Caracterización de pacientes con compromiso pulmonar intersticial asociado a esclerosis sistémica atendidos en el Hospital Militar Central desde enero de 1998 a mayo de 2008

La esclerosis sistémica es una enfermedad clínicamente heterogénea, caracterizada por sobreproducción y depósito de tejido colágeno en piel, órganos internos y pared de vasos sanguíneos. El pronóstico depende en gran parte del compromiso de órganos internos, particularmente el pulmón, siendo éste el segundo órgano más afectado, sólo superado por el esófago. Las dos principales presentaciones clínicas de compromiso pulmonar son la enfermedad pulmonar intersticial y la hipertensión arterial pulmonar, siendo la principal causa de mortalidad en estos pacientes. El objetivo del presente estudio consiste en describir las características clínicas, epidemiológicas, de función pulmonar e imagenológicas del compromiso pulmonar intersticial en pacientes con esclerosis sistémic

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

Association between Th-17 cytokine profile and clinical features in patients with spondyloarthritis

8 páginasObjectives In recent years, a substantial amount of information has become available on the relationship between cytokines associated with the Th-17 profile and the development of spondyloarthritis (SpA). The purpose of this study was to evaluate inflammation markers in serum and synovial fluid (SF) and levels of cytokines related to the Th-17 profile in patients with different subtypes of SpA and healthy subjects. Methods We evaluated this cytokine profile in light of the clinical activity of the disease in 62 patients. Serum cytokine levels (IL-17, IL-6, IL-1 alpha, TNF alpha, IFN-gamma) were measured by flow cytometry. IL-23, serum amyloid (SAA) and metalloproteinase 3 (MMP-3) were measured with ELISA. In all patients, clinical evaluation was performed using the activity and function indexes of the disease. Results A comparison showed that IL-17, IL-23, IL-1 alpha, IL-6, and TNF-alpha levels were significantly higher in the serum of SpA patients than healthy subjects (HS), and there were no differences among SpA subtypes. In SF we found higher concentrations of cytokines, but only IL-23 showed significant differences (p<0.05). We found a relationship between enthesitis and peripheral involvement and serum IL-17 levels (9 to 63 pg / ml). There was a correlation between levels above 63 pg/ml and a history of infection. Higher levels of IL-23 in synovial fluid could suggest local amplification of the Th-17 cytokine profile. Conclusions These results suggest a possible relationship between IL-17 and enthesis involvement in SpA

Role of periodontal disease in the development of autoimmune inflammatory entities clinical: implications and therapeutic challenges

8 páginasDuring the last decade the knowledge related to the pathogenesis of odontogenic infections and their possible association with systemic diseases has been of great interest. Periodontal pathogens that enter to bloodstream are involved in systemic pathological effects. The Focal Infection Theory is based on the pathophysiology correlation between chronic periodontitis and the development of certain autoimmune diseases. Rheumatoid arthritis as inflammatory disease is characterized by persistent synovitis and destruction of cartilage and bone. The etiology is uncertain, but some microorganisms may play important role in the lack of self- tolerance and the consequent development of autoimmunity. P. gingivalis may be involved in amplifying the immune response and induction of the disease in individuals with genetic susceptibility. Therefore, the concept of periodontal medicine as a discipline to integrate these associations has emerged.Durante la última década el área de conocimiento relacionada con la patogénesis de infecciones odontogénicas y su posible asociación con enfermedades sistémicas ha sido de gran interés. Patógenos periodontales que ingresan al torrente sanguíneo se encuentran implicados en efectos patológicos sistémicos y esto ha llevado al desarrollo de la Teoría de Infección Focal, que se basa en la correlación fisiopatológica entre periodontitis crónica y ciertas enfermedades autoinmunes. La artritis reumatoide, como enfermedad inflamatoria, se caracteriza por sinovitis persistente, destrucción del cartílago y del hueso. Su etiología es incierta, pero ciertos microorganismos pueden jugar un papel importante en la pérdida de autotolerancia y desarrollo de autoinmunidad. P. gingivalis puede estar comprometida en la amplificación de la respuesta inmune en individuos susceptibles genéticamente. Surge, entonces, el concepto de medicina periodontal como una disciplina que integra dichas asociaciones

