Revista Colombiana de Reumatología (English Edition)最新文献

Interstitial lung diseases are a heterogeneous group of respiratory diseases that are difficult to diagnose. The study of bronchoalveolar lavage (BAL) by flow cytometry can define typical cell patterns in different diseases, providing some help in differential diagnosis. In this article, we present a case of interstitial lung disease of unknown origin, in a patient previously diagnosed with rheumatoid arthritis who received treatment with methotrexate.

Temporal arteritis in patients under the age of 50 years is an unusual form of vasculitis with a group of aetiologies that include rheumatological and hematological diseases. Additionally, vasculitis mimickers should be excluded. We describe a case of temporal arteritis due to eosinophilic vasculitis in a 36-year-old woman, associated with a lymphocytic-variant of hypereosinophilic syndrome. She presented facial and neck swelling, pruritic hive-like lesions, subtle thickening in the left temporal artery, headache, visual alterations, mandibular claudication, and hypereosinophilia. The temporal artery biopsy confirmed panmural eosinophilic vasculitis, and peripheral blood and bone marrow flow cytometry revealed T lymphocytes with aberrant immunophenotype (CD3⁻CD4⁺). This case report describes the clinical features, histology, and treatment of temporal arteritis in young patients and hypereosinophilic syndrome, as well as clues for their differential diagnosis.

Introduction/Objective

To evaluate the association between autoantibodies with clinical manifestations (extraglandular and glandular) and histopathological findings of minor salivary gland biopsy in primary Sjögren’s syndrome.

Materials and methods

Observational, descriptive, and cross-sectional study. Forty-seven patients with pSS according to the ACR/EULAR 2016 criteria were included. A face-to-face survey, a review of medical records, and the measurement of autoantibodies (Ab) anti-Ro 52, anti-Ro 60, anti-La, antinuclear antibodies (ANA), rheumatoid factor (RF) IgA, IgG and IgM, and anti-alpha fodrin IgA and IgG were done. Characterization of the population and analysis of the association between clinical characteristics, autoantibodies, and histopathology were performed.

Results

Association of anti-alpha fodrin IgA and anti-Ro 52 Ab was found with pulmonary involvement (P = .014 and P = .031 respectively) and anti-La antibodies with haematological manifestations, specifically leukopenia (P = .011), lymphopenia (P = .023), and anaemia (P = .09). We found no association between the histopathological findings of the minor salivary gland biopsy and extraglandular manifestations.

Conclusions

The activation of B cells, reflected in the increased production of autoantibodies, is related to extraglandular manifestations in pSS, which is observed more frequently in patients with earlier diagnosis.

Clinical practice guideline 2022 for the early detection, diagnosis, treatment, and follow-up of patients with rheumatoid arthritis developed by the rheumatoid arthritis study group of the Colombian Association of Rheumatology. Rheumatoid arthritis (RA) is the most common autoimmune disease in adults. Worldwide, RA has a prevalence of 0.5%–1%, with an age-standardised prevalence rate of 246.6 per 100,000 population, being more common in women than in men and with peak presentation between the ages of 60 and 64 years. The disease is characterised by joint pain and inflammation and in some cases can cause extra-articular manifestations such as dry syndrome, vasculitis, pericarditis, pleuritis, scleritis, among others. RA causes great morbidity, impairment of quality of life, severe disability, high direct and indirect costs to health systems, disability, and absenteeism from work. This guideline was developed for rheumatologists, primary care physicians, specialists in related areas, and other actors in the system with the aim of providing the most relevant information on the early detection of the disease, and its correct diagnosis, treatment, and follow-up.

Introduction/Objective

To develop a cost minimization and a budget impact analysis of viscosupplementation with hylan G-F 20 1 × 6 mL for the treatment of knee osteoarthrosis in patients who are not suitable for pharmacological treatment or surgery in El Salvador and Panama.

Materials and methods

The cost minimization and budget impact analyses were developed from the perspective of the public health system, with a 1-year and 5-year analysis horizon, respectively. The main parameters of the models were acquisition costs, administration, and the need for retreatment. For the budgetary impact, quantification of the population was based on published epidemiological information and local databases. Costs were reported in US dollars at 2020 prices.

