Revista Colombiana de Reumatologia最新文献

The use of glucocorticoids is the most frequent cause of osteoporosis and osteoporotic fractures. Considering that glucocorticoid-induced osteoporosis (GIOP) is an underestimated and generally untreated problem, the Bone Metabolism study group of the Colombian Association of Rheumatology decided to create this Clinical Practice Guideline (CPG) in order to support rheumatologists and other specialists in the country who use this type of medication to manage inflammatory and autoimmune conditions, with recommendations on prevention, diagnosis, and treatment of GIOP. The recommendations presented here were constructed following the GRADE-ADOLOPMENT methodology. The American College of Rheumatology guideline, Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis, was selected as the source for updating the literature searches. The development of this CPG also included the participation of clinical experts from different specialties, patients, and the EpiThink Health Consulting technical-methodological team.

Interstitial lung disease refers to a group of disorders generally characterized by progressive scarring of lung tissue due to a wide variety of causes and associated with a plethora of symptoms. Patients with this diagnosis can be asymptomatic or present severe symptoms that could lead to death. Its signs and symptoms are the same in patients with concomitant connective tissue disease and those without. Genetics and immunity play essential roles in patients with interstitial lung disease and idiopathic inflammatory myopathy. Alterations in genes and excessive production of specific cytokines can lead to the development of interstitial lung disease. Interstitial lung disease can have several complications, including chronic respiratory distress and infections, and can worsen the prognosis of patients with idiopathic inflammatory myopathy. Here, we present a narrative review describing the epidemiology, pathophysiology, clinical manifestations, risk factors, and complications of the population with interstitial lung disease and idiopathic inflammatory myopathy.

Introduction

Adjuvant-induced autoimmune/inflammatory syndrome (ASIA) comprises a spectrum of clinical manifestations associated with exposure to diverse adjuvants that have in common the generation of non-specific autoantibodies and loss of immune tolerance.

Objective

This study aimed to develop a narrative review of the literature about the pathogenesis underlying ASIA syndrome, its differentiation from other defined autoimmune diseases, and prospects for future research in this field.

Materials and methods

A narrative review of the literature was conducted using Pubmed, Embase, and LILACS. All publications on the subject were included, with no time limit in English and Spanish. Finally, 25 articles published since 1990 were included, from which we reviewed the pathogenesis, diagnostic criteria, and its differentiation from other defined autoimmune processes.

Results

The appearance of ASIA syndrome seems to be linked to an individual's genetic predisposition (HLA-DRB1*01 or HLA-DRB4) and is the result of the interaction of external and endogenous factors that trigger autoimmune phenomena. In recent years, physicians have become more aware of the relationship between exposure to adjuvants and the development of underlying signs and symptoms that may correspond to ASIA syndrome. The current evidence supporting its existence is still contradictory. A timely diagnosis requires a multidisciplinary approach and could require immunosuppressive treatment in particular cases.

Conclusions

In recent years a relationship between exposure to adjuvants and the appearance of autoimmunity phenomena has been recognized. In clinical practice, physicians can find cases of ASIA syndrome. However, the evidence is still debated on the relationship between adjuvants and autoimmune clinical manifestations. ASIA syndrome classification criteria require validation in various populations before being applied to select patients for clinical studies. It is necessary to identify the risk factors for ASIA syndrome to understand its pathophysiology and make a timely diagnosis.

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.