Osteocondritis disecante: A propósito de un caso

 La OCD es una patología típica a tener en cuenta dentro del diagnostico diferencial del dolor de rodilla del niño y adolescente para evitar un posible retraso diagnóstico que conlleve su evolución hacia la limitación funcional, la inestabilidad articular, el dolor crónico o el desarrollo precoz de osteoartrosis. El tratamiento incluye opciones conservadoras o quirúrgicas en función de la edad, del tamaño y de la inestabilidad de la lesión condral. Â

Patología inflamatoria ocular: coriorretinitis serpinginosa

Dentro de la patología inflmatoria ocular, la coriorretinitis serpinginosa es un tipo de uveitis posterior que afecta a la coroides y al epitelio pigmentario de la retina. Es una entidad de muy baja prevalencia pero con un curso recurrente y progresivo que puede llevar a la pérdida irreversible de la agudeza visual. Presentamos dos casos con afectación inflmatoria característica así como el tratamiento y pronóstico con el que cursaron y se comenta la literatura más reciente respecto a las características demográfias y clínicas de las diferentes series de casos publicados así como una actualización terapéutica

IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study

Background: Patients with coronavirus disaese 2019 (COVID-19) can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome requiring invasive mechanical ventilation (IMV). Because IL-6 is a relevant cytokine in acute respiratory distress syndrome, the blockade of its receptor with tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective: We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods: A retrospective observational study was performed in hospitalized patients diagnosed with COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with preadministration and postadministration of TCZ. Multivariable logistic and linear regressions and survival analysis were performed depending on outcomes: need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio, or mortality. Results: One hundred forty-six patients were studied, predominantly males (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels greater than 30 pg/mL was the best predictor for IMV (odds ratio, 7.1; P < .001). Early administration of TCZ was associated with improvement in oxygenation (arterial oxygen tension/fraction of inspired oxygen ratio) in patients with high IL-6 (P = .048). Patients with high IL-6 not treated with TCZ showed high mortality (hazard ratio, 4.6; P = .003), as well as those with low IL-6 treated with TCZ (hazard ratio, 3.6; P = .016). No relevant serious adverse events were observed in TCZ-treated patients. Conclusions: Baseline IL-6 greater than 30 pg/mL predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administrationThis study was funded by Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and Instituto de Salud Carlos III (grant nos. RD16/0011/0012 and PI18/ 0371 to I.G.A., grant no. PI19/00549 to A.A., and grant no. SAF2017-82886-R to F.S.-M.) and co-funded by the European Regional Development Fund. The study was also funded by ‘‘La Caixa Banking Foundation’’ (grant no. HR17-00016 to F.S.-M.) and ‘‘Fondos Supera COVID19’’ by Banco de Santander and CRUE. None of these sponsors have had any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publicatio

AB0779 Does dactylitis/entesitis predict the response to a specific biological treatment in psoriatic arthritis?

Background: Spondylarthritis are diseases with a pathophysiological focus in enthesis with a different extent of synovial component. In the event of therapeutic failure with DMARDs, the clinician may consider biological therapy with anti-TNF drugs or other targets such as IL23 Despite this, most patients receive first-line anti-TNFs. Given that IL19 and IL23 activity is recognized at the level of the enthesis. Objectives: To evaluate whether the presence of dactylitis/entesitis could be useful in the choice of a particular biological therapy. Methods: A secondary analysis of a previous study was performed based on an electronic survey completed by patients with PsoA and distributed among members of the patient association “Acción Psoriasis”. Records from 191 respondents who had received at least one biological therapy were included. Patients were grouped according to the presence or absence of dactylitis or enthesitis. The rate of need to progress to the next therapeutic biologic line was compared. Results: 61 patients reported dactylitis and 155 enthesitis. Distribution of treatments in patients with dactylitis: 33 patients received an anti-TNF-alpha, 11 Secukinumab and 12 Ustekinumab. 15 patients in the group receiving an anti-TNF-alpha had to substitute another treatment within 2 years (45.4%). 3 patients in each of the remaining groups had to substitute treatment within 2 years (27.2% and 25%, respectively). Compared to those receiving anti-TNF-alpha therapy, patients treated with Secukinumab or Ustekinumab had greater therapeutic persistence at 2 years (P<0.001, in both cases). Distribution of treatments in patients with enthesitis (not including dactylitis): 115 received an antiTNF-alpha, 25 received Secukinumab and 18 received Ustekinumab. 38 patients who received an anti-TNF-alpha had to substitute it within 2 years (24.5%). 4 patients who received Secukinumab and 3 who received Ustekinumab had to substitute their treatments in less than 2 years (16% and 16.6%, respectively). Compared to patients receiving anti-TNF-alpha therapy, patients treated with Secukinumab and Ustekinumab had a higher proportion of therapeutic persistence at 2 years (P<0.05 for both cases). Conclusion: The presence of dactylitis more than enthesitis, is associated with a higher proportion of therapeutic persistence in those patients treated with anti-IL17 or anti-IL23 therapies. Although there are multiple factors that condition the choice of biological therapies in patients with PsoA, the presence of enthesitis and dactilitis (understood as polyenthesitis) should be considered among the most important ones.Sin financiación19.103 JCR (2020) Q1, 2/34 Rheumatology6.333 SJR (2020) Q1, 6/254 Biochemistry, Genetics and Molecular Biology (miscellaneous)No data IDR 2020UE

