Revista Colombiana de Reumatologia最新文献

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.

Osteopetrosis is a rare bone disease that occurs due to failure in bone resorption. Osteoclast dysfunction and persistent calcification of primary chondroids and bones are the cause of the disease. Osteopetrosis is a rare hereditary condition known as abnormal bone resorption. Considering the importance of prompt and timely diagnosis and follow-up and treatment with significant complications, we decided to report a case of neonatal osteopetrosis diagnosed 12 h following admission to the neonatal intensive care unit of Imam Reza Hospital. The 7-day-old male neonate was hospitalised due to abdominal mass and thrombocytopenia. Hepatosplenomegaly and thrombocytopenia were diagnosed on examination and tests. Finally, the infant was referred to the neonatal intensive care unit of Imam Reza Hospital in Mashhad at 7 days of age for further evaluation. Chest X-ray taken as part of sepsis workup showed increased rib and arm bone density. A facial X-ray was taken, and eye sign detected for the diagnosis of osteopetrosis. In every neonate with hepatosplenomegaly, thrombocytopenia, and increased bone density, in addition to a neonatal sepsis workup, a facial X-ray should be taken initially to observe signs and confirm osteopetrosis.

Introduction

Demand of biopolymer injections has steadily increased in the last decade. Complications associated with this procedure can be innocuous or even life-threatening, presenting from immediately to years later, locally or systemically, with mechanical, inflammatory, or autoimmune characteristics.

Objectives

To present a rare manifestation of an increasing health problem, clinicians must be attentive to this kind of complication.

Materials and methods

Clinical and laboratory data were searched from the clinical history; informed consent was obtained, and the Ethics Committee of Fundación Valle del Lili reviewed and approved this study. We report a patient who presented long-standing symptoms but only consulted after the onset of an acute lower limb arterial thrombosis that could have been fatal without rapid intervention. Ischemia was secondary to arterial obstruction related to biopolymer migration.

Results

A femoral and popliteal embolectomy was performed in which severe soft tissue fibrosis and encapsulated bodies were observed. The patient received thromboprophylaxis and low-dose oral glucocorticoid presenting a favorable evolution.

Conclusions

This substance probably acted as a foreign body and triggered an inflammatory reaction with a subsequent state of hypercoagulability, fibrosis, and nodule formation.

Introduction

Fibromyalgia is a chronic pain condition that represents a public health problem. It greatly impacts quality of life and affects the psychosocial dimension beyond physical aspects. However, there are insufficient studies aimed at determining the suffering levels of this population and its related factors to propose more comprehensive interventions.

Objective

To determine the levels of suffering and its associated factors in patients with fibromyalgia treated at the Colombian Institute of Pain.

Materials and methods

A quantitative, analytical observational, and cross-sectional study with a correlational design was carried out. Convenience sampling was used. Variables assessed included levels of suffering (PRISM), fibromyalgia impact on quality of life (FIQR), loneliness (UCLA), anxiety and depression (HADS), and vital stress (Vital Events Questionnaire). Descriptive and correlational statistics were obtained.

Results

There were sixty-two participants, 96.8% were women. Seventy-five percent manifested moderate to severe suffering, 62.9% had clinical indicators of loneliness, 75% clinically significant anxiety, and 25.8% clinically significant depression. Also, they reported a mean of 10 stressful vital events. A direct and significant association between suffering and impact on quality of life was found. This impact on quality of life was also significantly correlated with loneliness, anxiety, and depression. Vital stress was also significantly related to loneliness and anxiety. Although statistically significant, most correlations were moderate.

Conclusions

Patients with fibromyalgia experience relevant levels of suffering and impact on their quality of life. This impact is directly related with psychosocial factors beyond the well-known anxiety and depression. These results help visualize the intense suffering faced by this population and indicate the relevance of examining more deeply issues such as loneliness and vital stress.

Interstitial lung disease (ILD) is a leading cause of both morbidity and mortality in systemic sclerosis (SSc). Radiographic lung abnormalities on high-resolution computed tomography (HRCT) imaging may be identified in 75–90% of those with SSc, while clinically significant ILD occurs in up to 40%. Early detection is important as early treatment in those with progressive ILD may improve outcomes. Appropriately risk-stratifying systemic sclerosis-associated ILD (SSc-ILD) is important in identifying those at highest risk of progression. This article summarises recent advances in SSc-ILD, particularly recommendations for screening, defining disease progression and monitoring.

Approximately forty percent of patients with autoimmune diseases suffer from interstitial lung disease (ILD). There are currently no specific screening guidelines for these patients. ILD causes substantial morbidity and mortality; early recognition and diagnosis are essential to avoid treatment delays. The gold standard for management incorporates a multidisciplinary approach (MMD) with input from various specialties, such as pulmonary, rheumatology, radiology, and pathology, to reach a consensus regarding diagnosis and treatment. In this article, we will discuss the most common forms of ILD that affect patients with autoimmune diseases, as well as how to promptly and effectively diagnose and treat these conditions.