Revista Colombiana de Reumatología (English Edition)最新文献

Introduction

Telemedicine, defined as the provision of remote health services by health professionals using Information and Communication Technologies, has been adopted in healthcare in Colombia.

Objective

To establish recommendations for the implementation and management of telemedicine in clinical practice for rheumatological diseases in Colombia

Materials and methods

The recommendations were made in 3 phases. Phase 1 was based on an extended review and a systematic review of the literature. Phase 2 consisted of the selection of attributes and components based on the extended review to delimit the framework of the recommendations using the Delphi method. In phase 3, a group of experts, based on the systematic review, the selected attributes and components, and individual experience made recommendations through a nominal group.

Results

The framework of recommendations comprised 9 attributes and 26 components. A group of 7 rheumatologists in 4 cities of the country was formed. The nominal group drafted the final recommendations through 3 rounds according to the recommendations with a high priority rating.

Conclusion

This document contains recommendations for effective telemedicine healthcare for rheumatological diseases in Colombia. To establish effective telemedicine healthcare, it is necessary to evaluate different possible forms of care, the convenience of using telemedicine according to the clinical-cultural and sociodemographic profile of the patient, the access and implementation capacity of the different technological tools, and the exhaustive analysis of the barriers and facilitators to its adoption.

Synovial chondromatosis is an uncommon lesion characterized by cartilaginous metaplasia of the synovial layer with the usual formation of free osteocartilaginous bodies and typically involving large joints. Location in the ankle and foot is rare and, in turn, very rare in the synovial sheath of the foot tendons. The diagnosis of this little recognized entity is of great importance because it is a progressive condition that carries a substantial risk of local recurrence. Imaging tests such as CT or MRI help to identify the characteristic findings and the exact location to guide the orthopaedic surgeon in surgery. Its definitive treatment is surgical, through complete resection of the synovium (synovectomy).

Idiopathic inflammatory myopathy is a heterogeneous group of autoimmune disorders, that share some common manifestations, such as muscle weakness and elevation of serum creatine kinase. However, classification of idiopathic inflammatory myopathy into an existing clinical subtype is not always possible. The case is a 25-year-old male with an unrecognized form of idiopathic inflammatory myopathy, the onset of which resembled amyotrophic lateral sclerosis. The paper includes differential diagnosis with amyotrophic lateral sclerosis and congenital myopathies, and response to corticosteroid therapy.

Sarcoidosis is a multisystemic disease of unknown cause, secondary to a genetically determined immune reaction triggered by environmental factors, which leads to the formation of non-caseating granulomas. Ocular involvement is the second most frequent after pulmonary involvement. The most common finding is anterior granulomatous uveitis, but posterior uveitis, retinal peri-phlebitis, chorioretinitis, conjunctivitis, scleritis and optic neuritis can also be seen. We describe the case of a pediatric patient with long-standing multisystem involvement disease, in whom the demonstration of non-caseating granulomas in the conjunctival biopsy allowed a presumptive diagnosis of sarcoidosis.

Cryptococcus neoformans is the leading causal agent of invasive fungal infections in patients with systemic lupus erythematosus, frequently compromising the central nervous system and the lung. The infection develops during the first two years after diagnosis in patients with active disease, and the main risk factors are glucocorticoids, especially the cumulative dose, and lymphopenia. Mortality is high, exceeding 50%. We present the case of a man with active systemic lupus erythematosus who was admitted due to fever, arthritis, tenosynovitis, and purpura in whom disseminated C. neoformans infection was documented by initial isolation in blood and synovial fluid. Subsequently, he developed central nervous system symptoms like headache and nuchal rigidity that responded to induction treatment with amphotericin and flucytosine, and the manifestations resolved. Although joint and periarticular involvement by C. neoformans is infrequent, these are foci to consider in the approach to patients with lupus and suspected invasive fungal infection.

Schnitzler syndrome is a rare disease, in Colombia it is considered an orphan disease, of an auto-inflammatory nature, classified as a complex acquired inflammatory type of disease, which classically produces urticarial rash, long-standing fever, adenomegalies, and arthralgias coexisting with monoclonal gamma peak typically of the IgM type. We present the case of a young woman, with a larval picture that started with urticarial rash, with clinical characteristics compatible with the syndrome and evidence of monoclonal peak in protein electrophoresis meeting Lipsker-Baltimore 2001 criteria and Strasbourg 2013 criteria for diagnosis.

Infectious spondylodiscitis (ISD) is a rare infection of the spine. ISD caused by Acinetobacter baumannii and Citrobacter koseri is even rarer. Moreover, the association between ISD and malignancy is uncommon. In these case series, we report the remarkable case of a patient diagnosed with ISD associated with bone metastatic lesions of an unknown cancer and multiple myeloma accidentally discovered due to COVID-19 infection. We also reported two cases of ISD caused by rare organisms: the first case is a man with ISD caused by a multidrug resistant A. baumannii, and the second is a man with C. koseri bacteraemia complicated by paraspinal abscess and ISD.