Revista Colombiana de Reumatologia最新文献

Introduction

Granulomatosis with polyangiitis (GPA) and pyoderma gangrenosum are rare and difficult-to-diagnose pathologies with severe manifestations and a high burden of morbidity. GPA is a necrotizing systemic vasculitis of small vessels, while pyoderma gangrenosum is an inflammatory skin disease.

Objectives

The aim of this study is to describe the comprehensive clinical-pathological study process necessary to accurately identify these conditions and establish an effective treatment plan.

Materials and methods

A retrospective study was conducted on a case of a patient with cutaneous lesions suspected of pyoderma gangrenosum. Clinical data, including symptoms, laboratory tests, biopsies, and imaging results, were collected. A multidisciplinary review of the findings was carried out to reach an accurate diagnosis. The treatment consisted of administering methotrexate.

Results

Following the comprehensive clinical-pathological study, the diagnosis of granulomatosis with polyangiitis associated with pyoderma gangrenosum-like lesions was confirmed. The patient responded favourably to methotrexate treatment, and the cutaneous lesions completely resolved after one year.

Conclusions

This case illustrates the difficulty in diagnosing granulomatosis with polyangiitis and pyoderma gangrenosum, highlighting the importance of a multidisciplinary approach in their management. The comprehensive clinical-pathological study and appropriate treatment led to successful resolution of the patient's lesions. It is crucial to promote collaboration among different medical specialties to improve the diagnosis and treatment of these rare and highly morbid diseases.

Interstitial lung diseases are a heterogeneous group of respiratory diseases that are difficult to diagnose. The study of bronchoalveolar lavage (BAL) by flow cytometry can define typical cell patterns in different diseases, providing some help in differential diagnosis. In this article, we present a case of interstitial lung disease of unknown origin, in a patient previously diagnosed with rheumatoid arthritis who received treatment with methotrexate.

Interstitial lung disease in lupus is an entity that occurs infrequently and tends to progress slowly in most cases. Despite this, the therapeutic approach for moderate to severe cases is largely unknown because most of the evidence comes from case reports, many of which predate the advent of today's known treatments for lupus. Additionally, little progress has been made in understanding its pathophysiology and current concepts come from other connective tissue diseases such as systemic sclerosis or are grouped within the group of interstitial pneumonias with autoimmune characteristics. This, to an extent, has been an obstacle for research in this field, and to date there is no unified diagnostic and therapeutic approach. Therefore we conducted a state of the art search of the best evidence available to date, in terms of diagnostic methods and emerging therapies, to offer the clinician a practical vision for a comprehensive approach.

Introduction

Arthroplasty is a commonly used surgical procedure for the functional recovery of patients with impaired mobility and displacement. The post-surgical process implies dealing with pain and anxiety, a situation that must be addressed during hospitalization by the nursing staff, to guarantee pertinent and effective care that favours the processes of rehabilitation and patient satisfaction.

Objective

To identify the relationship between satisfaction with nursing care and the presence of anxiety and pain in women who underwent arthroplasty.

Materials and methods

Cross-sectional quantitative, with 63 patients undergoing arthroplasty at the Dr. Jorge Von Ahn National Hospital of Orthopaedics and Rehabilitation in León, Guatemala. The variables level of anxiety, pain, and satisfaction with nursing care were measured. Data were analysed with non-parametric statistics using Spearman's coefficient correlation test. International ethical considerations and informed consent were taken into account.

Results

The variable satisfaction with nursing care was related to low level of anxiety and null relationship with pain and the sociodemographic variables sex, age, ethnicity, level of education, and days of stay.

Conclusion

It is necessary to implement therapeutic nursing strategies that continue to humanize the hospital stay and recovery processes, and to conduct mixed studies that deepen the relationship between satisfaction with nursing care variables and anxiety and non-associated sociodemographic variables.

Introduction/Objective

To evaluate the association between autoantibodies with clinical manifestations (extraglandular and glandular) and histopathological findings of minor salivary gland biopsy in primary Sjögren's syndrome.

Materials and methods

Observational, descriptive, and cross-sectional study. Forty-seven patients with primary Sjögren's syndrome according to the ACR/EULAR 2016 criteria were included. A face-to-face survey, a review of medical records, and the measurement of autoantibodies anti-Ro 52, anti-Ro 60, anti-La, antinuclear antibodies, rheumatoid factor IgA, IgG and IgM, and anti-alpha fodrin IgA and IgG were done. Characterization of the population and analysis of the association between clinical characteristics, autoantibodies, and histopathology were performed.

Results

Association of anti-alpha fodrin IgA and anti-Ro 52 Ab was found with pulmonary involvement (P = .014 and P = .031 respectively) and anti-La antibodies with haematological manifestations, specifically leukopenia (P = .011), lymphopenia (P = .023), and anaemia (P = .09). We found no association between the histopathological findings of the minor salivary gland biopsy and extraglandular manifestations.

Conclusions

The activation of B cells, reflected in the increased production of autoantibodies, is related to extraglandular manifestations in primary Sjögren's syndrome, which is observed more frequently in patients with earlier diagnosis.

