Revista Colombiana de Reumatologia最新文献

Interstitial lung disease is a common complication of Sjögren's syndrome that can occur at diagnosis or during follow-up. To detect it, complete pulmonary function studies should be performed, including spirometry, measurement of lung volumes, and DLCO, with the latter being the most sensitive parameter for detecting the presence of the disease. High-resolution computed tomography is essential for the study. Sixty percent of patients present a single tomographic pattern, with non-specific interstitial pneumonia being the most frequent pattern, followed by usual interstitial pneumonia pattern. Mortality is high, being higher in those with lower forced vital capacity, lower DLCO, and higher fibrosis score on chest computed tomography. Currently, there are two international guidelines for the treatment of pulmonary manifestations of Sjögren, but recommendations are based on low-quality scientific evidence. A stepwise approach is suggested, initially with glucocorticoids, then immunosuppressants, and in refractory or severe cases, considering other agents such as rituximab. The use of antifibrotic medication is recommended in patients who develop progressive pulmonary fibrosis as defined by current criteria. It is important to bear in mind that although non-specific interstitial pneumonia is considered a pattern where inflammation predominates, there may be progression to progressive pulmonary fibrosis in some cases. Lung transplantation and oxygen therapy may be options for selected patients. The relevance of an interdisciplinary team approach to achieve adequate diagnosis and treatment of patients is highlighted.

Interstitial lung disease (ILD) is a common and serious manifestation of autoimmune rheumatic diseases. While the prevalence of ILD differs among the individual autoimmune rheumatic diseases, ILD remains an important cause of morbidity and mortality in systemic sclerosis, systemic lupus erythematosus, mixed connective tissue disease, primary Sjögren's disease, rheumatoid arthritis, and idiopathic inflammatory myositis. The present review summarizes recent literature on autoimmune-associated ILD with a focus on screening and monitoring for ILD progression. Reflecting on the currently available evidence, the authors propose a guideline for monitoring for progression in patients with newly diagnosed autoimmune-associated ILD. This review also highlights clinical and biological predictors of progressive pulmonary fibrosis and describes opportunity for further study in the rapidly evolving area of rheumatology and pulmonology.

Interstitial lung disease occurs with high frequency as an initial or late manifestation of multiple rheumatic diseases, including systemic sclerosis, idiopathic inflammatory myopathies, rheumatoid arthritis, systemic lupus erythematosus, primary Sjögren's syndrome and antineutrophil cytoplasmic antibody-associated vasculitis. Thus, the rheumatologist must be clear about certain concepts of pneumology, including the evaluation of lung function tests, the approach to radiological patterns observed on high-resolution computed tomography of the chest, and concepts such as interstitial pneumonia with autoimmune features. In this article, we present our approach to patients with interstitial lung disease, in whom an autoimmune etiology is suspected. We propose a sequential diagnostic strategy, recognizing the importance of the multidisciplinary team and including the autoimmune perspective with emphasis on clinical and serological domains. Other diagnostic tools such as capillaroscopy and minor salivary gland biopsy are also considered. We also take a critical look at the latest guidelines for progressive pulmonary fibrosis, since it is essential that the rheumatologist understands these concepts that are vital in a multidisciplinary team.

This article will mention the essential aspects of managing ILD associated with systemic autoimmune diseases such as rheumatoid arthritis (RA) and inflammatory myopathies (IIM). The prognosis of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) has recently improved because of tighter control of RA disease activity. This article presents recent evidence of the effect of methotrexate on RA-ILD, which is associated with a better prognosis. The available alternatives include the use of anti-fibrotic drugs. In managing interstitial lung disease related to anti-synthetase syndrome (ASSD-ILD) and anti-MDA5-associated ILD, immunosuppression and anti-fibrotic drug regimens are relevant aspects mentioned.

