Utilidad del “Índice Radiográfico de Entesis” (REI) como herramienta diagnostica en las Espondiloartritis

La realización del “REI” tiene una importancia en el aspecto diagnóstico, dado que el enfoque diagnóstico actual de las EAs, busca la obtención del diagnóstico temprano, en una fase pre-radiográfica como ha sido determinado en los lineamientos del grupo ASAS (Assessment of SpondyloArthritis international Society), donde se han creado varias técnicas a lo largo del tiempo buscando un diagnóstico precoz de las EAs. Aun no se tiene la estrategia ideal, dado que no en todas las partes del mundo se logra el acceso fácil, no hay suficientes expertos en la lectura e interpretación de los estudios, y el costo de su realización limita la posibilidad de su realización. En regiones del tercer mundo como nuestro país, la radiografia convencional de pelvis continúa siendo la piedra angular en el estudio de pacientes con sospecha de Espondiloartritis, teniendo como parámetros a interpretar las articulaciones sacroilíacas y la Columna lumbar, sin embargo su sensibilidad es muy baja para enfermedades tempranas. Con el REI, buscamos tener una herramienta diagnóstica en apoyo a la lectura de las articulaciones sacroiliacas, que nos permita dar una orientación diagnostica precisa, sobre todo en casos donde los hallazgos imagenológicos no completen los criterios para realizar un diagnóstico preciso.​ Nota: Para consultar la carta de autorización de publicación de este documento por favor copie y pegue el siguiente enlace en su navegador de internet: http://hdl.handle.net/10818/980

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

Higher levels of secretory IgA are associated with low disease activity index in patients with reactive arthritis and undifferentiated spondyloarthritis

Introduction: Both reactive arthritis (ReA) and undifferentiated spondyloarthritis (uSpA) belong to the group of autoinflammatory diseases called spondyloarthritis (SpA). Hypotheses have been proposed about a relationship between the intestinal mucosa and inflammation of joint tissues. The role of immunoglobulin IgA or secretory immunoglobulin A (SIgA) in the inflammatory and/or clinical activity of patients with SpA remains poorly understood. Objective: To evaluate the status of total IgA and SIgA, and the association among the levels of SIgA, IgA, IgA anti-Chlamydia trachomatis, and anti-Shigella spp. with the disease activity measures, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, was compared in a cohort of patients with ReA and uSpA and healthy subjects. Methods: This was a cross-sectional study. The serum concentrations of SIgA, IgA anti-C. trachomatis, anti-Shigella spp., and total IgA were measured. Disease activity was measured in each patient by means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Statistical analysis did include as bivariate evaluation, comparisons by Student’s t-test, Kruskal–Wallis test, and U Mann–Whitney test, with a multivariate evaluation by principal components analysis (PCA). A correlation analysis was carried out using the Pearson correlation coefficient and a linear regression models. All analysis were made using Stata version 11.2® for Windows, R V3.3.21. Statistical significance was defined a p-value <0.05. Results: In all, 46 patients (78.2% men; mean age, 34.8 ± 12.3 years) and 53 controls (41% men; mean age, 32 ± 11.4 years) were included in the study. The mean serum levels of SIgA were higher in SpA patients than in healthy subjects (p < 0.001). Only SIgA levels correlated with disease activity: BASDAI (r = −0.42, p = 0.0046), ASDAS-CRP (r = −0.37, p = 0.014), and ASDAS-ESR (r = −0.45, p = 0.0021). The negative correlation between SIgA and all activity indices was higher in HLA-B27-positive patients (BASDAI r = −0.70, p = 0.0009, ASDAS-CRP r = −0.58, p = 0.0093, and ASDAS-ESR r = −0.57, p = 0.0083). The PCA showed three factors: the first component was constituted by variables referred as clinical activity measures, the second did include the serological activity markers, and the last component was compounded by age and symptoms time. Conclusion: Elevated serum levels of SIgA were found to be related with low disease activity in patients with ReA and uSpA

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

Q3Q2Comunicación corta2195-2197The 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

The New ASAS Classification Criteria For Axial And Peripheral Spondylarthritis: Valid In The Latin American Patients, But

