Revista Colombiana de Reumatología (English Edition)最新文献

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.

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.