Manejo de la uveítis asociada a espondiloartropatías / Managment of uveitis associated to spondiloarthropaties

Alrededor de un tercio de los afectados por espondiloartropatías hará uveítis. Casi siempre serán uveítis anteriores, agudas, unilaterales y autolimitadas, que alter-narán entre uno y otro ojo. El tratamiento de elección es el corticoide tópico du-rante la crisis, que habitualmente resolverá en un plazo no mayor a doce semanas. Hay varias estrategias para reducir la frecuencia e intensidad de las crisis, las que han sido evaluadas en pequeños estudios en sujetos con tres o más episodios anuales. Han sido beneficiosos el metotrexato, sulfasalazina y antiinflamatorios no esteroidales (AI-NEs), estos últimos en dosis de dos veces por día, no así los AINEs en toma única diaria. Los agentes biológicos anti factor de necrosis tumoral (anti-TNF por su sigla en in-glés), excepto el etanercept, se asocian a muy altos índices de prevención de recidivas en estudios observacionales, pero los estudios comparativos sólo se han hecho para uveítis no-anteriores.

About one third of all subjects affected by spondiloarthropaties will suffer from uve-itis. These will happen to be acute, anterior, unilateral and self-limited uveitis attacks, alternating between one and other eye. First choice treatment consists of topical cor-ticosteroid during the episode that will usually resolve in no more than twelve weeks. There are several useful strategies to reduce the frequency and intensity of the uveitis at-tacks. These have been studied in small trials with reduced number of subjects suffering from three or more episodes per year. They have shown a beneficial effect for methotrex-ate, sulfasalazine and non-steroidal anti-inflammatory drugs (NSAIDs), these last when prescribed twice a day, without proven benefit from taking single daily doses of NSAIDs. Anti-tumor necrosis factor (anti-TNF) biologic agents, except for etanercept, are asso-ciated to a huge reduction in the frequency of uveitis attacks in observational studies, but comparative trials available have addressed non-anterior uveitis exclusively.

Abordagem Fisioterapêutica da Dor Crônica nas Espondiloartropatias Soronegativas / Treatment Physical Therapy of Cronic Pain in Spondyloarthropathies Seronegatives

Introdução: As espondiloartropatias formam um grupo de doenças distintas com características comuns, entre elas estão a espondilite anquilosante, artrite psoriática, artrite reativa e artrite enteropática. Caracterizam-se como doenças crônicas inflamatórias, e incluem uma variedade de características clínicas e genéticas, dentre essas está a associação com o antígeno HLA-B27. Objetivos: O estudo objetivou revisar na literatura informações sobre a abordagem fisioterapêutica na dor crônica nos indivíduos portadores de espondiloartropatias. Métodos: 26 artigos foram selecionados manualmente nas línguas portuguesa e inglesa indexados nas bases de dados eletrônicos SciELO, LILACS, e Pubmed partindo dos descritores Espondiloartropatias, Espondilite Anquilosante, Artrite Reativa, Artrite Psoriásica em cruzamento com a palavra chave Fisioterapia, de acordo com os Descritores em Ciências da Saúde (DeCS). Resultados: Foram analisados 178 artigos dos quais 147 artigos foram excluídos por não se enquadrarem nos critérios de seleção e 26 preencheram os critérios de inclusão, permitindo a fundamentação teórica e problemática do assunto pesquisado. Conclusão: O diagnóstico precoce juntamente com a cinesioterapia - com ênfase à hidrocinesioterapia - demonstra redução da dor, melhora na capacidade funcional, melhora da amplitude de movimento, diminuição do quadro inflamatório e melhora da qualidade de vida.

Introduction: Spondyloarthropathies form a group of different diseases with common characteristics, among them are ankylosing spondylitis, psoriatic arthritis, reactive arthritis and arthritis enteropathic. Are characterized as chronic inflammatory diseases, including a variety of clinical and genetic characteristics, among these is the association with the HLA-B27 antigen. Objectives: The aim of this study was to review the literature about the physical therapy approach to chronic pain in patients with spondyloarthritis. Méthods: We selected 26 articles, which were manually consulted in Portuguese and English indexed in electronic databases SciELO, LILACS and PubMed starting from descriptors Espondiloartropatias, Espondilite Anquilosante, Artrite Reativa, Artrite Psoriásica crossed with keyword Fisioterapia, all according to the Descriptors in Health Sciences (DeCS). Results: We analyzed 178 articles of which 147 articles were excluded because they do not fit the selection criteria and 26 met the inclusion criteria, allowing the theoretical foundation and problems of researched subject. Conclusion: Early diagnosis of seronegative spondyloarthropathies with kinesiotherapy - with emphasis on hydrokinesiotherapy - reduced pain, improved functional capacity, improved range of movement, decreased inflammatory process and improvement of quality of life of patients.

Características y manejo de la uveítis en el paciente con espondiloartropatías / Characteristics and management of uveitis associated to the spondiloarthropaties

La inflamación de los contenidos intraoculares o uveítis afectará a alrededor de un tercio de los pacientes con espondiloartropatías, especialmente a aquéllos con espondilitis anquilosante. La uveítis típica será unilateral, aguda y autolimitada, afectando los componentes de la úvea anterior: iris y cuerpo ciliar. Pese a ser muy sintomáticas se asocian a bajo riesgo de pérdida visual permanente. Su tratamiento es tópico, en base a corticoides y midriáticos. La terapia inmunosupresora y con menor frecuencia los biológicos, están reservados para los infrecuentes casos crónicos. Es posible reducir la frecuencia e intensidad de las recidivas con metotrexato o sulfasalazina, pero la evidencia que sostiene esta indicación es pobre.