THU0169 Comparison of the Synovial Response to Mechanical Stress Among Patients with Rheumatoid Arthritis in Clinical Remission on Methotrexate or Anti-Tnf

Sin financiación19.103 JCR (2020) Q1, 2/34 Rheumatology6.333 SJR (2020) Q1, 6/254 Biochemistry, Genetics and Molecular Biology (miscellaneous)No data IDR 2020UE

Delay and Diagnostic Pathway of Patients with Psoriatic Arthritis in Spain

Introducción y objetivos El retraso diagnóstico condiciona un peor pronóstico en pacientes con artritis psoriásica. Nuestro objetivo es determinar el tiempo de retraso diagnóstico, las especialidades consultadas y los puntos de derivación de pacientes con artritis psoriásica en nuestro medio. Pacientes y métodos Distribuimos una encuesta entre los miembros de la asociación española Acción Psoriasis indagando sobre los objetivos del estudio. Resultados Se analizaron 503 encuestas. El tiempo de retraso diagnóstico fue de 4,01±1,42 años. La proporción de pacientes que habían consultado, antes del diagnóstico, con atención primaria fue del 79,9%, con traumatología, del 33,8% y por urgencias, del 30,2%. La proporción de derivaciones que finalmente condujeron al diagnóstico provinieron de atención primaria en el 29,3% de los casos, de traumatología en el 15,8% y de urgencias en el 3,5%. Discusión y conclusiones El retraso diagnóstico detectado supera extensamente otros resultados europeos. Los servicios de urgencias ocupan un lugar importante de tránsito de estos pacientes, sin embargo, la proporción de derivaciones es muy bajo. Entendemos que incidir en este gremio médico en particular sobre la importancia del diagnóstico precoz podría resolver gran parte del retraso diagnóstico.Introduction and objectives Delayed diagnosis results in a worse prognosis in patients with psoriatic arthritis. Our objective is to determine the diagnostic delay, the specialties consulted and the referral points of patients with psoriatic arthritis in our environment. Patients and methods We distributed a survey to members of the Spanish association Acción Psoriasis inquiring about the objectives of the study. Results A total of 503 surveys were analysed. The diagnostic delay was 4.01±1.42 years. The proportion of patients who had consulted, before diagnosis, primary care was 79.9%, traumatology 33.8% and the emergency department was 30.2%. The proportion of referrals that eventually led to diagnosis came from primary care in 29.3% of cases, traumatology 15.8% and the emergency department 3.5%. Discussion and conclusions The delay in diagnosis far outweighs other European results. Emergency departments are an important transit point for these patients, but the proportion of referrals is very low. We believe that focusing on the importance of early diagnosis in this particular medical sector could resolve a large part of diagnostic delay.Sin financiaciónNo data JCR 20200.271 SJR (2020) Q4, 50/58 RheumatologyNo data IDR 2020UE