Interstitial pneumonia with autoimmune features (IPAF) was defined for research purposes as interstitial lung disease (ILD) associated with features of autoimmunity without diagnosed rheumatic disease (RD). Since publication of the IPAF criteria in 2015, there have been multiple studies of IPAF. However, much remains unknown regarding pathogenesis, prognosis, and treatment in IPAF. This narrative review details the history and classification of IPAF, lists challenges associated with classifying patients as IPAF, and explores the prevalence, epidemiology, and presentation of IPAF. We also examine prognosis and important features determining IPAF clinical course, outline pathogenesis, and review treatment strategies.

Clinical practice guideline 2022 for the early detection, diagnosis, treatment, and follow-up of patients with rheumatoid arthritis developed by the rheumatoid arthritis study group of the Colombian Association of Rheumatology. Rheumatoid arthritis (RA) is the most common autoimmune disease in adults. Worldwide, RA has a prevalence of .5%-1%, with an age-standardised prevalence rate of 246.6 per 100,000 population, being more common in women than in men and with peak presentation between the ages of 60 and 64 years. The disease is characterised by joint pain and inflammation and in some cases can cause extra-articular manifestations such as dry syndrome, vasculitis, pericarditis, pleuritis, scleritis, among others. RA causes great morbidity, impairment of quality of life, severe disability, high direct and indirect costs to health systems, disability, and absenteeism from work. This guideline was developed for rheumatologists, primary care physicians, specialists in related areas, and other actors in the system with the aim of providing the most relevant information on the early detection of the disease, and its correct diagnosis, treatment, and follow-up.

Introduction/Objective

To develop a cost minimization and a budget impact analysis of viscosupplementation with hylan G-F 20 1 × 6 mL for the treatment of knee osteoarthrosis in patients who are not suitable for pharmacological treatment or surgery in El Salvador and Panama.

Materials and methods

The cost minimization and budget impact analyses were developed from the perspective of the public health system, with a 1-year and 5-year analysis horizon, respectively. The main parameters of the models were acquisition costs, administration, and the need for retreatment. For the budgetary impact, quantification of the population was based on published epidemiological information and local databases. Costs were reported in US dollars at 2020 prices.

Results

In El Salvador, the savings derived from its use were $ 35.0 (10%) vs. hylan G-F 20 (2 mL) and $ 202.2 (39%) vs. hyaluronic acid. In Panama, the savings derived from its use were $154.6 (28%) vs. hylan G-F 20 (2 mL) and $567.7 (58%) vs. hyaluronic acid. In the budget impact analysis, considering a gradual substitution over 5 years, the introduction of hylan G-F 20 (6 mL) would be associated with savings of $138,513 (2%) in El Salvador, and $290,728 (3.6%) in Panama.

Conclusions

Viscosupplementation with hylan G-F 20 (6 mL) in patients with knee osteoarthrosis is a cost-saving alternative when compared to hylan G-F 20 (2 mL) and low molecular weight hyaluronic acid derivatives available in El Salvador and Panama.

Scleromyxoedema is a cutaneous fibromucinosis of unknown aetiology. It is associated with haematological dyscrasias and quite diverse manifestations. Pulmonary vascular involvement is rare and requires a differential diagnosis approach with systemic sclerosis. The case of a patient with scleromyxoedema with an extracutaneous pulmonary manifestation is described.

Temporal arteritis in patients under the age of 50 years is an unusual form of vasculitis with a group of aetiologies that include rheumatological and hematological diseases. Additionally, vasculitis mimickers should be excluded. We describe a case of temporal arteritis due to eosinophilic vasculitis in a 36-year-old woman, associated with a lymphocytic-variant of hypereosinophilic syndrome. She presented facial and neck swelling, pruritic hive-like lesions, subtle thickening in the left temporal artery, headache, visual alterations, mandibular claudication, and hypereosinophilia. The temporal artery biopsy confirmed panmural eosinophilic vasculitis, and peripheral blood and bone marrow flow cytometry revealed T lymphocytes with aberrant immunophenotype (CD3⁻CD4⁺). This case report describes the clinical features, histology, and treatment of temporal arteritis in young patients and hypereosinophilic syndrome, as well as clues for their differential diagnosis.