Consecuencias de la artritis reumatoide en la articulación temporomandibular y su manejo odontológico / Consequences of rheumatoid arthritis in the temporomandibular joint and its dental management

Introducción: la artritis reumatoide es parte del grupo de las enfermedades autoinmunes con incidencia considerable sobre la población. Se caracteriza por la afección de las articulaciones del cuerpo que la padece; en mayor frecuencia se encuentra afectada la articulación temporomandibular por el complejo articular que ésta presenta; entre los signos y síntomas que comúnmente podemos encontrar en pacientes con este tipo de enfermedad son los chasquidos o ruidos articulares, dolor orofacial, pérdida o imposibilidad del movimiento de la mandíbula y cambios anatómicos localizados en el área de la articulación temporomandibular. Objetivo: describir las consecuencias que desencadena la artritis reumatoide sobre la articulación temporomandibular y cómo es para el odontólogo el manejo de estos pacientes en consulta, evaluar los tratamientos para cada caso sobre un correcto diagnóstico. Material y métodos: se realizó una revisión bibliográfica de artículos recientes sobre el tema, utilizando buscadores como SciELO, Elsevier y PubMed, siendo 30 las fuentes seleccionadas con idiomas en inglés y español. Resultados: esta enfermedad autoinmune se caracteriza por afectar múltiples articulaciones del cuerpo humano simétrica y bilateralmente incluyendo la articulación temporomandibular (ATM), lo cual conlleva al riesgo de desarrollar trastornos temporomandibulares (TTM). Es importante conocer los métodos para realizar un correcto diagnóstico oportuno de la ATM del paciente con artritis reumatoide (AR) con la finalidad de ofrecer un tratamiento conservador. Conclusión: los trastornos temporomandibulares desencadenantes de la artritis reumatoide son afecciones que se deben considerar para el buen manejo del paciente con este padecimiento, comprender y respaldar un diagnóstico clínico es de vital importancia para dar al paciente un tratamiento adecuado dependiendo el grado de complejidad en la que cada individuo se encuentra; conocer el manejo adecuado y encaminar al paciente a una mejor calidad de vida es clave en la consulta odontológica del día a día (AU)

Introduction: rheumatoid arthritis is part of the group of autoimmune diseases with considerable incidence in the population. It is characterized by the affection of the joints of the body that suffers from it; most frequently the temporomandibular joint is affected due to the articular complex that it presents; among the signs and symptoms that we can commonly find in patients with this type of disease are joint clicks or noises, orofacial pain, loss or impossibility of jaw movement and anatomical changes located in the temporomandibular joint area. Objective: to describe the consequences that rheumatoid arthritis triggers on the temporomandibular joint and how it is for the dentist to manage these patients in consultation, to evaluate the treatments for each case on a correct diagnosis. Material and methods: a bibliographic review of recent articles on the subject was carried out, using search engines such as SciELO, Elsevier and PubMed, with 30 sources selected in English and Spanish. Results: this autoimmune disease is characterized by affecting multiple joints of the human body symmetrical and bilaterally including the TMJ which leads to the risk of developing TMD. It is important to know the methods to make a correct diagnosis of the TMJ of the patient with RA in order to offer a conservative treatment. Conclusions: the temporomandibular disorders that trigger rheumatoid arthritis are conditions that should be considered for the proper management of the patient with this condition, understanding and supporting a clinical diagnosis is of vital importance to give the patient an adequate treatment depending on the degree of complexity in which each individual is; knowing the proper management and directing the patient to a better quality of life is key in the day-to-day dental practice (AU)

Diffuse lung involvement in rheumatoid arthritis: a respiratory physician's perspective / 中华医学杂志(英文版)

The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis (RA), which is reported to occur in up to 60% to 80% of RA patients. Respiratory complications are the second leading cause of death due to RA. Although there is a wide spectrum of RA-associated respiratory diseases, interstitial lung disease is the most common manifestation and it impacts the prognosis of RA. There has been progress in understanding the management and progression of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and RA-associated respiratory diseases recently, for example, opportunistic pulmonary infectious diseases and toxicity from RA therapies. From a chest physicians' perspective, we will update the diagnosis and treatment of RA-associated ILD, methotrexate-associated lung disease, and the complication of Pneumocystis jiroveci pneumonia in RA in this review.

