New paradigm in spondyloarthritis: Lymphocytes Th-17

Las espondiloartritis son un grupo heterogéneo de enfermedades asociadas principalmente al complejo mayor de histocompatibilidad alelo HLA- B 27, y factores ambientales. La evidencia de esos desórdenes reflejan un origen autoinmune mediado por el sistema inmune adaptativo, en donde la composición de las lesiones inflamatorias está representada principalmente por macrófagos activados, linfocitos B y linfocitos T. El fenotipo y naturaleza de esas células T aún no están bien establecidos. Recientes estudios han demostrado que el clásico modelo de las células T CD4 efectoras Th-1/Th-2 en estas patologías debe ser reevaluado y darle espacio a las células Th-17 dentro de las patogenias inflamatorias articulares. Estudios preliminares dirigen la investigación hacia el eje IL-23/IL-17 en espondiloartropatías como una nueva propuesta. Considerar el bloqueo de las moléculas involucradas en esta vía podría ser interesante como nuevos blancos terapéuticos.Spondyloarthritides are a heterogeneous group of diseases which are mainly associated with HLA B 27 and environmental factors. The evidence for these disorders reflects an adaptive immune system-mediated autoimmune origin where inflammatory lesion composition is mainly represented by activated macrophages, B lymphocytes and T lymphocytes. These T-cells phenotype and nature has not been well established. Recent studies have shown that the classical CD4+ Th-1/Th-2 effector-cell model should be reevaluated and Th-17 cells should be introduced in inflammatory joint pathogenesis. Preliminary studies have directed research towards the IL-23/IL-17 axis in spondyloarthropathies as a new proposal. The intervention of the molecules involved in this pathway might be interesting as new therapeutic targets

Single breath carbon monoxide diffusing capacity (DLCO) test and its interpretation in autoimmune diseases. Application in clinical practice Part - II

13 páginasThe single breath DLCO (TLCO) has proved as an essential part of the routine pulmonary function screen, similar to spirometry. In spite of nearly 100 years research, there is still concern over the relative importance of the alveolarcapillary membranes versus the red cells as rate limiting steps in the overall transfer of carbon monoxide from gas to blood, but this is only a quantitative problem. The essential nature of the DLCO has already been elucidated by F.J.W. Roughton and R.E. Forster having played the major roles. Interpreting the DLCO, in conjunction with spirometry and lung volumes assessment, may assist in diagnosing the underlying disease and in the Rheumatology field it is essential it's knowledge because it offers the possibility of establish the differential diagnosis and a close follow-up of the patients with pulmonary manifestations in autoimmune diseases.El test de respiración única ha probado por si mismo ser una parte esencial del tamizaje de rutina de la función pulmonar, y de igual valor que la espirometría. A pesar de 100 años de investigación, aún no existe certeza sobre la relativa importancia de las membranas alveolo-capilares vs los eritrocitos como los pasos que sean delimitantes en el transporte global del monóxido de carbono del gas hacia la sangre, pero esto es solo un problema cuantitativo. La naturaleza esencial del test de DLCO ya ha sido elucidada, siendo F.J.W. Roughton y R.E. Forster los mayores protagonistas en esta descripción. La interpretación de la DLCO, en conjunto con la espirometría y los volúmenes pulmonares, pueden contribuir en la evaluación de enfermedades pulmonares subyacentes y, en el campo reumatológico es esencial su conocimiento puesto que ofrece la posibilidad de establecer un diagnóstico diferencial y un seguimiento cercano de los pacientes con enfermedades autoinmunes con manifestaciones pulmonares. El test de espiración única para la capacidad de difusión de monóxido de carbono, la espirometría y los gases arteriales son los test de función pulmonar más ampliamente utilizados para la evaluación y tratamiento de pacientes

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

Autoantibodies and fecal calprotectin levels in a group of Colombian patients with inflammatory bowel disease

