Síndrome de los anticuerpos antifosfolípido (I): estudio clínico y de laboratorio

Inclou referències bibliogràfique

Uso de las terapias biológicas en las enfermedades autoinmunes sistémicas

Inclou referències bibliogràfique

El laboratorio de inmunología en el diagnóstico y control de las enfermedades autoinmunitarias sistémicas (I): protocolo de estudio ante la sospecha clínica

Inclou referències bibliogràfique

Clinically-useful serum biomarkers for diagnosis and prognosis of sarcoidosis

Introduction: Sarcoidosis is a complex systemic disease with a silent, long-term evolution, and a heterogeneous clinical presentation. The diagnostic approach is complex with no single diagnostic test that may confirm the disease. Areas covered: A large list of serum biomarkers has been tested during the last 40 years. In this review, we analyse the potential usefulness in the diagnosis and prognosis of sarcoidosis of serum biomarkers classified according to their corresponding cellular source. Expert commentary: Diagnosis of sarcoidosis must always be approached as a multistep process based on a case-by-case integration of clinical, radiological, histological and serological data, none of which being pathognomonic. We found sIL-2R, CRP, SAA and chitotriosidase to be the best markers to confirm sarcoidosis (highest sensitivity), while ACE, gammaglobulins and lysozyme may be more useful for discarding sarcoidosis (highest specificity), taking into account that with the use of a higher cut-off we can increase specificity and with a lower cut-off we can increase sensitivity. Other biomarkers (TNF-a and CCL18) could help to identify patients with an enhanced risk of developing pulmonary fibrosis or progressive disease. The future scenario of the serological diagnostic approach of sarcoidosis will be the use of multi-assays including biomarkers from different cellular sources.Fil: Ramos Casals, Manuel. Sociedad Española de Medicina; España. Instituto Clínic de Medicina y Dermatología; EspañaFil: Retamozo, Maria Soledad. Instituto Clínic de Medicina y Dermatología; España. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Instituto Modelo de Cardiología Privado; ArgentinaFil: Siso Almirall, Antoni. Instituto de Investigaciones Biomédicas August Pi i Sunyer; EspañaFil: Pérez Alvarez, Roberto. Sociedad Española de Medicina; EspañaFil: Pallarés, Lucio. Sociedad Española de Medicina; España. Sarco GEAS SEMI Study Group; EspañaFil: Brito Zenón, Pilar. Sociedad Española de Medicina; España. Sarco GEAS SEMI Study Group; Españ

COVID GEAS: COVID-19 National Survey in Patients With Systemic Autoimmune Diseases

COVID-19 infection; Corticosteroids; Systemic autoimmune diseaseInfección por COVID-19; Corticosteroides; Enfermedad autoinmune sistémicaInfecció per COVID-19; Corticosteroides; Malaltia autoimmune sistèmicaObjectives: COVID-19 outcomes in population with systemic autoimmune diseases (SAD) remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 infection in people with rheumatic disease. Methods: Two phases cross-sectional survey of individuals with rheumatic disease in April 2020 and October 2020. COVID infection, severity of disease, age, sex, smoking status, underlying rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analyzed. Results: A total of 1,529 individuals with autoimmunity disease diagnosis were included. Out of 50 positive patients, 21 required telephone medical assistance, 16 received assessment by primary care physician, 9 were evaluated in Emergency Department and 4 patient required hospitalization. Multivariate analysis was performed without obtaining differences in any of the systemic autoimmune diseases. Regarding the treatments, significant differences were found (p 0.011) in the treatment with anti-TNF-alpha agents with OR 3.422 (1.322–8.858) and a trend to significance (p 0.094) was observed in patients receiving mycophenolate treatment [OR 2.016 (0.996–4-081)]. Conclusions: Anti-TNF-alpha treatment was associated with more than 3-fold risk of suffering from SARS-CoV-2 infection, although in all cases infection was mild. Cumulative incidence in patients with SAD was up to 5 times higher than general population but with great differences between autoimmune diseases.This work was supported by SEMAIS

Sarcoidosis

La sarcoidosis es una enfermedad sistémica de etiología desconocida que se caracteriza por el desarrollo de granulomas epiteloides no caseificantes. Los pulmones son los órganos más afectados (>90 % de los casos), seguidos de los ganglios linfáticos, la piel y los ojos. Esta revisión resume las principales manifestaciones clínicas y las opciones actuales de farmacoterapia. Los glucocorticoides son la primera línea de tratamiento para la sarcoidosis. Para los pacientes con las formas más severas de sarcoidosis (que necesitarán glucocorticoides durante largos períodos de tiempo) y para aquellos que son intolerantes o resistentes al tratamiento, se utilizan medicamentos inmunosupresores como agentes ahorradores de glucocorticoides. El manejo de la sarcoidosis extratorácica debe adaptarse al órgano u órgano específico involucrado;sin embargo, hay datos limitados de ensayos controlados para guiar el tratamiento de estos pacientes. La aparición de terapias biológicas ha aumentado el arsenal terapéutico disponible para tratar la sarcoidosis, siendo los agentes anti-TNF monoclonales los más prometedores, pero su uso todavía está limitado por la falta de licencias y costos.Sarcoidosis is a systemic disease of unknown etiology characterized by the development of non-caseating epitheloid granulomas. The lungs are the most commonly involved organ (>90% of cases), followed by the lymph nodes, the skin, and the eyes. Areas covered: This review summarizes current pharmacotherapy options and future directions for the development of new therapies. Glucocorticoids are the first-line therapy for sarcoidosis. For patients with the most severe forms of sarcoidosis (who will need glucocorticoids for long periods) and for those intolerant or refractory, immunosuppressive drugs are used as sparing agents. The management of extrathoracic sarcoidosis must be tailored to the specific organ or organs involved;however, there is limited data from controlled trials to guide the treatment of these patients. The emergence of biological therapies has increased the therapeutic armamentarium available to treat sarcoidosis, with monoclonal anti-TNF agents being the most promising, but their use is still limited by a lack of licensing and costsFil: Retamozo, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina. Instituto Universitario de Ciencias Biomédicas de Córdoba; ArgentinaFil: Brito Zeron, Pilar. Hospital Cima-sanitas; EspañaFil: Pérez Álvarez, Roberto. Sociedad Española de Medicina Interna; EspañaFil: Achad, Mario Oscar. Universidad Nacional de Córdoba; ArgentinaFil: Pallarés, Lucio. Sociedad Española de Medicina Interna; EspañaFil: Cuestas, Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Ramos Casals, Manuel. Sociedad Española de Medicina Interna; Españ