Asociación del hábito de fumar con la periodontitis crónica y la artritis reumatoide / Association of smoking with chronic periodontitis and rheumatoid arthritis

Introducción: Porphyromonas gingivalis es un microorganismo presente en las periodontitis, productor de la enzima peptidil arginina desminasa, inductora de la citrulinación de proteínas que convierte en antígenos, y que son reconocidos por los anticuerpos antipéptido cíclico citrulinados, marcadores específicos de la artritis reumatoide. Estudios clínicos y epidemiológicos relacionan el hábito de fumar con la periodontitis y la artritis reumatoide. Objetivo: Evaluar la asociación entre el hábito de fumar, la periodontitis crónica y la artritis reumatoide. Métodos: Se realizó un estudio observacional, analítico, de corte transversal, de casos y controles de pacientes con diagnóstico de artritis reumatoide tratados en el Centro de Reumatología y pacientes atendidos por medicina interna en el Hospital Clínico Quirúrgico 10 de octubre de La Habana, en el periodo entre septiembre del 2017 y mayo del 2019. Se estudiaron las variables edad, sexo, hábito de fumar y estado periodontal evaluado a través del índice de enfermedad periodontal de Russell y el nivel de inserción clínica. Para identificar la asociación entre variables se empleó la prueba de ji al cuadrado y el odds ratio. Se respetaron las legislaciones éticas. Resultados: En el estudio prevaleció el grupo de 35 a 44 años y el sexo femenino. El hábito de fumar predominó en los pacientes artríticos, con manifiesto incremento de la prevalencia y gravedad de la enfermedad periodontal. Conclusiones: El hábito de fumar incrementó el riesgo de periodontitis crónica en ambos grupos, y con menos intensidad de riesgo en la artritis reumatoide.

Introduction: Porphyromonas gingivalis is a microorganism present in periodontitis, producer of the enzyme peptidyl arginine deminase that induces citrullination of proteins, turning them into antigens, which are recognized by anti-citrullinated cyclic peptide antibodies, specific markers of rheumatoid arthritis. Clinical and epidemiological studies link smoking with periodontitis and rheumatoid arthritis. Objective: To evaluate the association between smoking, the presence of chronic periodontitis and rheumatoid arthritis. Methods: An observational, analytical, cross-sectional study of cases and controls of patients with a diagnosis of rheumatoid arthritis treated at the Rheumatology Center and patients treated by Internal Medicine in 10 de Octubre Surgical- Clinic Hospital in Havana, between September 2017 and May 2019. The variables were: age, sex, smoking habit and periodontal status evaluated through the Russell Periodontal Disease Index and Level of Clinical Insertion. For the association and relationship between variables, the chi square and the odds ratio were used. Ethical legislation was respected. Results: In the study the group of 35 to 44 years old and the female sex prevailed. Smoking prevailed in arthritic patients with a remarkable increase in the prevalence and severity of periodontal disease. Conclusions: Smoking increased the risk of chronic periodontitis in both groups with less intensity of risk in rheumatoid arthritis.

Productividad laboral en pacientes con artritis reumatoide temprana / Work productivity in patients with early rheumatoid arthritis

Introducción: La artritis reumatoide tiene un importante impacto sobre la función física y la productividad laboral. Objetivo: Determinar la productividad laboral de los pacientes con artritis reumatoide temprana identificando su relación con variables sociodemográficas y clínicas. Método: Se realizó un estudio observacional descriptivo de corte transversal en 53 pacientes atendidos en el Centro de Referencia de Enfermedades Reumáticas entre enero a diciembre de 2019. Para evaluar la productividad laboral se utilizó el cuestionario WPAI-AR. Resultados: Predominaron los pacientes entre los 35-55 años de edad (60,4 por ciento), el sexo femenino (60,4 por ciento). La productividad laboral medida a través de WPAI-AR reportó durante los últimos 7 días una media de 4,64 horas laborales perdidas, secundaria a la artritis reumatoide, con un porciento de pérdida por ausentismo del 16,5 por ciento y presentismo del 59,6 por ciento. Conclusiones: El mayor porciento de afectación de la productividad laboral le correspondió al presentismo. Se encontró asociación entre la pérdida de productividad laboral y la actividad clínica, la discapacidad funcional y la calidad de vida relacionada con la salud(AU)