The inflammatory disease affecting the intraocular contents we know as uveitis will affect around one every three patients with spondyloarthropaties, in particular those presenting ankylosing spondylitis. The typical uveitis attack will be unilateral, acute and self-limited, affecting the components of the anterior uvea; this is iris and ciliary body. Despite being very symptomatic, their associated risk of permanent vision loss is low. Treatment is based on topical therapy with corticosteroids and mydriatic eye drops. Systemic immunosuppressive therapy and rarely biologic agents are reserved for the infrequent chronic cases. The use of methotrexate and sulfadiazine could possibly reduce the frequency and intensity of uveitis recurrencies, but evidence supporting this practice is poor.

Espondiloartropatía entérica: presentación de un caso / Enteric spondyloarthropathy: a case presentation

Seronegative arthropathies or spondyloarthropathy belong to a group of diseases that share clinical and genetic characteristics associated strongly with major histocompatibility complex class I HLA-B27. We report a case of a female patient of 39 years old with nightly back pain, morning stiffness and diffuse lumbar pain in the right buttock. In the immunological study observed negative rheumatoid factor and radiographic study observed right sacroiliitis. The final diagnosis is an enteric spondyloarthropathy...

Las artropatías seronegativas o espondiloartropatías corresponden a un grupo de enfermedades que comparten características clínicas y genéticas, asociadas fuertemente con el complejo mayor de histocompatibilidad clase I HLA-B27. Se presenta el caso de una paciente de 39 años con dolor lumbar nocturno, rigidez matutina lumbar y dolor difuso en la región glútea derecha.En el estudio inmunológico se observa factor reumatoídeo negativo, y al estudio radiológico se constata sacroileítis derecha. El diagnóstico final es una espondiloartropatía entérica...

Acute anterior uveitis as the initial presentation of alkaptonuria.

Alkaptonuria is a rare autosomal recessive metabolic disorder that may present with multi-system involvement such as ochronotic arthropathy, renal, urethral and prostatic calculi, cardiac valvular lesions and pigmentation of the skin, sclera, cartilage and other connective tissues. An association of the disease with uveitis has never been reported. We report the first case of alkaptonuria with ochronotic arthropathy presenting with recurrent acute anterior uveitis as the initial manifestation. The possible common link with the HLA-B27 gene is discussed.

Hepatitis C virus seroprevalence and genotypes in patients with diffuse connective tissue diseases and spondyloarthropathies

Many extrahepatic manifestations, including rheumatic diseases, have been reported to be associated with hepatitis C virus (HCV) infection. In order to investigate the prevalence of HCV infection among patients with rheumatic diseases, in the present study we interviewed 367 patients and tested their blood samples for HCV antibodies (anti-HCV) by an enzyme-linked immunosorbent assay. Anti-HCV-reactive samples were retested for confirmation by a line immunoassay and also for HCV RNA detection by the polymerase chain reaction. HCV RNA-positive samples were genotyped by INNO-LIPA. An overall HCV infection prevalence of 1.9 percent (7/367) was found. Of the 7 HCV-infected patients, 4 had systemic lupus erythematosus and 3 rheumatoid arthritis, resulting in positivity rates of 2.3 and 3.4 percent, respectively. HCV RNA genotyping revealed the presence of subtypes 1a (57.1 percent), 1b (28.6 percent) and 3a (14.3 percent). The clinical course was favorable for all HCV-infected patients, except one, who died due to renal insufficiency related to lupus nephritis. These results demonstrate a low HCV infection prevalence among the population studied. In the few positive cases, we observed no adverse influence of this infection on the clinical evolution of the rheumatic disease.

Recomendaciones del Comité de Expertos de la Asociación Colombiana de Reumatología para el empleo de terapia biológica en las espondiloartropatías / Recommendations of the expert committee of the rheumatology Colombian association for the use of biologic therapy in the spondyloarthropathies

Las espondiloartropatías son un grupo de enfermedades que comparten ciertas características clínicas, radiológicas y de laboratorio. Estudios recientes resaltan la importancia de estas que pueden como grupo llegar a tener una prevalencia mayor que patologías frecuentes como la artritis reumatoide, con implicaciones de los aspectos sociales, laborales y fármacoeconómicos. El manejo tradicional de estas patologías no presentó avances significativos hasta hace cinco años cuando con la aparición de los inhibidores del factor de necrosis tumoral (TNF), la llamada terapia biológica se cambió las perspectivas del tratamiento de este grupo de enfermedades convirtiéndose en el día de hoy en una gran herramienta terapéutica. La Asociación Colombiana de Reumatología teniendo en cuenta el conocimiento de este gran avance y el alto impacto de éste en la parte de costos ha desarrollado unas recomendaciones para la utilización de la terapia biológica en las espondiloartropatías mediante la modalidad de consenso con la participación de especialistas expertos en esta área de la reumatología