Revista Colombiana de Reumatologia最新文献

Introduction

Antiphospholipid syndrome diagnosis requires abnormal results of lupus anticoagulant and high titles of anticardiolipin (aCL) and β2glycoprotein I (anti-β2GPI) antibodies. The latter immunological tests lack a standard threshold in clinical practice.

Objective

To determine the 99th percentile of aCL and anti-β2GPI in healthy volunteers.

Materials and methods

This cross-sectional study reviewed antibody titles of anticardiolipin and β2glycoprotein I (IgG and IgM by enzyme-linked immunosorbent assay) in forty-nine healthy blood donors in Medellin, Colombia. Sociodemographic and immunological variables are also assessed. Antibody titles are described in median and interquartile range and the 99th percentile was estimated.

Results

We analysed samples from 16 men and 33 women. We found that the upper limits of the reference range (99th percentile) of aCL and anti-β2GPI were: aCL IgM: 18.0, aCL IgG: 16.1, anti-β2GPI IgM: 16.4, and anti- β2GPI IgG: 6.9.

Conclusions

The upper limits obtained differ greatly from the arbitrary classification values suggested in the international guidelines, taking into account that values greater than 40 international units are usually required, and the values identified in this study are between 6.9 and 18 international units. We suggest conducting additional studies that validate cut-off points according to the percentiles explored in this work.

Optic neuritis is a rare ocular manifestation of inflammatory bowel diseases and spondyloarthritis. The use of tumour necrosis alpha inhibitors to treat these conditions remains possible. We report a case of a 62-year-old-woman with a 17 year-history of axial and peripheral spondyloarthritis associated with Crohn's disease, treated with tumour necrosis alpha inhibitors, who developed an asymmetric retrobulbar optic neuritis that promptly responded to a high dose of steroids.

Introduction

Interstitial lung disease (ILD) usually has a poor therapeutic response and prognosis. One of the methods that could help in the diagnosis and optimize the management of these patients is capillaroscopy. The study aimed to determine the clinical and capillaroscopic characteristics of patients with ILD and the frequency of findings suggestive of autoimmune disease.

Materials and methods

A descriptive observational study that evaluated patients with ILD treated between 2010 and 2019 without a previous diagnosis of autoimmune disease. An interview, capillaroscopy, and a laboratory tests were performed.

Results

28 patients were evaluated, 16 (57.1%) were women and 17 (60.7%) had hypertension. Three patients (10.7%) reported morning stiffness for more than 60 minutes and there was one unexplained digital oedema. There were no telangiectasias, Raynaud's phenomenon, mechanic's hands, sclerodactyly or Gottron's sign, or ANAs titres greater than 1:80. The rest of the laboratory tests were negative in 100% of the patients. In the capillaroscopies, 13 (46.4%) patients had a normal capillaroscopic pattern and 15 (53.6%) had capillaroscopic abnormalities of undetermined significance. There were none with a pattern of systemic sclerosis or similar.

Conclusions

No laboratory or capillaroscopy findings were found that suggested interstitial disease with autoimmune features, possibly due to the low prevalence of the disease, its high mortality, and underdiagnosis. These findings reinforce the concept of capillaroscopic normality in patients with non-autoimmune ILD and call for an active search for ILD with autoimmune features for prognostic purposes.

Introduction and objective

The criteria for Sjögren's syndrome (SS) classification (ACR/EULAR 2016), include labial salivary gland (LSG) biopsy using the focus score (FS). But, in some cases it continues to be based on Chisholm and Mason (CM). Our objective was to evaluate the frequency of SS in patients with dry symptoms using FS and CM and to evaluate the degree of inter and intra-observer concordance of the histopathological reading by both methods.

Materials and methods

Cross-sectional study design. All patients with dry symptoms and studies to perform the SS classification criteria (2016) were included. The samples were independently evaluated by two readers. Descriptive statistics was used for the calculation of SS frequency. Agreement (Cohen's kappa coefficient) was analysed (STATA) for each test (CM and FS). Ethics approval was obtained.

Results

92 patients were included. According to the 2016 criteria, SS was reported in 26.1% patients in whom FS was used and in 34.8% patients in whom CM was used. The degree of intra-observer concordance for the diagnosis of FLS was perfect and moderate-high for observers. Inter-observer agreement was substantial, with kappa values of .77 FS and .75 CM.

Conclusions

FS method is a more detailed and specific score that facilitates correct classification. The use of CM as a histopathological classificatory method for SS includes more patients when compared with FS. These results are of relevance to standardise the reading of LSG biopsy in specialized services attending SS patients.

Cryptococcus neoformans is the leading causal agent of invasive fungal infections in patients with systemic lupus erythematosus, frequently compromising the central nervous system and the lung. The infection develops during the first two years after diagnosis in patients with active disease, and the main risk factors are glucocorticoids, especially the cumulative dose, and lymphopenia. Mortality is high, exceeding 50%. We present the case of a man with active systemic lupus erythematosus who was admitted due to fever, arthritis, tenosynovitis, and purpura in whom disseminated C. neoformans infection was documented by initial isolation in blood and synovial fluid. Subsequently, he developed central nervous system symptoms like headache and nuchal rigidity that responded to induction treatment with amphotericin and flucytosine, and the manifestations resolved. Although joint and periarticular involvement by C. neoformans is infrequent, these are foci to consider in the approach to patients with lupus and suspected invasive fungal infection.

Schnitzler syndrome is a rare disease, in Colombia it is considered an orphan disease, of an auto-inflammatory nature, classified as a complex acquired inflammatory type of disease, which classically produces urticarial rash, long-standing fever, adenomegalies, and arthralgias coexisting with monoclonal gamma peak typically of the IgM type. We present the case of a young woman, with a larval picture that started with urticarial rash, with clinical characteristics compatible with the syndrome and evidence of monoclonal peak in protein electrophoresis meeting Lipsker-Baltimore 2001 criteria and Strasbourg 2013 criteria for diagnosis.

Splenic infarction is a rare condition usually associated with systemic conditions. Antiphospholipid syndrome (APS) is an autoimmune condition that can present as abdominal pain due to splenic infarction. We describe a patient with systemic lupus erythematosus, admitted due to acute abdominal pain. Abdominal CT scan showed splenic infarction, and tests for antiphospholipid and anti-β2-glycoprotein I antibodies were positive. The pathophysiology and clinical presentation of splenic infarction associated with APS is discussed, emphasizing the importance of including this entity in the differential diagnosis of abdominal pain of uncertain cause in patients with systemic conditions.

Silicone breast implants are considered highly immunogenic adjuvant devices in the human body, however, the medical evidence linking the development of autoimmune diseases and Adjuvant-induced Inflammatory Autoimmunity Syndrome (ASIA) in patients using breast implants is not conclusive. In the following manuscript, an exploratory systematic review was carried out using the Scopus and PubMed databases, including analytical and descriptive observational studies with no time limit. Twenty-one articles were included, which showed that the main autoimmune diseases associated with this group of patients were undifferentiated diseases of connective tissue; most of the patients presented symptoms such as chronic fatigue, arthralgia, fever, and myalgia. The objective of this study is to synthesize and analyse the current medical literature on the frequency of rheumatological diseases concomitant with ASIA in users of silicone breast implants.