Introduction: rheumatoid arthritis has been reported to have a significant impact on physical function and work productivity. Objectives: To determine the labor productivity of patient's diagnosis with early rheumatoid arthritis and to identify its possible relationship with sociodemographic and clinical variables. Methods: A cross-sectional descriptive observational study was carried out in 53 patients treated at the Reference Center for Rheumatic Diseases between January to December 2019. To evaluate labor productivity, the WPAIR AR questionnaire was used. Results: patients between 35-55 years of age predominated 60.4 percent, the female sex 60.4 percent. Labor productivity measured by WPAI AR reported during the last 7 days an average of 4.64 working hours lost, secondary to early rheumatoid arthritis, with a percentage of loss due to absenteeism of 16.5 percent and presenteeism of 59.6 percent. Conclusion: Conclusion: the highest percentage of affectation of labor productivity corresponded to labor presenteeism. Loss of work productivity was significantly associated with clinical activity, functional capacity, and health-related quality of lifepor ciento(AU)

Enfoque rehabilitador de paciente con artritis reumatoide evolucionada e ictus / Rehabilitation approach to patients with advanced rheumatoid arthritis and stroke

La artritis reumatoide es una enfermedad crónica, sistémica, inflamatoria, que afecta de forma predominante a las articulaciones periféricas y produce una sinovitis inflamatoria con distribución simétrica. El objetivo de este artículo es describir una experiencia en el tratamiento rehabilitador de una paciente con artritis reumatoide evolucionada e ictus. Se presenta el caso de una mujer de 71 años que ingresó en la unidad de recuperación funcional tras un ictus agudo de perfil lacunar, con clínica sensitivomotora de miembro inferior derecho y antecedentes de artritis reumatoide evolucionada. Se incluyó en un programa de rehabilitación, donde se constató la mejoría de la funcionalidad y reeducación de la marcha con ayudas técnicas. La rehabilitación es fundamental en la atención integral de pacientes con artritis reumatoide e ictus(AU)

Rheumatoid arthritis is a chronic, systemic, inflammatory disease that predominantly affects the peripheral joints producing an inflammatory synovitis with a symmetrical distribution. The objective of this article is to describe an experience in the rehabilitative treatment of a patient with advanced rheumatoid arthritis and stroke. We present a 71-year-old woman who was admitted to the functional recovery unit after acute lacunar-profile stroke, with sensorimotor symptoms of the right lower limb and a history of advanced rheumatoid arthritis. He was included in a rehabilitation program, where functional improvement and gait reeducation with technical aids were observed. Rehabilitation is essential in the comprehensive management of patients with rheumatoid arthritis and stroke(AU)

Salud bucal en pacientes con enfermedades reumáticas / Oral health in patients with rheumatic diseases

Introducción: La salud bucal es uno de los factores que pueden influir negativamente en el control de las enfermedades reumáticas; los procesos inflamatorios e infecciosos constituyen las principales alteraciones de la salud bucal en estos pacientes. Objetivo: Evaluar la salud bucal de los pacientes con enfermedades reumáticas. Métodos: Se realizó una investigación básica, no experimental y descriptiva de un universo de 136 pacientes con enfermedades reumáticas atendidos en el Hospital General Andino de Chimborazo durante el periodo diciembre de 2021 a abril de 2022. A cada uno de ellos se le realizó un examen bucal general para identificar las alteraciones de la salud bucal presentes en cada caso. Se estudiaron las variables características generales de los pacientes (edad, sexo, enfermedad reumática y tiempo de evolución de la enfermedad) y la variable salud bucal (presencia de afecciones bucales, tipo de afección bucal, frecuencia de asistencia a controles odontológicos y nivel de salud bucal). Resultados: Promedio de edad de 51,23 años, predominio de pacientes femeninas (78,68 por ciento), con diagnóstico de artritis reumatoide (77,20 por ciento) y tiempo de evolución de la enfermedad reumática inferior a 5 años (44,12 por ciento). El 72,80 por ciento de los pacientes presentó al menos una enfermedad bucal. La adentia parcial o total (61,62 por ciento) y la presencia de caries dentales (52,52 por ciento) fueron las de mayor frecuencia. El 30,88 por ciento de los pacientes solo acudió a control odontológico ante la presencia de dolor y en el 71,32 por ciento se consideró la salud bucal como inadecuada. Conclusiones: Se identificó un elevado porcentaje de pacientes con enfermedad reumática y al menos una afección bucal. Existió predominio de pacientes que solo acuden a consulta odontológica ante la presencia de una urgencia o emergencia. La salud bucal de los pacientes es inadecuada(AU)

