Necrosis óseas asépticas avasculares

Se presentan 30 casos de necrosis osea aséptica avascular. Se hace el análisis de los hallazgos clínicos, de los métodos de laboratorio empleados para el diagnóstico, de los factores que pueden desempeñar algún papel en su génesis y de los diferentes tipos de tratamiento empleados.30 cases of avascular aseptic bone necrosis are presented. The clinical findings, the laboratory methods used for diagnosis, the factors that may play a role in the pathogenesis and the different schedules of treatment used are analyzed

Is the treatment with biological or non-biological DMARDS a modifier of periodontal condition in patients with rheumatoid arthritis?

Background and objective: Experimental models suggest the use of different therapy protocols in rheumatoid arthritis (RA) as modulators on periodontal condition. This study evaluated the effects of conventional drug treatment and anti-TNF therapy in patients with RA on microbiological and periodontal condition, establishing the association of markers of periodontal infection with indexes of rheumatic activity. Materials and methods: One hundred seventy nine individuals with RA were evaluated (62 with anti-TNF-. and 115 with only DMARDs). The periodontal evaluation included plaque and gingival indexes, bleeding on probing (BOP), clinical attachment loss (CAL), pocket depth (PD) and subgingival plaque samples for microbiological analysis. Rheumatologic evaluations included a clinical examination, rheumatoid factor (RF), antibodies against cyclic-citrullinated peptides (ACPAs), and activity markers (DAS28-ERS), high sensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR). Results: Anti-TNF-alpha therapy influenced periodontal microbiota with a higher frequency of T. denticola (p=0.01). Methotrexate combined with leflunomide exhibited a higher extension of CAL (p=0.005), and anti-TNF-alpha therapy with methotrexate was associated with a lower extension of CAL (p=0.05). The use of corticosteroids exerted a protective effect on the number of teeth (p=0.027). The type of DMARD affected P. gingivalis, T. forsythia and E. nodatum presence. Elevated ACPAs titers were associated with the presence of red complex periodontal pathogens (p=0.025). Bleeding on probing was associated with elevated CPR levels (p=0.05), and ESR was associated with a greater PD (p=0.044) and presence of red complex (p=0.030). Conclusion: Different pharmacological treatments for RA affect the clinical condition and subgingival microbiota

Predictive factors related to the progression of periodontal disease in patients with early rheumatoid arthritis: A cohort study

Background: Rheumatoid arthritis (RA) and periodontal disease are inter-related conditions. However, factors predictive of periodontal disease progression in patients with early rheumatoid arthritis (eRA) are lacking. The aim of this study was to identify factors associated with the progression of clinical attachment loss (CAL) in interproximal dental sites of eRA patients. Methods: Twenty-eight eRA patients were evaluated for the progression of CAL at 280 interproximal dental sites at 1 year of follow-up. Markers of RA activity (rheumatoid factor, erythrocyte sedimentation rate, and C-reactive protein), a marker of bone resorption (Dickkopf-related protein 1), Disease Activity Score 28 and Simple Disease Activity Index were included as potential systemic predictive factors. Plaque index, gingival index, pocket depth, clinical attachment level and Dickkopf-related protein 1 in crevicular fluid at baseline were included as potential local predictive factors. Data were analysed in a hierarchical structure using generalised linear mixed models for progression at each site (> 2 mm) during follow-up. Results: C-reactive protein level was the most important predictive systemic factor for the progression of CAL. The mean CAL and a high degree of gingival inflammation in interproximal sites at baseline were important predictive local factors (p < 0.0001). Patients who received combined treatment with disease-modifying antirheumatic drugs and corticosteroids exhibited less CAL (p < 0.0001). The predictive value of the generalised linear mixed model for progression was 85%. Conclusions: Systemic factors, including RA disease activity and baseline periodontal condition, were associated with periodontal progression. Pharmacological treatment may affect periodontal progression in patients with early RA

Hidroxiprolina en enfermedades reumáticas

A study based on the behaviour of hydroxyproline in 64 cases, 16 normal individuals, 10 with rheumatoid arthritis, 5 with systemic lupus erythematosus, 30 with osteoporois, 2 with vitamin D resistant rickets and 1 with osteomalacia, is presented, hydroxyproline is an amino acid derived from proline and is actually considered of great value in the study of collagen metabolism. The results obtained in each group of disease are presented and compared with those obtained in the normal individuals. We think that these late are very useful to establish in our medium, the average of normal free serum hydroxyproline and of total and free urine hydroxyproline, since we did not find related data in the consulted ational literature

Necrosis óseas asépticas avasculares

30 cases of avascular aseptic bone necrosis are presented. The clinical findings, the laboratory methods used for diagnosis, the factors that may play a role in the pathogenesis and the different schedules of treatment used are analyzed