Revista Colombiana de Reumatologia最新文献

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.

Objective

To establish associations between the development of lupus nephritis (LN) and the expression of antibodies against C1q (anti-C1q) and serum adiponectin as these biomarkers have been previously postulated to be associated with the presence of LN.

Materials and methods

A case–control study nested in a cohort was chosen. Patients with SLE with renal involvement were included. Measurement of antibodies against C1q, levels of adiponectin, and HLA expression DRB1 and DQB1 were evaluated. We searched for possible associations between the measured biomarkers and allelic HLA types found.

Results

One hundred and six patients were recruited with LN with a mean age of 35 years. Mean adiponectin levels were 16.9 μg/mL, and 60% of patients presented anti-C1q positivity. HLA DRB1*0404 and DRB1*1101 are protective factors for LN (OR: .42, p = .0030 and OR: 0.49, p = .046 respectively). HLA DRB1*0701 (OR: 3.15, p = .0452) and DRB1*0802 (OR: 8.3, p = .020) are susceptibility factors for LN. There was a tendency for association between anti-C1q positivity and high levels of adiponectin with type IV LN (OR 2.3 [95% CI: 0.68–8.2] and (OR: 2.67 [95% CI: .76–9.9] respectively). There was a tendency for association between anti-C1q positivity and HLA expression DRB1*0701 (OR 2.7 [95% CI: .81–11.5]), as well as high levels of adiponectin and HLA expression DRB1*0404 (OR 3.03 [95% CI: .92–12.8]). No association was found between anti-C1q and adiponectin with the expression of HLA DRB1*1501. There was positive correlation between levels of anti-C1q and the activity index in renal biopsy.

Conclusions

In the Colombian population there is a tendency for association of anti-C1q with the expression of HLA DRB1*07; however, the expression of other HLA II genes known as risk factors for LN, was not associated with the expression of anti-C1q, adiponectin or any specific type of LN.

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-vascular endothelial growth factor anti, and systemic immunosuppression with excellent response. In conclusion, early diagnosis and proper treatment according to disease stage could improve visual prognosis.

Introduction

Antiphospholipid syndrome diagnosis requires abnormal results of lupus anticoagulant and high titles of anticardiolipin (aCL) and β2glycoprotein I (anti-β2GPI) antibodies. The latter immunological tests lack a standard threshold in clinical practice.

Objective

To determine the 99th percentile of aCL and anti-β2GPI in healthy volunteers.

Materials and methods

This cross-sectional study reviewed antibody titles of anticardiolipin and β2glycoprotein I (IgG and IgM by enzyme-linked immunosorbent assay) in forty-nine healthy blood donors in Medellin, Colombia. Sociodemographic and immunological variables are also assessed. Antibody titles are described in median and interquartile range and the 99th percentile was estimated.

Results

We analysed samples from 16 men and 33 women. We found that the upper limits of the reference range (99th percentile) of aCL and anti-β2GPI were: aCL IgM: 18.0, aCL IgG: 16.1, anti-β2GPI IgM: 16.4, and anti- β2GPI IgG: 6.9.

Conclusions

The upper limits obtained differ greatly from the arbitrary classification values suggested in the international guidelines, taking into account that values greater than 40 international units are usually required, and the values identified in this study are between 6.9 and 18 international units. We suggest conducting additional studies that validate cut-off points according to the percentiles explored in this work.

Optic neuritis is a rare ocular manifestation of inflammatory bowel diseases and spondyloarthritis. The use of tumour necrosis alpha inhibitors to treat these conditions remains possible. We report a case of a 62-year-old-woman with a 17 year-history of axial and peripheral spondyloarthritis associated with Crohn's disease, treated with tumour necrosis alpha inhibitors, who developed an asymmetric retrobulbar optic neuritis that promptly responded to a high dose of steroids.

Introduction

Interstitial lung disease (ILD) usually has a poor therapeutic response and prognosis. One of the methods that could help in the diagnosis and optimize the management of these patients is capillaroscopy. The study aimed to determine the clinical and capillaroscopic characteristics of patients with ILD and the frequency of findings suggestive of autoimmune disease.

Materials and methods

A descriptive observational study that evaluated patients with ILD treated between 2010 and 2019 without a previous diagnosis of autoimmune disease. An interview, capillaroscopy, and a laboratory tests were performed.

Results

28 patients were evaluated, 16 (57.1%) were women and 17 (60.7%) had hypertension. Three patients (10.7%) reported morning stiffness for more than 60 minutes and there was one unexplained digital oedema. There were no telangiectasias, Raynaud's phenomenon, mechanic's hands, sclerodactyly or Gottron's sign, or ANAs titres greater than 1:80. The rest of the laboratory tests were negative in 100% of the patients. In the capillaroscopies, 13 (46.4%) patients had a normal capillaroscopic pattern and 15 (53.6%) had capillaroscopic abnormalities of undetermined significance. There were none with a pattern of systemic sclerosis or similar.

Conclusions

No laboratory or capillaroscopy findings were found that suggested interstitial disease with autoimmune features, possibly due to the low prevalence of the disease, its high mortality, and underdiagnosis. These findings reinforce the concept of capillaroscopic normality in patients with non-autoimmune ILD and call for an active search for ILD with autoimmune features for prognostic purposes.

Introduction and objective

The criteria for Sjögren's syndrome (SS) classification (ACR/EULAR 2016), include labial salivary gland (LSG) biopsy using the focus score (FS). But, in some cases it continues to be based on Chisholm and Mason (CM). Our objective was to evaluate the frequency of SS in patients with dry symptoms using FS and CM and to evaluate the degree of inter and intra-observer concordance of the histopathological reading by both methods.

Materials and methods

Cross-sectional study design. All patients with dry symptoms and studies to perform the SS classification criteria (2016) were included. The samples were independently evaluated by two readers. Descriptive statistics was used for the calculation of SS frequency. Agreement (Cohen's kappa coefficient) was analysed (STATA) for each test (CM and FS). Ethics approval was obtained.

Results

92 patients were included. According to the 2016 criteria, SS was reported in 26.1% patients in whom FS was used and in 34.8% patients in whom CM was used. The degree of intra-observer concordance for the diagnosis of FLS was perfect and moderate-high for observers. Inter-observer agreement was substantial, with kappa values of .77 FS and .75 CM.

Conclusions

FS method is a more detailed and specific score that facilitates correct classification. The use of CM as a histopathological classificatory method for SS includes more patients when compared with FS. These results are of relevance to standardise the reading of LSG biopsy in specialized services attending SS patients.

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.