Introduction: Oral health has been identified as one of the factors that can negatively influence the control of chronic diseases such as rheumatic diseases; Inflammatory and infectious processes constitute the main alterations of oral health in patients with this type of disease. Objective: To evaluate the oral health of patients with rheumatic diseases treated at the Hospital General Andino de Chimborazo. Methods: A basic, non-experimental and descriptive research was carried out with a universe of 169 patients with rheumatic diseases treated at the Andean General Hospital of Chimborazo during the period December 2021 - April 2022. The sample was made up of 136 patients who met the inclusion criteria defined for the research. Each of them underwent a general oral examination to identify the oral health alterations present in each case. Results: Average age of 51.23 years, predominance of female patients (78.68 percent), diagnosed with rheumatoid arthritis (77.20 percent) and evolution time of rheumatic disease less than 5 years (44.12 percent). 72.80 percent of the patients presented at least one oral disease. Partial or total adentia (61.62 percent) and the presence of dental caries (52.52 percent) were the most frequently identified. 30.88 percent of patients only go to dental control in the presence of pain and in 71.32 percent oral health was considered inadequate. Conclusions: A high percentage of patients with rheumatic disease who presented at least one oral condition was identified. There was a predominance of patients who only attend a dental consultation in the presence of an urgency or emergency. The oral health of the patients is inadequate(AU)

Utilidad de la proteína C reactiva en el posoperatorio inmediato de un paciente reumático con apendicitis aguda / Usefulness of C-reactive protein in the immediate postoperative period of rheumatic patients with acute appendicitis

Las enfermedades reumáticas son un grupo de afecciones que se caracterizan por la presencia de manifestaciones y complicaciones sistémicas derivadas del proceso inflamatorio mantenido. Los reactantes de fase aguda, como es el caso de la proteína C reactiva constituyen un marcador de actividad de la enfermedad. Sin embargo, su utilidad se magnifica en los pacientes reumáticos que tienen que ser sometidos a una intervención quirúrgica, circunstancia en la que se tornan un marcador eficiente que muestra la magnitud del proceso inflamatorio. Se presenta el caso de una paciente femenina de 53 años edad, con diagnóstico de artritis reumatoide y síndrome de Sjögren secundario, que tuvo que ser sometida a intervención quirúrgica por diagnóstico de apendicitis aguda. Se realizó seguimiento clínico y de laboratorio utilizando la proteína C reactiva como marcador de elección para monitorear la intensidad del proceso inflamatorio resultante de la intervención quirúrgica y de los efectos de esta en la actividad clínica de las enfermedades reumáticas de base. Después del tratamiento quirúrgico y medicamentoso, la paciente fue dada de alta hospitalaria sin manifestaciones articulares, digestivas ni alteraciones de los exámenes de laboratorio(AU)

Rheumatic diseases are a group of conditions characterized by the presence of systemic manifestations and complications derived from the sustained inflammatory process. Acute phase reactants, such as C-reactive protein, constitute a marker of disease activity. However, its usefulness is magnified in those rheumatic patients who have to undergo surgery, being an efficient marker that shows the magnitude of the inflammatory process. We present the case of a 53-year-old female patient diagnosed with rheumatoid arthritis and secondary Sjögren's syndrome who had to undergo surgery due to a diagnosis of acute appendicitis. Clinical and laboratory follow-up was performed using C-reactive protein as the marker of choice to monitor the intensity of the inflammatory process resulting from the surgical intervention and its effects on the clinical activity of underlying rheumatic diseases(AU)

Autoanticuerpos en pacientes con diagnóstico de COVID-19 y enfermedades reumáticas / Autoantibodies in Patients with Diagnosis of Covid-19 and Rheumatic Diseases

Introducción: La COVID-19 es una enfermedad que causa alteraciones del sistema inmunitario. Estas pueden afectar el perfil inmunológico de las enfermedades reumáticas. Objetivo: Identificar el comportamiento del perfil inmunológico de los pacientes con enfermedades reumáticas en los cuales se confirmó el diagnóstico de COVID-19. Métodos: Se realizó una investigación básica con elementos de investigación clínica de 116 pacientes con enfermedades reumáticas, según los criterios del American College of Rheumatology, diagnosticados con COVID-19 entre mayo y diciembre del 2020 y atendidos en unidades asistenciales de la ciudad de Riobamba en Ecuador. Se determinaron los valores del perfil inmunológico en relación con la enfermedad reumática de base en el momento del diagnóstico de la COVID-19, y transcurridos los 7, 15, 30 y 90 días del diagnóstico de la afectación respiratoria. Resultados: Se identificó aumento del factor reumatoide en el 76,31 por ciento de los casos con artritis reumatoide a los 30 días del diagnóstico de COVID-19. El 18,18 por ciento de los pacientes con espondiloartropatías presentó factor reumatoide positivo a partir de los 15 días del diagnóstico de la enfermedad respiratoria. Aumentaron los pacientes con lupus y consumo de complemento y pacientes con síndrome de Sjögren y positividad de anti-SSa (61,54 por ciento ) y anti-SSb (41,15 por ciento ). Conclusiones: La COVID-19 causa cambios en el perfil inmunológico de los pacientes con enfermedades reumáticas: positividad de anticuerpos y consumo de complemento, y evoluciona de manera irregular en la positividad del factor reumatoide en pacientes con espondiloartropatías. La mayoría de las alteraciones inmunitarias se mantienen hasta 90 días después del diagnóstico de la COVID-19(AU)

Introduction: COVID-19 is a disease that generates alterations of the immune system. These can affect the immune profile of rheumatic diseases. Objective: To identify the behavior of the immunological profile of patients with rheumatic diseases in whom the diagnosis of COVID-19 was confirmed. Methodology: A basic research was carried out including elements of clinical research. Universe made up of 116 patients with rheumatic diseases, according to the criteria of the American College of Rheumatology, and COVID-19. Immunological profile values ―were determined in relation to the underlying rheumatic disease at the time of diagnosis of COVID-19, and after 7, 15, 30 and 90 days after the diagnosis of respiratory involvement. Results: An increase in rheumatoid factor was identified in up to 76.31 percent of the cases with rheumatoid arthritis 30 days after diagnosis of COVID-19. 18.18 percent of the patients with spondyloarthropathies presented positive RF after 15 days of diagnosis of the respiratory disease. There was an increase in patients with lupus and supplement consumption and patients with Sjögren's syndrome and positivity of anti-SSa (61.54 percent) and anti-SSb (41.15 percent). Conclusions: COVID-19 generates changes in the immunological profile of patients with RD due to antibody positivity and complement consumption; even behaving irregularly in the case of RF positivity in patients with AD. Most immune alterations persist for up to 90 days after COVID-19 diagnosis(AU)

Manifestaciones cardiovasculares en pacientes con enfermedades reumáticas y COVID-19 / Cardiovascular manifestations in patients with rheumatic diseases and COVID-19

Introducción: La COVID-19 causa una variada gama de manifestaciones clínicas. En pacientes con enfermedades reumáticas destacan, además de las manifestaciones respiratorias, las manifestaciones articulares, dermatológicas, generales y cardiovasculares. Objetivo: Identificar las manifestaciones cardiovasculares que con mayor frecuencia se presentan en pacientes con enfermedades reumáticas afectados por la COVID-19. Métodos: Se realizó una investigación básica, no experimental, con alcance exploratorio, descriptivo y explicativo de un universo constituido por 37 pacientes con diagnóstico previo de enfermedad reumática y diagnóstico confirmado de COVID-19. Se empleó la observación dirigida y la revisión documental como técnicas de investigación para identificar la presencia de manifestaciones cardiovasculares en este tipo de pacientes. Resultados: Predominaron las pacientes femeninas (59,56 por ciento), con diagnóstico de osteoartritis (72,97 por ciento) y artritis reumatoide (72,97 por ciento) y con comorbilidades asociadas (83,78 por ciento). La hipertensión arterial (61,29 por ciento) y el hipotiroidismo (38,71 por ciento) fueron las comorbilidades más frecuentes. El 70,27 por ciento de los pacientes presentaron manifestaciones cardiovasculares: hipertensión arterial (65,38 por ciento), trastornos del ritmo cardiaco (57,69 por ciento) y el síndrome de Raynaud (53,85 por ciento). El 80,0 por ciento de los pacientes masculinos presentaron manifestaciones cardiovasculares, al igual que el 80,64 por ciento de los casos con enfermedad reumática, COVID-19 y comorbilidades asociadas. Conclusiones: Las manifestaciones cardiovasculares se presentaron con elevada frecuencia en los pacientes reumáticos con diagnóstico de COVID-19, sobre todo pacientes masculinos con comorbilidades asociadas. Las manifestaciones cardiovasculares más frecuentes fueron la hipertensión arterial, los trastornos del ritmo y el síndrome de Raynaud(AU)

