sampling was used. Variables assessed included levels of suffering (PRISM), FM impact on quality of life (FIQR), loneliness (UCLA), anxiety and depression (HADS), and vital stress (Vital Events Questionnaire). Descriptive and correlational statistics were obtained.

Results

There were sixty-two participants, 96.8% were women. Seventy-five percent manifested moderate to severe suffering, 62.9% had clinical indicators of loneliness, 75% clinically significant anxiety, and 25.8% clinically significant depression. Also, they reported a mean of 10 stressful vital events. A direct and significant association between suffering and impact on quality of life was found. This impact on quality of life was also significantly correlated with loneliness, anxiety, and depression. Vital stress was also significantly related to loneliness and anxiety. Although statistically significant, most correlations were moderate.

Conclusions

Patients with FM experience relevant levels of suffering and impact on their quality of life. This impact is directly related with psychosocial factors beyond the well-known anxiety and depression. These results help visualize the intense suffering faced by this population and indicate the relevance of examining more deeply issues such as loneliness and vital stress.

Interstitial pneumonia with autoimmune features (IPAF) was defined for research purposes as interstitial lung disease (ILD) associated with features of autoimmunity without diagnosed rheumatic disease (RD). Since publication of the IPAF criteria in 2015, there have been multiple studies of IPAF. However, much remains unknown regarding pathogenesis, prognosis, and treatment in IPAF. This narrative review details the history and classification of IPAF, lists challenges associated with classifying patients as IPAF, and explores the prevalence, epidemiology, and presentation of IPAF. We also examine prognosis and important features determining IPAF clinical course, outline pathogenesis, and review treatment strategies.

Introduction/Objective

Early diagnosis of rheumatoid arthritis (RA) can improve the prognosis of the disease by reducing joint destruction and achieving a better rate of remission. Musculoskeletal ultrasound (US) has become a potent tool to detect synovitis and erosions. However, until now, there has been a lack of consensus on the US scoring system to help in diagnosing RA early. The purpose of our study was to elaborate a US set suitable for classifying RA patients with inflammatory arthralgia or expressing synovitis and who did not satisfy ACR/EULAR criteria, called “USSRA” (UltraSound Set for Rheumatoid Arthritis).

Materials and methods

A multistep study was conducted. A preliminary set of joints, tendons, and erosions to include in the USSRA were identified through a deep literature screening. The final step of this study was the validation of the final set by international experts in US using a Delphi process.

Results

The preliminary set included 20 joints, 16 tendons, and 8 erosion sites for assessment. After the Delphi process, the changes were to add an assessment of two additional wrist joints and remove one. As for the tendons, two sites were removed from the final set. No changes were proposed for the section erosions. The elementary lesions and scoring system were clarified. The final USSRA forms include 18 joints, 12 tendons, and 8 sites of erosion.

Conclusion

The USSRA is a novel diagnostic tool proposed for detecting early RA in routine practice. The next step will be to assess the reliability of this set in a patient-based exercise.

Introduction

Demand of biopolymer injections has steadily increased in the last decade. Complications associated with this procedure can be innocuous or even life-threatening, presenting from immediately to years later, locally or systemically, with mechanical, inflammatory, or autoimmune characteristics.

Objectives

To present a rare manifestation of an increasing health problem, clinicians must be attentive to this kind of complication.

Materials and methods

Clinical and laboratory data were searched from the clinical history; informed consent was obtained, and the Ethics Committee of Fundación Valle del Lili reviewed and approved this study. We report a patient who presented long-standing symptoms but only consulted after the onset of an acute lower limb arterial thrombosis that could have been fatal without rapid intervention. Ischemia was secondary to arterial obstruction related to biopolymer migration.

Results

A femoral and popliteal embolectomy was performed in which severe soft tissue fibrosis and encapsulated bodies were observed. The patient received thromboprophylaxis and low-dose oral glucocorticoid presenting a favorable evolution.

Conclusions

This substance probably acted as a foreign body and triggered an inflammatory reaction with a subsequent state of hypercoagulability, fibrosis, and nodule formation.

Interstitial lung disease (ILD) is a common and potentially devastating complication of systemic sclerosis (SSc), a chronic autoimmune disorder characterized by fibrosis and vascular abnormalities. The association between SSc and ILD underscores the intricate interplay between immune dysregulation, vasculopathy, and tissue fibrosis. This review provides a comprehensive overview of the immunological, clinical, and radiological features of ILD in the context of SSc. It highlights the diverse spectrum of ILD patterns observed in SSc patients, ranging from non-specific interstitial pneumonia to usual interstitial pneumonia. The intricate pathogenic mechanisms linking SSc and ILD involve aberrant immune responses, endothelial dysfunction, profibrotic cytokine signaling, and genetic factors. Immunological alterations, diagnostic challenges, and prognostic implications are discussed, underscoring the need for multidisciplinary management strategies. By elucidating the complex relationship between SSc and ILD, this review aims to contribute to a deeper understanding of the underlying mechanisms and facilitate the development of interdisciplinary interventions for improved patient outcomes.

Interstitial lung disease (ILD) is a serious extra-articular co-morbidity in rheumatoid arthritis (RA) patients and accounts for a substantial part of the increased mortality in RA. In this review, we describe how environmental and lifestyle factors interact with genetic variants in the HLA genetic locus in triggering RA-specific antibodies against post-translationally modified, mainly citrullinated proteins (ACPA), which are associated with an increased risk of ILD. The same environmental risk factors, i.e. exposure to noxious agents such as smoke to the lungs contribute additionally to the emergence of RA ILD as does long-lasting high disease activity and an additional ILD-specific genetic risk variant related to mucus formation (MUC5B). Options for prevention and therapy of RA ILD resulting from this so far incomplete knowledge of its pathophysiology are expanding. The most obvious option is to address modifiable environmental risk factors, such as smoking and exposure to other noxious agents affecting the lungs. The second option is to reduce the inflammatory activity of RA; here different anti-rheumatic therapies appear to have differential effects on ILD development. The third and novel option is to use anti-fibrotic therapy which may reduce the development of RA ILD but has not yet been shown to revert existing fibrosis. The main conclusion concerning the clinical handling of RA ILD is therefore an early awareness of the risk for RA ILD combined with active measures to reduce modifiable environmental/lifestyle factors and use optimal anti-rheumatic therapies for early and sustained reduction of disease activity. These actions should be combined with a preparedness to use anti-fibrotic therapy for patients at high risk for ILD despite previous risk reduction efforts.

Interstitial lung disease occurs with high frequency as an initial or late manifestation of multiple rheumatic diseases, including systemic sclerosis, idiopathic inflammatory myopathies, rheumatoid arthritis, systemic lupus erythematosus, primary Sjögren's syndrome and antineutrophil cytoplasmic antibody-associated vasculitis. Thus, the rheumatologist must be clear about certain concepts of pneumology, including the evaluation of lung function tests, the approach to radiological patterns observed on high-resolution computed tomography of the chest, and concepts such as interstitial pneumonia with autoimmune features. In this article, we present our approach to patients with interstitial lung disease, in whom an autoimmune etiology is suspected. We propose a sequential diagnostic strategy, recognizing the importance of the multidisciplinary team and including the autoimmune perspective with emphasis on clinical and serological domains. Other diagnostic tools such as capillaroscopy and minor salivary gland biopsy are also considered. We also take a critical look at the latest guidelines for progressive pulmonary fibrosis, since it is essential that the rheumatologist understands these concepts that are vital in a multidisciplinary team.