2 páginasBackground: Different Spondylarthritis (SpA) presentation pattern have been described in Latin American countries. The Undiferentiated Spondylarthritis (uSpA) and Reactive Arthritis (ReA) forms are frequent (about 75%), whereas Ankylosing Spondylitis (AS) is near to 25%. Mixtures of axial and peripheral manifestations are common at onset and during evolution of the disease. We assess the new ASAS classification criteria for axial and peripheral SpA in a cohort of Colombian patients with established diagnostic of the disease. Methods: Two hundred and eighty-one consecutive patients were evaluated in the last 10 years following the ASAS recommendations. Seventy four, with established diagnostic (by experts) were selected. All of them had complete clinical and laboratory information (including HLA-B27 screening), X-ray and magnetic resonance imaging of sacroiliac joints and were under 45 years old at the beginning of the disease. We also collected a control group: patients referred to our clinic in the same period of time with chronic back pain in which the diagnostic of SpA was ruled out, after following the same protocol. Summary of the Results: A total of 74 patients (58 males, 16 females) with definite SpA (15 AS, 39 uSpA and 20 ReA), and 48 controls (34 males, 14 females) were analyzed. Mean disease duration in SpA patients was 1,4_1,1 vs. 4,5_4,3 years; mean age at disease onset was: 25,2_7,3 vs. 30,5_7,6 years. The key clinical findings were: arthritis and enthesitis in 75,7% (vs. 4,2% in controls), and inflammatory back pain (IBP) in 56,8% of the patients (vs. 4,2%). The other differences between the groups were: twenty-seven (36,5%) HLA-B27 positive patients (vs. 4,2%); buttock pain present in 32,4% of the patients and only 8,3% of the controls. Dactylitis was present in 24,7% of the patients vs. 0% in the controls. Uveitis was documented in 10,8% of the patients but not in controls. The family history of SpA was present in 4,2% of the patients (0% in the controls). The new Axial SpA classification criteria had a sensitivity and specificity of 66,2 and 91,7%; and the peripheral SpA classification criteria had a sensitivity and specificity of 90,5 and 87,5% respectively. When we decided to test them combined, we obtained a sensitivity of 93,2% and specificity of 87,5%. The European Spondylarthritis Study Group (ESSG) criteria had a sensitivity and specificity of 91,9 and 100%. Conclusions: Although, the new ASAS classification criteria for axial and peripheral SpA show a good performance in our cohort, the predominant mixed form of the disease in the Latin American patients and low prevalence of HLA-B27 positivity should make us keep in mind the ESSG criteria. These results should be validated in a large group of patients

Biomarkers for spondyloarthropathies. State of the art

7 páginasAmong rheumatic diseases and specifically spondyloarthropathies (SpA), the study of biomarkers, defined as molecules that reflect either biologic or specific pathological process, is an important and necessary area in basic and clinical research, being a consequence or the response of an intervention. Other markers provide information about the pathogenesis of this disease. Recently, HLA-B27 has been used as diagnostic criteria to detect SpA. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) are clinical scores used to assess disease activity. A new activity index, Ankylosing Spondylitis Disease Activity Score (ASDAS) considers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as biomarkers. This review describes the state of the art of research on SpA biomarkers. There are promising new candidates as biomarkers such as metallopro-teinase 3, Type II collagen neoepitopes (C2C and C1-2C), C-propeptide of Type II collagen (CPII), aggrecan 846 epitope, macrophage colony stimulating factor, serum amyloid A protein and interleukin-6, among others

Bone remodeling in spondyloarthritis

Spondyloarthritis is a group of several related but phenotypically distinct chronic inflammatory diseases, characterized by progressive new bone formation which leads to ankylosis and functional disability. Radiographic images evidence not only erosive changes but also overgrowth of bony structures called syndesmophytes. These inflammation, bone destruction and new bone formation are located in the entheses, which constitutes the primary organ of the disease. As a consequence, the inflammatory process results in excess of bone formation and the impact depends on the location, cell type, cytokines and local microenvironment factors. Several molecules playing a role as immune modulators or regulators of bone homeostasis, mediate the imbalance between bone resorption and formation. In the same way, animal models suggest that joint ankylosis may be independent from the effects of tumor necrosis factor alpha. Therefore, the process of new tissue (bone) formation can be considered as an additional therapeutic target. The Wnt signaling pathway, which is considered the primary regulator of osteoblastogenesis, constitutes a new research field of great interest in the last decade

