Psoriasis: aspectos comparativos entre la edad pediátrica y adulta de interés para el médico general

Introducao: La psoriasis es una enfermedad sistémica con alto impacto en la calidad de vida, afecta 1 a 2% de la población general y puede iniciarse en el lactante o debutar en la infancia, adolescencia o adultez. Dependiendo de la edad, las características clínicas varían y, por tanto, el tratamiento es diferente. Objetivo: Transmitir al médico general aspectos comparativos útiles para su práctica diaria, que le permitan un abordaje inicial y un manejo interdisciplinario de la psoriasis. Resultados: El 27% de los casos se manifiesta antes de los 15 años con placas delgadas o gotas, con localización retroauricular, facial, umbilical o en el área del pañal, lo que puede retrasar el diagnóstico. Dependiendo de la edad, localización y extensión de las lesiones, los tratamientos tópicos y la fototerapia UVB nb son de elección en las formas leves a moderadas en los niños y adultos, por ser seguros y efectivos, los sistémicos y biológicos se reservan para formas severas, artropáticas, por el potencial riesgo de efectos adversos. Conclusao: Tanto el manejo inicial para mejorar la barrera de la piel como los tratamientos tópicos pueden ser realizados por el médico generalista, de forma interdisciplinaria. Para casos con formas clínicas más complejas y comorbilidades, el manejo debe ser más intensivo. Las formas severas sub tratadas afectan la calidad de vida

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd