Revista Colombiana de Reumatologia最新文献

Sjögren's Syndrome (SS) is an autoimmune pathology with glandular and/or extraglandular compromise, secondary to the infiltration of lymphoid cells. The clinical course varies depending on genetic susceptibility, comorbidities, patient's age, and environmental risk factors. Lymphoid proliferation and differentiation are key factors in the progression of SS to haematological malignancies or amyloidosis. Amyloidosis is a secondary entity to the aberrant accumulation of soluble plasma proteins, derived from chronic infectious, inflammatory, neoplastic and haematolymphoid processes. The clinical manifestations vary and depend on the constitutive protein and the age of the patient; and may have glandular or extraglandular, local, or systemic compromise. Among the affected organs, pulmonary involvement poses a diagnostic and therapeutic challenge due to its variable course and clinical manifestation. The following is a case report of a woman over 70 years old, with SS and amyloidosis with glandular and extra glandular manifestations at pulmonary level.

Introduction/Objective

The purpose of this study was to evaluate patients in clinical remission of psoriasis for at least for one year, who maintained therapeutic goals after initiating optimization of biologic therapy.

Materials and methods

A descriptive, observational study was conducted on patients with a diagnosis of moderate–severe psoriasis in treatment with biologic therapy who were started on optimization of biologic therapy.

Results

A total of 29 patients started therapeutic optimization, of these, 27 patients were in the target range with absolute PASI less than 3. Only one patient failed therapeutic optimization with final PASI 3.6 and there was a case of a patient who lost continuity of management due to an accident and had a final PASI 3.8. Most of the patients were male, with an average age of 53 years, married, employed, residing in urban areas, with psoriasis of more than ten years of evolution, without associated morbidities, and without previous biologic treatment, the most frequently used being etanercept and adalimumab.

Conclusion

Optimizing biologic therapy in patients with moderate–severe psoriasis may be viable. We seek to share this experience to propose a protocol to reduce the possibility of adverse events due to the prolonged use of this type of therapy, preserving clinical response and reducing costs to the health system.

Autoimmune diseases comprise a wide and diverse group of diseases, each with its own specific complications, and with common complications such as pulmonary involvement. Lung involvement is extensive and one of its complications is interstitial lung disease, which varies widely within each of the autoimmune diseases. Health-related quality of life is defined as all those aspects that reflect the impact of the disease and the perception of disability and daily functionality of the patient. Even though this concept is subjective, health researchers have sought to define it to serve as a tool in the evaluation of interventions in subjects with different types of pathologies, so much so that it has become a main outcome in program evaluation and clinical research. To date, we are not aware of tools designed with the objective of measuring quality of life specifically in lung involvement due to interstitial lung disease related to autoimmune diseases. The objective of this review will be to further explore the available information on the measurement of quality of life in these patients.

Antisynthetase syndrome is a rare disease, with varying degrees of lung, muscle, joint, and skin involvement. Due to the introduction of new diagnostic tests, it is possible to detect the disease earlier and to determine the best treatment strategy. However, in our country the availability of these tests is limited. We present the case of a patient with antisynthetase syndrome associated with anti-PL7 antibodies in whom, thanks to the early identification of these antibodies, timely initiation of treatment for the disease was achieved.

Introduction

Telemedicine, defined as the provision of remote health services by health professionals using Information and Communication Technologies, has been adopted in healthcare in Colombia.

Objective

To establish recommendations for the implementation and management of telemedicine in clinical practice for rheumatological diseases in Colombia.

Materials and methods

The recommendations were made in 3 phases. Phase 1 was based on an extended review and a systematic review of the literature. Phase 2 consisted of the selection of attributes and components based on the extended review to delimit the framework of the recommendations using the Delphi method. In phase 3, a group of experts, based on the systematic review, the selected attributes and components, and individual experience made recommendations through a nominal group.

Results

The framework of recommendations comprised 9 attributes and 26 components. A group of 7 rheumatologists in 4 cities of the country was formed. The nominal group drafted the final recommendations through 3 rounds according to the recommendations with a high priority rating.