Interstitial lung disease (ILD) is a common and potentially devastating complication of systemic sclerosis (SSc), a chronic autoimmune disorder characterized by fibrosis and vascular abnormalities. The association between SSc and ILD underscores the intricate interplay between immune dysregulation, vasculopathy, and tissue fibrosis. This review provides a comprehensive overview of the immunological, clinical, and radiological features of ILD in the context of SSc. It highlights the diverse spectrum of ILD patterns observed in SSc patients, ranging from non-specific interstitial pneumonia to usual interstitial pneumonia. The intricate pathogenic mechanisms linking SSc and ILD involve aberrant immune responses, endothelial dysfunction, profibrotic cytokine signaling, and genetic factors. Immunological alterations, diagnostic challenges, and prognostic implications are discussed, underscoring the need for multidisciplinary management strategies. By elucidating the complex relationship between SSc and ILD, this review aims to contribute to a deeper understanding of the underlying mechanisms and facilitate the development of interdisciplinary interventions for improved patient outcomes.

An increasing number of musculoskeletal clinical manifestations, the onset of diseases and rheumatological manifestations have been seen in the paediatric population surviving COVID-19, however, the medical literature on the subject is limited.

The objective is to explore the available evidence on musculoskeletal symptoms and autoimmune diseases in the paediatric population with post-COVID syndrome.

Scoping systematic review in PubMed and Scopus through search strategies. Observational and experimental studies are included in populations under 21 years of age with and without autoimmune diseases, without time limit in English and Spanish.

The 28 documents included: case reports (n = 6), cross-sectional studies (n = 5), prospective cohort studies (n = 5), retrospective cohort (n = 6), case series (n = 6), ambidirectional section (n = 1), randomized controlled trial (n = 1), and longitudinal section study (n = 1). The total study population was 56,738 patients. The most frequent symptoms presented in long COVID-19 are myalgias and arthralgias. The evidence showing a relationship between SARS-CoV-2 infection in the development of musculoskeletal symptoms and autoimmune diseases in the convalescent period is limited.

As a conclusion, myalgias and arthralgias are the most frequent symptoms in long COVID. patients with SARS-CoV-2 infection and a history of rheumatic disease who are undergoing immunomodulatory treatment do not have a dangerous risk of developing severe presentations and/or complications of the disease.

Recent advances in deciphering the genetic architecture of RA-ILD support the hypothesis of RA-ILD as a complex disease with a heterogeneous phenotype encompassing at least the usual interstitial pneumonia (UIP) and non-UIP high-resolution CT patterns. The results of genetic studies support the hypothesis of a common genetic background between idiopathic pulmonary fibrosis (IPF) and RA-ILD, and more specifically RA-UIP, a subset of the disease associated with a poor prognosis. Overall, these findings suggest the existence of shared pathogenic pathways between IPF and RA-ILD providing new opportunities for future intervention in RA-ILD, particularly with drugs that have been shown to be active in IPF.

Introduction

Connective tissue disease-related interstitial lung disease (CTD-ILD) accounts for 30% of all cases of ILD. Some patients progress and develop progressive pulmonary fibrosis, which has a prognosis comparable to interstitial pulmonary fibrosis. In this study, relevant evidence about epidemiology, risk factors, biomarkers, and treatment are reviewed.

Materials and methods

A systematic review of the literature was carried out. Original observational and descriptive articles were included. Articles not providing information about the CTD diagnosis were excluded. PUBMED, EMBASE, SCOPUS, and LILACS were all searched. The total number of articles obtained was 528; data were extracted from 61 original articles.

Results

On average, ILD in these patients progressed by 33.7% over time. Patients with progressive pulmonary fibrosis had a similar 3.7-year median survival as those with idiopathic pulmonary fibrosis. Mortality was markedly increased (hazards ratio 3.29; 95% CI 2.76–3.82). A progressive course was seen in 34% of scleroderma (SSc) related ILD cases. Six interferon-induced proteins and a proteomic profile of 12 biomarkers were used to predict progression and response to treatment. The INBUILD and SENSCIS studies that assessed the effectiveness of nintedanib effectiveness revealed a reduced decrease in forced vital capacity. Progression in rheumatoid arthritis (RA) related ILD ranges from 38% to 50%. Control of RA disease activity and use of antifibrotics benefit the lungs.

Conclusion

A significant proportion of patients with CTD-ILD have progressive lung disease, with the corresponding adverse mortality effects. The majority of the data regarding CTD-ILD are from cohorts of patients with RA-ILD and SSc-ILD, in which antifibrotics and concurrent immunosuppressive treatments have been effective. There is not enough information available on other autoimmune disorders to draw any firm conclusions regarding progression rates or treatment effects.

Introduction/Objective

The aim of this study was to investigate the frequency of fibromyalgia (FM) in axial spondyloarthritis (ax-SpA) patients using the current FM diagnostic criteria (2016 Revised Fibromyalgia Diagnostic Criteria). Additionally, we aimed to investigate the relationship between FM severity and disease activity, functional status, and quality of life (QoL).

Materials and methods

Disease activity, functional disability and QoL were evaluated. FM severity was measured with the fibromyalgia impact questionnaire (FIQ).

Results

One hundred and three patients with ax-SpA (55.3% female; mean age 44 ± 10.85 years) were included. FM was detected in 49.5% of the patients. While FM was detected in 71% of patients with a history of peripheral arthritis, FM was present in 59.2% of patients without (p = 0.009). FM-ax-SpA patients showed higher disease activity except for C-reactive protein; functional status and QoL were statistically worse in patients with FM-SpA. Significant positive correlations were found between FIQ and disease activity, functional disability and QoL (p < .001).

Conclusions

The most effective features associated with the presence of FM were detected as gender and a history of peripheral arthritis. Presence of FM may cause an overestimation of disease activity, FM severity correlates with disease activity.