Comparison of body mass index, anti-citrullinated peptides antibodies status and periodontal condition in first degree relatives individuals to rheumatoid arthritis

Association studies in rheumatoid arthritis (RA) have been focused in the pre-clinical phases of the disease in asymptomatic individuals with higher risk to develop RA such as first-degree relatives (FDR). Previous data has shown that obesity, the anti-citrullinated peptides antibodies (ACPA) status and the periodontal condition may modulate the severity and the clinical presentation of RA. The objective of this study were to investigate the body mass index (BMI), ACPA status, the frequency and severity of periodontal disease and the level of antibodies IgG-1, IGG-2 against P. gingivalis in healthy FDR individuals of RA-patients and compare these variables with a control group of healthy individuals from general population

Gastrointestinal Symptoms and Elevated Levels of Anti- Saccharomyces cerevisiae Antibodies Are Associated with Higher Disease Activity in Colombian Patients with Spondyloarthritis

9 páginasBackground. Spondyloarthritis (SpA) is a group of articular inflammatory rheumatic diseases that their gastrointestinal manifestations are around 10% of their extra-articular symptoms, supporting that the inflammatory response of the intestinal mucosa could be associated with the clinical status. Objectives. To investigate the association between gastrointestinal symptoms and autoantibodies and disease activity between SpA patients, healthy subjects (HS), and patients with inflammatory bowel disease (IBD). Methods. 102 SpA patients, 29 IBD patients, and 117 HS were included. Autoantibodies as ASCA, ANCA, anti-tTG, anti-DGP, ANA, and IgA were measured. The patients were assessed to evaluate clinical and gastrointestinal symptoms. An association analysis was performed using Chi square test and a logistic regression. Results. Significant differences were found for ASCA levels in SpA (28.2%) compared to IBD (14.2%) and HS (6.0%) (), as well as for ANAS in SpA (49.5%) and IBD (37.9%) () and abdominal pain () between SpA (54.3%) and IBD (27.5%). Significant associations were found between BASDAI > 4 and gastrointestinal symptoms () and IgA (). The association for abdominal bloating was maintained (OR: 3.93, CI-95%, 1.14–13.56; ). Conclusions. Gastrointestinal symptoms, ASCA, ANAS, and IgA levels were associated with high disease activity in SpA compared with IBD and HS

Ocronosis: descripción de dos casos familiares, reseña histórica y revisión de la literatura

5 páginasLa ocronosis es la manifestación de la alcaptonuria en el tejido conjuntivo, se origina por la pérdida en el metabolismo del ácido homogentísico, producto de la mutación autosómica recesiva del gen HGO, en el brazo largo del cromosoma 3 (3q21-23). Es una patología infrecuente, que se caracteriza por la presencia de calcificaciones de los discos intervertebrales y depósito de ácido homogentísico en el tejido conjuntivo y los tendones. Se presentan dos casos compatibles con las características clínicas y radiológicas de ocronosis

Association of tumor necrosis factor alpha-308 promoter polymorphism with spondyloarthritides patients in Colombia

4 páginasThe pathogenesis of SpA is considered to be a complex and multi-factorial process and, similar to other autoimmune diseases, includes the activity of proinflammatory cytokines such as TNF alpha. Our study compared the -308 promoter polymorphism of TNF alpha with TNF alpha levels, HLA-B27 status, age at the onset of symptoms, SpA subtype and the clinical degree of activity in Colombian SpA patients and healthy subjects (HS). Comparisons of the TNF alpha-308A genotype among HS and SpA patients (P = 0.004), uSpA patients (P = 0.040), ReA patients (P = 0.001), were significantly different and AS patients (P = 0.110), as were alleles for SpAs (P = 0.007) between patients with SpAs and controls. Initial exploratory analyses demonstrated that the TNF alpha-308 SNP genotype frequencies were different among SpA patients and HS in the Colombian population studied. Furthermore, there was no significant correlation with activity and functional clinical index, serum TNF alpha level or HLA B27 status. Allele frequencies, on the other hand, were correlated with the activity clinical index