Results

In El Salvador, the savings derived from its use were $ 35.0 (10%) vs. hylan G-F 20 (2 mL) and $ 202.2 (39%) vs. hyaluronic acid. In Panama, the savings derived from its use were $154.6 (28%) vs. hylan G-F 20 (2 mL) and $567.7 (58%) vs. hyaluronic acid. In the budget impact analysis, considering a gradual substitution over 5 years, the introduction of hylan G-F 20 (6 mL) would be associated with savings of $138,513 (2%) in El Salvador, and $290,728 (3.6%) in Panama.

Conclusions

Viscosupplementation with hylan G-F 20 (6 mL) in patients with knee osteoarthrosis is a cost-saving alternative when compared to hylan G-F 20 (2 mL) and low molecular weight hyaluronic acid derivatives available in El Salvador and Panama.

Osteopetrosis is a rare bone disease that occurs due to failure in bone resorption. Osteoclast dysfunction and persistent calcification of primary chondroids and bones are the cause of the disease. Osteopetrosis is a rare hereditary condition known as abnormal bone resorption. Considering the importance of prompt and timely diagnosis and follow-up and treatment with significant complications, we decided to report a case of neonatal osteopetrosis diagnosed 12 h following admission to the neonatal intensive care unit of Imam Reza Hospital. The 7-day-old male neonate was hospitalised due to abdominal mass and thrombocytopenia. Hepatosplenomegaly and thrombocytopenia were diagnosed on examination and tests. Finally, the infant was referred to the neonatal intensive care unit of Imam Reza Hospital in Mashhad at 7 days of age for further evaluation. Chest X-ray taken as part of sepsis workup showed increased rib and arm bone density. A facial X-ray was taken, and eye sign detected for the diagnosis of osteopetrosis. In every neonate with hepatosplenomegaly, thrombocytopenia, and increased bone density, in addition to a neonatal sepsis workup, a facial X-ray should be taken initially to observe signs and confirm osteopetrosis.

Introduction

Corticosteroids are hormones released by the adrenal gland that act on sodium and glucose metabolism and have anti-inflammatory properties. The first synthetic corticosteroids were prednisolone and prednisone. Deflazacort is the most recent of the synthetic corticosteroids, with molecular differences that bestow benefits such as, for example, in relation to sodium loss, anti-inflammatory potency and immunosuppressive activity, and lower interference on glucose and phosphocalcium metabolism.

Objective

We decided to conduct this study to describe the effect of deflazacort compared to other corticosteroids in rheumatoid arthritis.

Materials and methods

We conducted a scoping review. A literature search was conducted in Pubmed, Cochrane and BVS databases, and in grey literature, for controlled clinical trials or equivalence studies conducted in adult patients with rheumatoid arthritis and the use of deflazacort versus other corticosteroids. We excluded articles that did not clearly mention the dose of deflazacort, or the comparator used.

Results

The search of the 3 databases yielded 166 studies, of which 5 met the eligibility criteria and were included. Four studies evaluated deflazacort versus prednisolone, and one versus methylprednisolone. The results were similar for all 5: less decline in bone mineral density and glucose metabolism.

Conclusions

Deflazacort and prednisolone have pharmacological differences that influence adverse effects at the level of bone and glucose metabolism. However, further studies are required for deflazacort to be used routinely in our practice, especially in diseases such as rheumatoid arthritis.

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) is an infrequent disease, of as yet unknown aetiology, which affects the retina with no systemic injury, causing progressive retinal ischaemia and visual loss. We describe the case of a Colombian patient with a diagnosis of IRVAN guided by clinical examination and diagnostic images, after previously ruling out other ocular infections, autoimmune, or systemic diseases. Our patient was treated with peripheral laser, intravitreous anti-VEGF, and systemic immunosuppression with excellent response. In conclusion, early diagnosis and proper treatment according to disease stage could improve visual prognosis.

Psoriasis is a disease that is not limited to skin involvement, the importance of systemic compromise is recognized more than ever, especially because of the associated comorbidities, which are explained by the marked chronic systemic inflammatory response mediated by pro-inflammatory cytokines (mainly TNF-α, IL23, IL 17), which play an important role in the induction of insulin resistance, endothelial dysfunction, accelerated atherosclerosis and the increased risk of cardio-cerebrovascular events. The relationship with these outcomes has been demonstrated and hence the concept of psoriatic march, a term that is gaining increasing importance aimed at maintaining and reinforcing the approach to a skin disease with systemic compromise, associated morbidity and mortality that can be preventable and manageable. The pathophysiological mechanisms that explain these phenomena are variable, however, new concepts have been identified, which have made it possible to improve the current approach to the disease and thus establish mechanisms to reduce cardiovascular risk in patients with psoriasis.