Reumatismo最新文献

Objective: Renal biopsy contributes to the diagnosis, follow-up, and treatment of many rheumatic conditions. This study assessed the diagnostic role and safety of renal biopsies in a tertiary rheumatology clinic.

Methods: Renal biopsies performed between June 2020 and December 2022 were screened, and demographic, clinical, histopathological, and safety data were collected from patient records.

Results: In this study, 33 males and 38 females were included. Except for 1 patient who received acetylsalicylic acid, antiaggregant, and/or anticoagulant drugs were stopped before the biopsy. Complications included a decrease of hemoglobin in 8 patients (11.3%) and microscopic hematuria in 40 patients (56.3%). Control ultrasonography was performed in 16 patients (22.5%), and a self-limiting hematoma was found in 4 of them (5.6%) without additional complications. While less than 10 glomeruli were obtained in 9 patients (9.9%), diagnosis success was 94.4%. Histopathological data were consistent with one of the pre-biopsy diagnoses in 54 of 67 cases (80.6%) but showed discrepancies in 19.4% (n=13) of patients. A repeat biopsy was performed in 7 patients for re-staging or insufficient biopsy.

Conclusions: Renal biopsy significantly contributes to rheumatology practice, especially in patients with complex clinical and laboratory findings or in whom different treatments can be given according to the presence, severity, and type of renal involvement. Although the possibility of obtaining insufficient tissue and the need for re-staging and repeat biopsy in the follow-up might be expected, complication risk does not seem to be a big concern. Renal biopsy often evidenced discrepancies between pre-biopsy diagnosis and histopathological findings.

We thank Finsterer et al. for the attention paid to our publication; we recognize the validity of the points mentioned in their letter to the editor and will try to answer the observations made.

Objective: Dietary interventions to improve fibromyalgia (FM) symptoms reported conflicting results. This study aimed to treat FM patients with a gluten-free diet (GFD), alternated with a non-restricted gluten-containing diet, followed by a rechallenge of the GFD.

Methods: Twenty postmenopausal women with FM and no history of celiac disease participated. A GFD was assigned for 6 months. This was followed by 3 months of a non-restricted gluten-containing diet and then a new GFD for another 6 months. At each visit, the widespread pain index (WPI) and the symptom severity scale (SS) scores were evaluated.

Results: The mean age of the patients enrolled was 53.9±10 years. None of the patients had a diagnosis of irritable bowel disease, although they reported vague gastrointestinal symptoms. After 6 months of a GFD, a statistically significant reduction was observed for the WPI (10.3±1.8 vs 7.7±1.4; p<0.0001) and the SS scale (6.4±1.8 vs 4.15±1.6; p=0.0002). The D percentage reduction of the WPI after 6 months of GFD was -24%±9%, while for the SS scale, it was -36%±21%. The following reintroduction of a gluten-containing diet brought about a statistically significant rise in the absolute SS scale and WPI, as well as a D modification of the WPI (21%±13%) and of the SS scale (74%±90%). The rechallenge of the GFD showed a significant improvement in absolute and D WPI (-24%±7%) and SS (-36%±11%). No modifications to the body mass index were found.

Conclusions: A GFD improved FM symptoms evaluated with WPI and SS. This was confirmed for the first time, also with a rechallenge of the GFD that followed a non-restricted gluten-containing diet.

Objective: Contemporary studies reporting outcomes of critical care in patients with inflammatory and autoimmune rheumatological diseases are scarce. This study describes 15 years of experience from 2005-2019 in a Colombian referral hospital.

Methods: This observational, descriptive, consecutive case series study was performed on adult patients with inflammatory and autoimmune rheumatic diseases who were admitted to the intensive care unit (ICU) of the San Ignacio University Hospital in Bogotá (Colombia), from January 1, 2005, to December 21, 2019. We describe the sociodemographic characteristics, admission causes and criteria, lengths of stay, immunosuppressive treatment, systemic support, and mortality.

Results: The study included 300 patients with a median age of 48 years [interquartile range (IQR) 31-62 years], predominantly female (76%). Disease exacerbations (30%), infections (17.6%), and cardiovascular diseases (15%) were the main causes of admission. Respiratory failure (23%) most commonly caused by septic shock (24%) was the principal indication for intensive care admission. The most frequent infections were community-acquired pneumonia (11.6%) and soft-tissue infections (9%). In 40.3% of patients, inotropic and vasopressor support was required. The median length of stay was 4 days (IQR 2-8), and global mortality was 21.6%.

Conclusions: Rheumatic diseases in the ICU are still associated with high morbidity and mortality. Patients with inflammatory and autoimmune rheumatic diseases require a meticulous clinical approach, strict clinical monitoring, frequent assessment of complications, evaluation of systemic support needs, and specific management.

Objective: The pathophysiology of fibromyalgia (FM), a continuously painful syndrome with no known origin, has been related to mitochondrial dysfunction, oxidative stress, and inflammation. Recent studies have shown that FM may be associated with an oxidative balance disorder. The objective of this study was to measure the levels of oxidative stress in FM patients and try to understand the association between FM and free radicals.