Background: The purpose of the study is to investigate the frequency of serum anti-Saccharomyces cerevisiae antibodies (ASCA), anti-neutrophil cytoplasmic antibodies (ANCA), anti-nuclear antibodies (ANAS), IgA, C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fecal calprotectin (FC) and its association between diagnosis, endoscopic findings, histopathologic and clinical activity, in patients with diagnosis or suspected inflammatory bowel disease (IBD). Methods: An observational cross-section study was designed including 52 patients with IBD or suspected IBD. ASCA, ANCA, ANAS, IgA, CRP, ESR and FC were measured. Patients were divided according to histological findings into ulcerative colitis (UC), Crohn's disease (CD) and others (normal mucosa, chronic proctocolitis, nonspecific colitis and ileitis). A descriptive analysis was made and associations were evaluated using chi2 test, Kruskal Wallis and Mann- Whitney U test. Results: The association between IBD and ASCA levels was statistically significant (p=0.036). ANCA levels showed statistical significance in IBD patients (p=0.048). When comparing FC levels within UC, CD and others a statistical significance was obtained (p=0.032). A large percentage of patients (78.5%) with high positive levels FC were classified as active histopathology. A significant percentage (54.5%) with levels up to 50 mg/kg had quiescent activity. Positive levels of FC were related with serum activity markers with statistical significance (CRP: p=0.007 and ESR: p=0.003). Conclusions: The frequencies of p-ANCA and ASCAs for UC and CD were established in a Colombian population. IBD patients with histopathologic activity had higher levels of FC. We also found that patients with quiescent disease have elevated FC levels

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

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.During 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

Abscess rare complication of Wegener's granulomatosis: report of three cases

11 páginasLa granulomatosis con poliangeítis es una vasculitis necrotizante de pequeño vaso que puede afectar a múltiples órganos, se describen formas clínicas localizadas y generalizadas, esta última caracterizada por compromiso renal y pulmonar grave, asociada a la presencia de PR3- ANCA circulante en más del 90% de los casos. Se presentan tres casos de pacientes con diagnóstico patológico de granulomatosis con poliangeítis, dos de ellos con lesiones pulmonares detectadas en radiografías convencionales y tomografía computarizada (TC), imágenes compatibles con abscesos pulmonares; hallazgos poco comunes en las manifestaciones imaginológicas de la granulomatosis con poliangeítis en el sistema respiratorio, se añade además un tercer caso complicado con absceso paraesofágico. Se destaca la importancia y utilidad de la radiología convencional y la tomografía computarizada (TC) para el diagnóstico de esta enfermedad y de sus complicaciones

Association of Dickkopf-1 Polymorphisms With Radiological Damage and Periodontal Disease in Patients With Early Rheumatoid Arthritis

Background Rheumatoid arthritis (RA) is a systemic autoimmune disease that increased bone resorption. Periodontal disease (PD) is an associated risk factor of RA. Studies suggest an association between bone markers such as the dickkopf-related protein 1 (DKK-1) and progression of radiological damage. We aimed to evaluate the marker DKK-1, its polymorphisms in patients with early rheumatoid arthritis (eRA), and its association with rheumatic, radiological, and periodontal variables. Methods This is a cross-sectional study. Samples were obtained from 63 patients with eRA. Radiographs of hands and feet were evaluated by Sharp–van der Heijde score (SHS) and Simple Erosion Narrowing Score (SENS). Serum DKK-1 levels and high-resolution fusion analysis was used for polymorphisms (rs1896368, rs1896367, rs1528873). Bivariate analyses were performed. Results Individuals heterozygous for rs1896367 had more frequent erosions (p = 0.026) and joint space narrowing (p = 0.005) in the feet, higher SHS (p = 0.016), and higher SENS (p ≤ 0.001). Patients homozygous for rs1896368 had less frequent joint space narrowing in hands and feet as assessed by SHS and less presence of erosions by SENS (odds ratio, 0.04; 95% confidence interval, 0.00–0.93; p < 0.05). The presence of PD was associated with the homozygous of rs1896367 (p = 0.009) and the heterozygous of rs1896368 (p = 0.033). Conclusions Polymorphism rs1896367 seems to be associated with greater radiological compromise; rs1896368 confers protection against bone damage in Colombian eRA patients