Introduction: COVID-19 generates a wide range of clinical manifestations in general. In patients with rheumatic diseases, in addition to respiratory manifestations, joint, dermatological, general and cardiovascular manifestations, among others, stand out. Objective: To identify the cardiovascular manifestations that most frequently occur in patients with rheumatic diseases and COVID-19. Methods: A basic, non-experimental research was carried out, with an exploratory, descriptive and explanatory scope. Universe made up of 37 patients with a previous diagnosis of rheumatic disease and a confirmed diagnosis of COVID-19. Directed observation and documentary review were used as research techniques to identify the presence of cardiovascular manifestations in this type of patient. Results: Predominance of female patients (59.56 percent), diagnosed with osteoarthritis (72.97 percent) and rheumatoid arthritis (72.97 percent) and with associated comorbidities (83.78 percent). Hypertension (61.29 percent) and hypothyroidism (38.71 percent) were the most frequent comorbidities. 70.27 percent of the patients presented cardiovascular manifestations, predominantly arterial hypertension (65.38 percent), rhythm disorders (57.69 percent) and Raynaud´s syndrome (53.85 percent). 80.0 percent of the male patients presented cardiovascular manifestations, as did 80.64 percent of the cases with rheumatic disease, COVID-19 and associated comorbidities. Conclusions: Cardiovascular manifestations occurred with high frequency in rheumatic patients diagnosed with COVID-19; being more frequent in male patients and with associated comorbidities. High blood pressure, rhythm disorders and Raynaud's syndrome were the most frequent(AU)

Rheumatoid meningitis: report of two cases / Meningitis reumatoide. Informe de dos casos

ABSTRACT Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis (RA). RM mimics many other conditions such as subdural empyema, unsteady gait, focal brain dysfunction, stroke, relapsing-remitting motor signs, headache, neuropsychiatric disorders, seizures, parkinsonism, and meningeal tumors. RM is considered a disease with poor prognosis. However, cases reported in the last decade show a good outcome. We report two cases with a favorable outcome. A 48-year-old man with a three-year history of RA admitted for headache, sensory disturbances, and speech difficulties. Brain magnetic resonance imaging (MRI) showed a left parietal subdural laminar lesion with restricted diffusion and a small left superior frontal acute infarction. A subdural empyema was originally suspected, and antimicrobials were prescribed. A follow-up MRI did not show progression of the subdural lesion and the patient was discharged 14 days after admission without focal deficits. A 44-year-old female patient with two years of seronegative RA was admitted for severe headache, confusion, nausea and vomiting. Brain MRI showed subtle supra and infratentorial leptomeningeal involvement and a left cerebellar acute infarct. A meningoencephalitis due to etanercept was initially thought and treated with dexamethasone. The patient was discharged but had to be admitted again and a new MRI showed a progression of the leptomeningeal involvement. She worsened and required endotracheal intubation. Cyclophosphamide was started and the patient became asymptomatic three months later. We propose that treatment should not be delayed waiting a biopsy when a diagnosis of RM is made and after a cerebrospinal fluid infection has been ruled out.

Meningitis reumatoide es una complicación rara de la artritis reumatoide. Esta enfermedad simula varias afecciones neurológicas, como empiema subdural, marcha inestable, accidente cerebrovascular, signos motores recurrentes-remitentes, cefalea, trastornos neuropsiquiátricos, convulsiones, parkinsonismo y tumores de las meninges. Es considerada de mal pronóstico, sin embargo, casos en la última década muestran lo contrario. Informamos dos casos con buen pronóstico. Un hombre de 48 años con tres años de artritis reumatoide ingresado por cefalea, trastornos sensoriales y dificultades del habla. La resonancia magnética (RM) cerebral mostró una lesión laminar subdural parietal izquierda y un pequeño infarto agudo frontal izquierdo. Inicialmente se sospechó un empiema subdural y se trató con antibióticos. Una RM de control no mostró progresión de la lesión subdural y el paciente fue dado de alta 14 días después del ingreso sin déficit focales. Una mujer de 44 años con dos años de artritis reumatoide seronegativa fue ingresada por cefalea, confusión náuseas y vómitos. La RM cerebral mostró un compromiso sutil leptomeníngeo supra e infratentorial y un infarto agudo cerebeloso izquierdo. Inicialmente se consideró una meningoencefalitis debido a etanercept y se trató con dexametasona. Fue dada de alta pero debió ingresar al hospital nuevamente y una nueva RM mostró progresión del compromiso leptomeníngeo. Ella se agravó y requirió intubación endotraqueal. Se inició ciclofosfamida y la paciente se hizo asintomática tres meses después. Proponemos que el tratamiento no debe retrasarse esperando una biopsia de meninges cuando se realiza un diagnóstico clínico de meningitis reumatoide, después de descartar infecciones meníngeas.