Methods: This study was performed on 100 volunteers admitted to the University of Health Sciences, Sultan 2, Abdulhamid Han Health Application and Research Center Physical Therapy and Rehabilitation Clinic, including 50 healthy controls and 50 patients with FM. To analyze oxidative stress biomarkers, total oxidant status (TOS) and total antioxidant status (TAS) levels were measured. Total thiol (TT) and native thiol (NT) concentrations were measured to determine the relationship between thiol groups. Disulfide (DIS) and oxidative stress index (OSI) were calculated with mathematical formulas.

Results: While TOS and OSI levels were statistically higher in FM patients, TAS levels were significantly lower compared to the healthy control group (p<0.001). In comparison to the healthy control group, FM patients had considerably decreased TT and NT levels. DIS levels were significantly higher in FM patients than in controls (p<0.001).

Conclusions: Reactive oxygen species have several negative impacts on the human body. As a result of the measurements we analyzed, the relationship between FM and oxidative stress should be studied in terms of disease progression and may help improve the treatment process.

Antiphospholipid syndrome (APS) can affect different organ systems, including the heart and adrenal glands. Despite being known for its prothrombotic characteristics, APS can have serious bleeding complications. Occasionally, thrombotic and bleeding episodes can present simultaneously in an APS patient. Whenever these events co-occur, resuming anticoagulation becomes a topic of debate. As such, we present the case of a 43-year-old male with triple positive antiphospholipid antibodies, indicating APS, who presented with chest pain. Anticoagulants were switched one month before presentation from warfarin to a direct oral anticoagulant, rivaroxaban. Non-ST elevation myocardial infarction, as well as new-onset left-sided adrenal hemorrhage, were diagnosed. The patient developed adrenal insufficiency; therefore, corticosteroids were administered, and warfarin was resumed to prevent further thrombotic episodes.

Acute gouty arthritis is a recognized complication of hyperuricemia and one of the most common forms of inflammatory arthritis in adults. Drug-induced hyperuricemia is increasingly prevalent in clinical practice. Diuretics, antitubercular medications, and immunosuppressants are the common drugs associated with hyperuricemia. Oral isotretinoin is the drug of choice for different forms of severe acne and is rarely associated with hyperuricemia. We present the case of a 30-year-old male with severe acne vulgaris who was prescribed isotretinoin and later presented with acute gout. The patient developed hyperuricemia and swelling of the right first metatarsophalangeal joint within two months of isotretinoin commencement. There was a second episode of similar joint swelling three months later, parallel to the isotretinoin rechallenge. The dose of isotretinoin was reduced with the addition of febuxostat. The patient did not develop further episodes and remained symptom-free without urate-lowering therapy.

Adenosine deaminase 2 deficiency (DADA2) is a rare monogenic vasculopathy caused by loss-of-function homozygous or compound heterozygous mutations in ADA2, formerly CECR1 (cat eye syndrome chromosome region 1) gene. The DADA2 phenotype is widely heterogeneous, and patients may present with fever, weight loss, livedo reticularis/racemosa, digital ischemia, cutaneous ulceration, peripheral neuropathy, abdominal pain, bowel perforation, and portal or nephrogenic hypertension. More specific manifestations include early-onset ischemic or hemorrhagic stroke, mild immunodeficiency and hypogammaglobinemia, cytopenia, and vision disturbances. Herein, we present the case of a young male with vasculitis associated with DADA2. The presence of HLA-B51 and the clinical features of this patient raised the question of similarities between ADA2 deficiency, Behçet's disease, and NOD2-associated diseases. Treatment of this rare monogenic disease is challenging and based on small case series. The long-term experience of this patient proved the difficulties of prednisone tapering and the lack of satisfactory therapeutic strategies.

We read with interest the article by Camargo-Coronel et al. reporting on a systematic review of patients with idiopathic, inflammatory myopathy developing after anti-SARS-CoV-2 vaccinations.

Arthur Conan Doyle, the creator of Sherlock Holmes, was an experienced physician who treated gouty patients. A gouty character appears in The Adventure of the Missing Three-Quarter, a Sherlock Holmes novel. This offers the possibility of discussing gout from the peculiar perspective of a medical writer in light of the historical-medical context of the time. This study was conducted using Conan Doyle's autobiographical, scientific, and literary primary sources, as well as past and current medical literature. The Adventure of the Missing Three-Quarter was autobiographical. Conan Doyle himself was a rugby player and his wife died of tuberculosis. Furthermore, in 1884, in The Lancet, he described the hereditary case of a female gouty patient, presenting with ocular manifestations. In agreement with the concept of rich man's gout, the gouty patient of Sherlock Holmes' story, Lord Mount James, was a rich irascible noble but he was not addicted to the pleasures of food and sex. Following the usual funny representation of gouty patients, Conan Doyle made fun of Lord Mount James, but he misquoted a true case of gout cited in the literature. In his scientific and literary production on gout, Conan Doyle stuck to the most updated medical concepts of the time, demonstrating an uncommon knowledge of scientific literature.