Revista Colombiana de Reumatología (English Edition)最新文献

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

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

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

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.

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.