Artritis por Parvovirus B19: Caso clínico / Parvovirus B19 arthritis: Report of three cases

Parvovirus B19 infection is highly prevalent in children and the most common manifestation is a facial rash. In adults, acute polyarthritis and skin rash are often the presenting features. We report three patients with the disease. A 40-year-old female presenting with fever, myalgias and painful swelling of elbows, knees, wrists and feet, with functional limitation, after having a respiratory infection. Additionally, an erythematous skin rash appeared in both extremities. IgM antibodies against Parvovirus B19 were positive. The skin biopsy disclosed a leukocytoclastic vasculitis. The patient was treated with anti-inflammatory drugs and antihistaminics. A 40-year-old female, presenting with skin rash and pain in wrists and hands. IgM antibodies against parvovirus were positive. The patient was treated successfully with acetaminophen. A 38-year-old male with psoriasis, presenting with generalized and progressive polyarthralgia. A Parvovirus viral load determination found 239000 copies of the virus and IgM antibodies were positive. He was successfully treated with non-steroidal anti-inflammatory drugs.

Guía clínica: lupus eritematoso sistémico (LES) / Systemic lupus erythematosus: a clinical guide

El Lupus Eritematoso Sistémico (LES) es una enfermedad inflamatoria, sistémica, crónica, de patogenia autoinmune. Sus manifestaciones varían desde afecciones leves a graves o fatales. En más común en mujeres y su prevalencia varía entre 40 a 200 casos/100.000 habitantes. El diagnóstico y reconocimiento precoz de sus manifestaciones sistémicas son críticos para una adecuada derivación, tratamiento y pronóstico de los pacientes. A petición del MINSAL, la Sociedad Chilena de Reumatología designó un grupo de trabajo para la elaboración de una guía clínica de LES. Objetivos: Definir niveles de atención, criterios de derivación según gravedad y elaborar recomendaciones para el diagnóstico, tratamiento y seguimiento de los principales compromisos del LES siguiendo la metodología de realización de guías clínicas. Metodología: Se siguieron las indicaciones para realización de guías clínicas basadas en criterios de evaluación (AGREE) y una combinación de criterios de medicina basada en la evidencia y consenso de expertos. La pesquisa bibliográfica se centró en la búsqueda de respuesta para 13 preguntas seleccionadas, respecto a: niveles de atención y criterios de derivación; abordaje general; principales compromisos graves del LES y situaciones especiales. Para cada pregunta se hizo una recomendación. La evidencia se estableció usando una escala tradicional. Además, se midió el grado de acuerdo (GdA) con las recomendaciones efectuadas, mediante una escala de 0 a 10 puntos, por los reumatólogos integrantes del grupo de trabajo y por cinco pares independientes. Resultados: Se desarrollaron 13 recomendaciones respecto a: 1) Rol del médico no especialista y criterios de derivación. 2) Rol del reumatólogo. 3) Sospecha y diagnóstico precoz del LES. 4) Pronóstico y gravedad. 5) Evaluación de actividad y daño en el LES. 6) Patología asociada al LES. 7) Fármacos utilizados en el LES y su toxicidad. 8) Bases diagnósticas de nefropatía lúpica. 9) Tratamiento de nefropatía lúpica...

Systemic lupus erythematosus (SLE) is an inflammatory, systemic and chronic disease of autoimmune pathogenesis. Manifestations vary from mild to serious or fatal conditions. It is most common among women and its prevalence varies between 40 to 200 cases/100.000 inhabitants. Early diagnosis as well as identification of systemic manifestations are critical for adequate referral, treatment and prognosis. At the request of Chile's health ministry, the Chilean Society of Rheumatology designated a work group to elaborate clinical guidelines for SLE. Objectives: Define levels of attention, criteria for referral according to seriousness, and elaborate recommendations for diagnosis, treatment and follow-up of the main disorders of SLE following the clinical guideline execution methodology. Methodology: Indications for the creation of clinical guidelines based on the AGREE evaluation criteria and a combination of medical criteria based on expert evidence and consensus were followed. Bibliographical investigation was centered on responding 13 selected questions with respect to: level of attention and referral criteria; general approach; main critical SLE compromises, and special situations. A recommendation was given for each question. Evidence was established using a traditional scale. Moreover, the degree of agreement was measured (GdA) with the recommendations carried out, by means of a scale from 0 to 10 by the rheumatologists who made up the work group and by five independent peers. Results: 13 recommendations were developed with respect to: 1) Role played by non-specialized physicians and referral criteria; 2) Role played by rheumatologist; 3) Suspicion and early diagnosis of SLE; 4) Prognosis and seriousness; 5) evaluation of SLE activity and damage; 6) Pathology associated to SLE; 7) Drugs used for SLE and their toxicity; 8) Diagnostic basis for lupus nephritis; 9) Treatment for lupus nephritis; 10) Neuropsychiatric manifestations of SLE; 11) SLE and...