Conclusions

This document contains recommendations for effective telemedicine healthcare for rheumatological diseases in Colombia. To establish effective telemedicine healthcare, it is necessary to evaluate different possible forms of care, the convenience of using telemedicine according to the clinical-cultural and sociodemographic profile of the patient, the access and implementation capacity of the different technological tools, and the exhaustive analysis of the barriers and facilitators to its adoption.

Introduction

Corticosteroids are hormones released by the adrenal gland that act on sodium and glucose metabolism and have anti-inflammatory properties. The first synthetic corticosteroids were prednisolone and prednisone. Deflazacort is the most recent of the synthetic corticosteroids, with molecular differences that bestow benefits such as, for example, in relation to sodium loss, anti-inflammatory potency and immunosuppressive activity, and lower interference on glucose and phosphocalcium metabolism.

Objective

We decided to conduct this study to describe the effect of deflazacort compared to other corticosteroids in rheumatoid arthritis.

Materials and methods

We conducted a scoping review. A literature search was conducted in Pubmed, Cochrane and BVS databases, and in grey literature, for controlled clinical trials or equivalence studies conducted in adult patients with rheumatoid arthritis and the use of deflazacort versus other corticosteroids. We excluded articles that did not clearly mention the dose of deflazacort, or the comparator used.

Results

The search of the 3 databases yielded 166 studies, of which 5 met the eligibility criteria and were included. Four studies evaluated deflazacort versus prednisolone, and one versus methylprednisolone. The results were similar for all 5: less decline in bone mineral density and glucose metabolism.

Conclusions

Deflazacort and prednisolone have pharmacological differences that influence adverse effects at the level of bone and glucose metabolism. However, further studies are required for deflazacort to be used routinely in our practice, especially in diseases such as rheumatoid arthritis.

Objective

To establish associations between the development of lupus nephritis (LN) and the expression of antibodies against C1q (anti-C1q) and serum adiponectin as these biomarkers have been previously postulated to be associated with the presence of LN.

Materials and methods

A case–control study nested in a cohort was chosen. Patients with SLE with renal involvement were included. Measurement of antibodies against C1q, levels of adiponectin, and HLA expression DRB1 and DQB1 were evaluated. We searched for possible associations between the measured biomarkers and allelic HLA types found.

Results

One hundred and six patients were recruited with LN with a mean age of 35 years. Mean adiponectin levels were 16.9 μg/mL, and 60% of patients presented anti-C1q positivity. HLA DRB1*0404 and DRB1*1101 are protective factors for LN (OR: .42, p = .0030 and OR: 0.49, p = .046 respectively). HLA DRB1*0701 (OR: 3.15, p = .0452) and DRB1*0802 (OR: 8.3, p = .020) are susceptibility factors for LN. There was a tendency for association between anti-C1q positivity and high levels of adiponectin with type IV LN (OR 2.3 [95% CI: 0.68–8.2] and (OR: 2.67 [95% CI: .76–9.9] respectively). There was a tendency for association between anti-C1q positivity and HLA expression DRB1*0701 (OR 2.7 [95% CI: .81–11.5]), as well as high levels of adiponectin and HLA expression DRB1*0404 (OR 3.03 [95% CI: .92–12.8]). No association was found between anti-C1q and adiponectin with the expression of HLA DRB1*1501. There was positive correlation between levels of anti-C1q and the activity index in renal biopsy.

Conclusions

In the Colombian population there is a tendency for association of anti-C1q with the expression of HLA DRB1*07; however, the expression of other HLA II genes known as risk factors for LN, was not associated with the expression of anti-C1q, adiponectin or any specific type of LN.

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) is an infrequent disease, of as yet unknown aetiology, which affects the retina with no systemic injury, causing progressive retinal ischaemia and visual loss. We describe the case of a Colombian patient with a diagnosis of IRVAN guided by clinical examination and diagnostic images, after previously ruling out other ocular infections, autoimmune, or systemic diseases. Our patient was treated with peripheral laser, intravitreous anti-vascular endothelial growth factor anti, and systemic immunosuppression with excellent response. In conclusion, early diagnosis and proper treatment according to disease stage could improve visual prognosis.