Revista Colombiana de Reumatologia最新文献

Transient osteoporosis of pregnancy is a pathology of low prevalence and difficult diagnosis that mainly affects pregnant women in the third trimester of pregnancy. It is characterized by mechanical joint pain, more frequent in the lower limbs, radiological osteopenia, and bone oedema on magnetic resonance imaging. A series of 4 cases is presented in pregnant women between 26 weeks of gestation and the early puerperium with symptoms of coxalgia and/or knee pain. The treatment was based on conservative measures: analgesics that are allowed during pregnancy and non-weight bearing on the joints, and the possibility of corticosteroid infiltration into the joint. Bisphosphonates can be added in the puerperium. All cases resolved within a maximum of 9 months, without subsequent sequelae.

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

Reactive arthritis (ReA) is a monoarthritis or oligoarthritis that mainly affects the extremities, it can be related to bacterial or viral infections. Currently, COVID-19 has been linked to the development of arthropathies due to its inflammatory component.

Objective

A scoping review of the literature that describes the clinical characteristics of ReA in survivors of SARS-CoV-2 infection.

Materials and methods

A systematic review based on the guidelines for reporting systematic reviews adapted for Prisma-P exploratory reviews and steps proposed by Arksey and adjusted by Levan. Experimental and observational studies published in PubMed and Scopus, English and Spanish, which answered the research questions posed, were included.

Results

Twenty-five documents were included describing the main clinical manifestations of ReA in 27 patients with a history of SARS-CoV-2 infection. The time from the onset of symptoms or microbiological diagnosis of COVID-19 to the development of articular and/or extra-articular manifestations compatible with ReA ranged from 7 days to 120 days. The clinical joint manifestations described were arthralgia and oedema, predominantly in knee, ankle, elbow, interphalangeal, metatarsophalangeal, and metacarpophalangeal joints.

Conclusions

Arthralgias in the extremities are the main symptom of ReA in patients with a history of COVID-19, whose symptoms can present in a period of days to weeks from the onset of clinical symptoms or microbiological diagnosis of SARS-CoV-2 infection.

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

Alveolar hemorrhage syndrome can be secondary to multiple autoimmune disorders. The objective is to describe three diffuse alveolar hemorrhage (DAH) cases secondary to anti-synthetase syndrome (ASSD).

Presentation of the case

Three cases of ADH secondary to ASSD are described: one positive to anti-PL7, another positive to anti-PL12, and the last patient with double positivity to anti-Jo1 and anti-OJ. The patients presented improvement after receiving immunosuppressive treatment.

Discussion

The evolution with therapeutic response and resolution of DAH supports the conclusion that ASSD is a potentially treatable cause of DAH and should be considered within the differential diagnosis in diagnosing DAH.

Conclusion

The described cases contribute to the knowledge of DAH, where ASSD should be considered in diagnosing DAH.

Introduction/Objective

To describe the safety and response to treatment with rituximab (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-3L, 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.

Introduction

Anti-synthetase syndrome is a recently characterized entity whose morbidity and mortality are mainly determined by interstitial lung involvement. For this reason, it is considered important to identify the association between the presence of anti-synthetase antibodies and the presence and putatively, the development of a specific radiological pattern of interstitial lung disease.

Objective

To determine the association between the antibodies present at the time of diagnosis of anti-synthetase syndrome and the presence of interstitial lung disease.

Materials and methods

Systematic review of the literature and meta-analysis. The search strategy was carried out in: EMBASE, LILACS, PUBMED, CENTRAL (Cochrane), and Grey Literature. The primary outcomes were the detection of the different radiological patterns of interstitial lung disease, and the reported specific anti-synthetase antibody.

Results

One hundred seventy-six patients were identified; Jo-1 in combination with NSIP was the most frequent pattern. Quantitative analysis suggests that PL-7 expression is associated with the presence of UIP and NSIP. For obstructive pneumonitis, a relationship was observed with the presence of anti EJ, while the expression of PL-7 was negatively associated. Also, EJ had a negative association with the presence of NSIP. The observed associations were corroborated with the subgroup analysis carried out using the two retrospective observational studies identified.

Conclusion

Despite the limitations, PL-7 and EJ showed significant associations with the presence of specific patterns of interstitial lung disease. Jo-1 did not have a significant specific association. Studies of higher methodological quality are required to generate recommendations that affect clinical practice.