Acute corneal melting one week after an uncomplicated cataract surgery in a patient who previously underwent eyelid radiation and with undiagnosed rheumatoid arthritis: a case report / Ceratomalácia aguda uma semana após cirurgia de catarata sem complicações em uma paciente com irradiação prévia de uma pálpebra e artrite reumatoide não diagnosticada: relato de caso

ABSTRACT This is a rare case report of acute, paracentral corneal melting and perforation occurring 1 week after an uneventful cataract surgery, with discussions on possible pathogenetic mechanisms. Relevant literature was also reviewed. Herein, a case of an 86-year-old woman with acute, paracentral, and sterile corneal melting and perforation in her left eye at 1 week after an uncomplicated cataract extraction is described. This occurs at the base of ocular surface disorders due to previous radiation of her lower eyelid and cheeks for the treatment of cancer and previously undiagnosed rheumatoid arthritis. She underwent surgical treatment using Gundersen's conjunctival flap for the existing perforation due to low visual expectancies and reluctance to undergo corneal keratoplasty due to the risk of corneal graft rejection. The risk of coming across an acute corneal melting after an uncomplicated cataract surgery in the eyes with ocular surface disorders should always be considered.

RESUMO É apresentado um caso raro de ceratomalácia paracentral aguda estéril e perfuração da córnea em uma paciente de 86 anos, uma semana após cirurgia para catarata sem intercorrências. Também são discutidos possíveis mecanismos de patogênese e a literatura relevante é revisada. Esses distúrbios da superfície ocular ocorreram devido à irradiação da pálpebra inferior e da bochecha em um tratamento de câncer e a uma artrite reumatoide não diagnosticada anteriormente. A paciente submeteu-se a um tratamento cirúrgico com um flap conjuntival de Gundersen sobre a perfuração existente, devido às suas baixas expectativas visuais e à relutância em submeter-se a uma ceratoplastia da córnea, considerando o risco de rejeição do enxerto corneano. Deve-se sempre considerar o risco de ocorrência de ceratomalácia aguda após cirurgias de catarata sem complicações em olhos apresentando distúrbios da superfície ocular.

Effect of chemokines CXCL9 and CXCL10 on bone erosion in patients with rheumatoid arthritis / 北京大学学报(医学版)

OBJECTIVE@#To detect the serum level of soluble chemokines CXCL9 and CXCL10 in patients with rheumatoid arthritis (RA), and to analyze their correlation with bone erosion, as well as the clinical significance in RA.@*METHODS@#In the study, 105 cases of RA patients, 90 osteoarthritis (OA) patients and 25 healthy controls in Peking University People's Hospital were included. All the clinical information of the patients was collected, and the serum CXCL9 and CXCL10 levels of both patients and healthy controls were measured by enzyme-linked immune sorbent assay (ELISA). CXCL9 and CXCL10 levels among different groups were compared. The correlation between serum levels with clinical/laboratory parameters and the occurrence of bone erosion in RA were analyzed. Independent sample t test, Chi square test, Mann-Whitney U test, Spearman's rank correlation and Logistic regression were used for statistical analysis.@*RESULTS@#The levels of CXCL9 and CXCL10 were significantly higher in the RA patients [250.02 (126.98, 484.29) ng/L, 108.43 (55.16, 197.17) ng/L] than in the OA patients [165.05 (75.89, 266.37) ng/L, 69.00 (33.25, 104.74) ng/L] and the health controls [79.47 (38.22, 140.63) ng/L, 55.44 (18.76, 95.86) ng/L] (all P < 0.01). Spearman's correlation analysis showed that the level of serum CXCL9 was positively correlated with swollen joints (SJC), rheumatoid factor (RF) and disease activity score 28 (DAS28) (r=0.302, 0.285, 0.289; P=0.009, 0.015, 0.013). The level of serum CXCL10 was positively correlated with tender joints (TJC), SJC, C-reactive protein (CRP), immunoglobulin (Ig) A, IgM, RF, anti-cyclic citrullinated peptide antibody (ACPA), and DAS28 (r=0.339, 0.402, 0.269, 0.266, 0.345, 0.570, 0.540, 0.364; P=0.010, 0.002, 0.043, 0.045, 0.009, < 0.001, < 0.001, 0.006). Serum CXCL9 and CXCL10 levels in the RA patients with bone erosion were extremely higher than those without bone erosion [306.84 (234.02, 460.55) ng/L vs. 149.90 (75.88, 257.72) ng/L, 153.74 (89.50, 209.59) ng/L vs. 54.53 (26.30, 83.69) ng/L, respectively] (all P < 0.01). Logistic regression analysis showed that disease duration, DAS28 and serum level of CXCL9 were correlated with bone erosion in the RA patients (P < 0.05).@*CONCLUSION@#Serum levels of CXCL9 and CXCL10 were remarkably elevated in patients with RA, and correlated with disease activities and occurrence of bone erosion. Chemokines CXCL9 and CXCL10 might be involved in the pathogenesis and bone destruction in RA.