Retraso y recorrido diagnóstico de pacientes con artritis psoriásica en España

Delayed diagnosis results in a worse prognosis in patients with psoriatic arthritis. Our objective is to determine the diagnostic delay, the specialties consulted and the referral points of patients with psoriatic arthritis in our environment. Patients and methods We distributed a survey to members of the Spanish association Acción Psoriasis inquiring about the objectives of the study. Results A total of 503 surveys were analysed. The diagnostic delay was 4.01 ± 1.42 years. The proportion of patients who had consulted, before diagnosis, primary care was 79.9%, traumatology 33.8% and the emergency department was 30.2%. The proportion of referrals that eventually led to diagnosis came from primary care in 29.3% of cases, traumatology 15.8% and the emergency department 3.5%. Discussion and conclusions The delay in diagnosis far outweighs other European results. Emergency departments are an important transit point for these patients, but the proportion of referrals is very low. We believe that focusing on the importance of early diagnosis in this particular medical sector could resolve a large part of diagnostic delay.El retraso diagnóstico condiciona un peor pronóstico en pacientes con artritis psoriásica. Nuestro objetivo es determinar el tiempo de retraso diagnóstico, las especialidades consultadas y los puntos de derivación de pacientes con artritis psoriásica en nuestro medio. Pacientes y métodos Distribuimos una encuesta entre los miembros de la asociación española Acción Psoriasis indagando sobre los objetivos del estudio. Resultados Se analizaron 503 encuestas. El tiempo de retraso diagnóstico fue de 4,01 ± 1,42 años. La proporción de pacientes que habían consultado, antes del diagnóstico, con atención primaria fue del 79,9%, con traumatología, del 33,8% y por urgencias, del 30,2%. La proporción de derivaciones que finalmente condujeron al diagnóstico provinieron de atención primaria en el 29,3% de los casos, de traumatología en el 15,8% y de urgencias en el 3,5%. Discusión y conclusiones El retraso diagnóstico detectado supera extensamente otros resultados europeos. Los servicios de urgencias ocupan un lugar importante de tránsito de estos pacientes, sin embargo, la proporción de derivaciones es muy bajo. Entendemos que incidir en este gremio médico en particular sobre la importancia del diagnóstico precoz podría resolver gran parte del retraso diagnóstico.Sin financiaciónNo data 2021UE

Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review

Background: Congenital cytomegalovirus infection (CMVc) affects 0.7%-6% of recent births. Among its clinical manifestations are low weight and length at birth. Objective: Describe the growth patterns of children with CMVc in their early years. Methods: Observational, multicenter study of patients with CMVc. Anthropometric data were collected during the first 2 years of life and compared with World Health Organization standards. Results: Anthropometric characteristics of 383 children with CMVc were studied, of which 198 (51%) were symptomatic at birth. At birth, 9% were small for gestational age (SGA) in terms of their weight and length and 17% had microcephaly. At 24 ± 3 months, 10% had a weight and length ≤2 SD, and 13% a head circumference ≤2 SD. Of those who were SGA at birth, at 24 ± 3 months >20% remained at ≤2 SD of their weight and length. Conversely, 75% of children with low weight or length at 24 ± 3 had not been SGA at birth. 20% of infants with microcephaly at birth remained with microcephaly, and 10% of those without microcephaly developed it at 24 ± 3 months. The average growth rate in length and weight was normal. Patients who were symptomatic at birth, premature and with motor and neurocognitive impairment had a significantly higher risk of low weight and length at 24 ± 3 months. Conclusion: Around 10% of children with CMVc are at ≤2 SD in weight, length and head circumference at 24 ± 3 months. The lack of adequate growth is associated with symptoms at birth, prematurity and motor and neurocognitive impairment. Growth impairment could be incorporated into the symptomatic spectrum of CMVc.Sin financiación2.980 JCR (2020) Q3, 24/34 Rheumatology0.835 SJR (2020) Q2, 29/58 RheumatologyNo data IDR 2019UE

Recurrence of Vertebral Fracture in Patients With Osteoporotic Vertebral Fractures: Retrospective Review in Moncloa University Hospital. Preliminary Results