Factores de riesgo y prevalencia de osteoporosis en mujeres premenopáusicas de estratos económicos pobres en Colombia

6 páginasIntroduction: The prevalence of osteoporosis in premenopausal women along with associated risk factors has not been well elucidated. Recent studies have shown that poverty is a risk factor for osteoporosis.Objective: To determine the prevalence of osteoporosis and its risk factors in a group of premenopausal women of poor economic background in Colombia.Materials and methods: The study comprised 1483 women between 35 and 53 years of age with at least one risk factor for osteoporosis. Demographic characteristics, reproductive factors, comorbidities, and risk factors for osteoporosis were evaluated. Lumbar vertebrae (L2–L4) and the femur neck were assessed using dual-energy X-ray absorptiometry.Results: Of the 1483 patients, 1443 (97.3%) had at least one risk factor for osteoporosis and 40 (2.7%) had no risk factors. Patients with one risk factor were referred to have a dual-energy X-ray absorptiometry scan, which 795 women completed. Osteopenia was found in 30.5% and osteoporosis in 4.8% of these women. The majority of these women were homemakers, and 18.5% of the patients with osteoporosis were also illiterate (P, 0.001). The risk factors identified in this population were: hypothyroidism (odds ratio [OR] = 5.19, 95% confidence interval [CI]:1.6–16), age over 45 years old (OR = 1.13, 95% CI: 1.0–1.2), a history of malnutrition or low birth weight (OR = 2.35, 95% CI: 1.0–5.2), or early-onset menopause (OR = 3.4, 95% CI: 1.6–7.2).Conclusion: Premenopausal Colombian women from impoverished areas showed increased rates of osteopenia and osteoporosis compared with the data described in the current literature. Hypothyroidism was an outstanding risk factor in Colombian premenopausal women with osteo-porosis. This shows the influence of poverty and other risk factors on the onset of osteoporosis in women aged 35–53 yearsIntroducción: La prevalencia de osteoporosis en mujeres premenopáusicas junto con los factores de riesgo asociados no ha sido bien dilucidada. Estudios recientes han demostrado que la pobreza es un factor de riesgo para la osteoporosis.Objetivo: Determinar la prevalencia de osteoporosis y sus factores de riesgo en un grupo de mujeres premenopáusicas de estrato económico pobre en Colombia.Materiales y métodos: El estudio estuvo compuesto por 1483 mujeres entre 35 y 35 años. 53 años de edad con al menos un factor de riesgo para osteoporosis. Se evaluaron características demográficas, factores reproductivos, comorbilidades y factores de riesgo de osteoporosis. Las vértebras lumbares (L2-L4) y el cuello del fémur se evaluaron mediante absorciometría de rayos X de energía dual. Resultados: De los 1483 pacientes, 1443 (97,3%) tenían al menos un factor de riesgo de osteoporosis y 40 (2,7%) no tenían factores de riesgo. A los pacientes con un factor de riesgo se les realizó una absorciometría de rayos X de energía dual, que completaron 795 mujeres. Se encontró osteopenia en el 30,5% y osteoporosis en el 4,8% de estas mujeres. La mayoría de estas mujeres eran amas de casa y el 18,5% de los pacientes con osteoporosis también eran analfabetos (P, 0,001). Los factores de riesgo identificados en esta población fueron: hipotiroidismo (odds ratio [OR] = 5,19, intervalo de confianza [IC] 95%: 1,6-16), edad mayor de 45 años (OR = 1,13, IC 95%: 1,0-1,2) , antecedentes de desnutrición o bajo peso al nacer (OR = 2,35, IC 95%: 1,0-5,2), o menopausia de inicio temprano (OR = 3,4, IC 95%: 1,6-7,2). Conclusión: Mujeres colombianas premenopáusicas de zonas empobrecidas. mostraron mayores tasas de osteopenia y osteoporosis en comparación con los datos descritos en la literatura actual. El hipotiroidismo fue un factor de riesgo destacado en mujeres colombianas premenopáusicas con osteoporosis. Muestra la influencia de la pobreza y otros factores de riesgo en la aparición de osteoporosis en mujeres de 35 a 53 años