Seminarios de la Fundación Espa?ola de Reumatología最新文献

The sports world has always experimented with novel treatment techniques, given the need of elite athletes to recover quickly. These techniques have often been drawn from useful treatments for musculoskeletal diseases. For the last decade, neuromuscular taping, also known as kinesiotaping, has been used in Europe in the early treatment of osteomuscular lesions. However, this non-invasive technique is useful in many other areas, including disorders resistant to conventional treatments such as trochanteritis and plantar fasciitis, among others. In the present article, we review the utility of kinesiotaping and its possible indications in rheumatic diseases.

Heart failure (HF) is a highly prevalent syndrome. In Spain the prevalence is 7-8%, representing a substantial healthcare burden and one of the most frequent diagnoses in internal medicine. The major causes of HF are hypertensive heart disease, dilated cardiomyopathy and high blood pressure. These causes vary in importance depending on the population studied. Because the signs and symptoms of HF are non-specific, clinical diagnosis is not easy. Several clinical diagnostic criteria are available for better standardization, the most widely used being the Framingham criteria. All patients with HF should undergo echocardiography. Determination of B-type natriuretic peptide (BNP) (or pro-BNP) is an important diagnostic aid. Mortality is high, between 40% and 50% at 5 years. The availability of angiotensin converting-enzyme inhibitors and beta blockers (to be used in all patients without contraindications) has represented a huge advance in the treatment of this syndrome. However, many of these patients will be treated in the final stage of their disease and will require a more palliative than curative approach.

Biological therapies may herald the cure for rheumatoid arthritis. Targeted biologic therapies have changed the outcome of this disease. Tocilizumab is a humanized monoclonal antibody against the interleukin-6 receptor and has been approved in many countries for the treatment of moderate to severe rheumatoid arthritis. A number of clinical trials have demonstrated the efficacy of tocilizumab in active rheumatoid arthritis. This review summarizes the data on the safety and dosage of this drug.

Current treatment options for systemic lupus erythematosus (SLE) fail to control all the manifestations of the disease or fully prevent flares. The most extensively studied biological therapies are directed against B cells, although other biological targets have also been explored. Biological agents against tumor necrosis factor-alfa differ in their efficacy and have been associated with the generation of antinuclear and anti-dsDNA antibodies. Anti-interleukin-10 and anti-interleukin-6 agents have also been studied, with encouraging results. Abatacept, which has been approved in rheumatoid arthritis, has not shown efficacy in placebo-controlled clinical trials.

Livedoid vasculopathy is a rare disease characterized by chronic, painful ulceration of the lower limbs that tends to progress to white atrophic lesions (atrophie blanche). These lesions are not pathognomonic but are the result of multiple processes. Livedoid vasculopathy is much more common in females, and usually occurs bilaterally in the distal third of the lower extremities.

Diagnosis is not easy and is often not made until the disease has progressed. Consequently clinical and pathological correlation is required to suspect this entity. Biopsy of skin lesions aids diagnosis, but lacks pathognomonic findings. A broad therapeutic arsenal is available, which should be assessed individually according to the characteristics of each patient.

Jaccoud's arthropathy (JA) occurs in 5% of patients with systemic lupus erythematosus and causes deformities in the hands and feet due to intermittent inflammation of the periarticular soft tissues, including tendons and joint capsules. These deformities include subluxation of the metacarpophalangeal joints, ulnar deviation of the 2nd to 5th fingers, swan neck deformities, Z deformity of the thumb, hallux valgus, subluxation of the metatarsophalangeal joints and other, non-erosive subluxations. In the early stages of the disease, these deformities are reversible but become irreversible in the long-term and usually require surgical correction. The clinical management of JA is always aimed at early control of joint inflammation and preventing severe limitation of movement and persistent loss of joint function.

Denosumab is a human monoclonal antibody IgG2 against RANKL that prevents the coupling of the RANKL with its receptor RANK on osteoclast and osteoclast precursors, which is essential for the formation, activity and survival of osteoclasts, disabling the bone resorption. The action of the Denosumab on bone remodeling is rapid, sustained and reversible. The recommended dose is of 60 mg for subcutaneous route every 6 months. The reduction of the relative risk of new vertebral fractures is of 68% (2.3% vs 7.2%, p < 0.0001), 20% (6.5% vs 8.0%) in non vertebral fractures and 40% (0.7% vs 1.2%) in the case of the of hip. At 36 months the lumbar bone mineral density increased 9.2% and 6.2% in the total hip, in comparison with the placebo. It is a safe drug with a low incident of cutaneous effects. The frequency and route of administration can be useful to improve the compliance of the osteoporosis treatment.