Background Current drugs for patients who suffer from stablished osteoporosis (OP) with osteoporotic vertebral fracture (VF) have demonstrated their efficacy with different levels of evidence for secondary prevention of fractures1. In fact, this level of efficacy can be limited in real clinical practice, with pluripathological and previously polimedicated patients. Objectives Main objective of this study is to describe the percentage of patients with VF in which the therapeutic goal of avoiding new VF during their follow-up has been achieved. As a secondary objective, clinical and therapeutic differences will be analyzed among distinct groups arisen from achieving or not the therapeutic goal. Methods Retrospective, observational, longitudinal, descriptive study of patients from Rheumatology Departament in Moncloa University Hospital who have suffered a osteoporotic VF. Results 133 cases have been reviewed, 115 (86.5%) females and 18 males (13.5%). Average age is 72 years (+/- 7) and average follow-up time is 2.68 years (+/- 2.3). 25 cases (18.5%) were smokers, 9 (6.8%) oncologic patients, 33 (24%) with chronic corticotherapy and 28 (21%) with immune-mediated diseases. 81 patients (60.9%) had previous VF (0.933 fracture /patient) and 14 (10.5%) non-vertebral fracture (NVF). The average VF was 1.967/patient and 0.133/patient for NVF. 52 patients (39.1%) had received prior treatment for OP (36 Biphosphonate, 23 Denosumab, 5 SERM, 2 strontium ranelate and 1 teriparatide) and in 39 cases (29.3%) a cementoplasty was performed. Initial treatments prescribed by Rheumatology Departament were Biphosphonates (48%),Denosumab (31%) and Teriparatide (21%). 35 patients received sequencial-treatment (26.9%). 86.5 % of patients haven’t presented new VF. 18 cases (13.5%) have been registered with new VF. This group is composed by 13 females and 5 males; the average age was 75 years (+/-7.5) and the average follow-up time 2.8 years (+/- 2.46); 14 (77.8 %) patients presented previous VF and 3 (16.7 %) previous NVF. The average number of previous VF was 2.0/patient and 0.33/patient for NVF. 14 cases (78.8%) of new VF ocurred during the first year of follow-up. The treatment they were receiving at the time of the new VF was in 8 cases with Denosumab (44%), 4 with Teriparatide (22%), 2 Alendronate (11%), 3 Riserdronate (16%) and 1 case without treatment. Conclusion These are preliminary data from a register for prognosis evaluation of patients who suffer VF in Moncloa University Hospital. A larger sample size is necessary to developed a strategic conclusion in this patients, pluripathological, with previous osteoporotic fractures and treatment.78 % of new VF ocurred during the first year of the follow-up, 44% of them were receiving Denosumab, 77% (vs. 58% of the patients without new VF) had previous VF and 44% (vs. 37% patients without new VF) had received previous OP treatment.Sin financiación16.102 JCR (2019) Q1, 2/32 Rheumatology6.142 SJR (2019) Q1, 6/280 Biochemistry, Genetics and Molecular Biology (miscellaneous)No data IDR 2019UE

Relationship between anthropometric variables and the cross-sectional area of the median nerve by ultrasound assessment in healthy subjects

Objective: Ultrasound study of the wrist in patients with suspected entrapment syndrome has severe limitations due to the variability of what is considered normal for the cross-sectional area of the median nerve and where to proceed to measure it. We aim to determine the extent to which different anthropometric variables influence the median nerve area in subjects without carpal tunnel syndrome. Methods: We conducted an observational study based on a multivariate linear regression analysis using as a dependent variable the area of the median nerve cut at two specific points in the wrist of healthy subjects. The independent variables were sex, age, height, weight, body mass index, finger flexor strength, and carpal circumference. Major results: The measurements of the median nerve cross-sectional area were normalized using a quadratic fixing procedure. Of all the variables included in the linear regression analysis, only carpal circumference and sex (0: female, 1: male) contributed significantly in the final model using the wrist crease as the measurement point (Constant B=-209.45, carpal circumference coefficient=21.07, sex coefficient 10.87). At four centimeters distal to the carpal fold, the model included the same variables (Constant B=-221.84, carpal circumference coefficient=24.01, and sex coefficient=11.41). Conclusion: Both the wrist circumference and the sex are variables that should be considered to determine cut-off points of normality in future validation studies about the cross-sectional area of the median nerve.Sin financiación1.290 JCR (2020) Q4, 33/34 Rheumatology0.397 SJR (2020) Q3, 1488/2447 Medicine (miscellaneous)No data IDR 2020UE