Relationship between corticotherapy and increased cardiac risk in patients with rheumatoid arthritis

Rheumatoid arthritis is an autoimmune inflammatory joint disease with global prevalence of 0.4% to 1.0%. Extra-articular manifestations increase its morbidity and severity, and cardiovascular diseases present the greatest risk. Therapeutic approaches have been used to treat rheumatoid arthritis, often involving the use of multiple classes of drugs with different mechanisms and forms of action. Corticosteroid therapy is widely used in this therapeutic combination; however, its use has been widely questioned because of its high toxicity and some negative effects, including the possibility of increased cardiovascular risk, depending on the dosage. Some studies have provided important insights into how glucocorticoids have an impact on cardiac complications in patients with rheumatoid arthritis. Most of these studies have concluded that exposure to these drugs at high or cumulative doses is associated with increased risk of death, as well as possibly being associated with the presence of a positive rheumatoid factor.

Estrategias en el manejo y actualización de las enfermedades autoinmunes y reumáticas en la epidemia por SARSCoV-2 y la COVID-19 Sociedad Cubana de Reumatología y su Grupo Nacional / Strategies in its Management and Updating of the Autoimmune-rheumatic Diseases in the SARSCoV-2 Pandemic and COVID-19 Cuban Rheumatology Society and its National Group

Al igual que en las enfermedades autoinmunes y reumáticas, las infecciones por virus pueden ser disparadores de mecanismos inmunopatogénicos. El SARSCoV-2 puede causar la liberación de citocinas y provocar un daño tisular grave, sobre todo pulmonar, con peligro para la vida. Se suma a ello el riesgo del uso de medicamentos inmunosupresores, empleados en los protocolos de tratamiento de las afecciones autoinmunes y también contra la infección viral de COVID-19. Hoy no contamos con conocimientos y evidencias científicas suficientemente sólidas para el enfrentamiento a la COVID-19, y cómo puede impactar entre los pacientes inmunodeprimidos por afecciones reumáticas. El Grupo Nacional de Atención y Enfrentamiento a la COVID-19 de la Sociedad Cubana de Reumatología se propuso elaborar un documento científico actualizado con las bases teórico-prácticas que permita acceder al conocimiento acerca de la infección por SARSCoV-2 y la COVID-19, y su repercusión sobre los pacientes con enfermedades autoinmunes y reumáticas para esbozar una estrategia de trabajo y ofrecer recomendaciones para los reumatólogos y pacientes cubanos. Se realizó un estudio de revisión y actualización acerca de la asociación entre las enfermedades reumáticas y autoinmunes y la COVID-19. Se emplearon las palabras clave enfermedades reumáticas, lupus eritematoso sistémico, artritis reumatoide, virus SARSCoV-2 y COVID-19. Se realizó una amplia búsqueda en MEDLINE y LILACS, y se revisaron más de 150 artículos, boletines de actualización de los sitios Web, páginas de salud de Cuba, resúmenes seleccionados por su calidad metodológica, revisiones y metaanálisis sobre el tema. A partir de la información recogida, se estableció una discusión y análisis considerando las principales experiencias internacionales, criterios de expertos, experiencias previas con otros virus en el Sistema de Salud de Cuba, con la participación de su red de científicos liderados por la Sociedad Cubana de Reumatología y su Grupo Nacional y el apoyo de la comunidad de reumatólogos(AU)

The outbreak of the infection by the new coronavirus SARSCoV-2, COVID-19, in December in Wuhan Province of China, has become a pandemic and health emergency given the deficiency of antiviral therapy for the acute respiratory syndrome that generates danger to life. The debut of the epidemic was in China, then the epicenter developed in Europe, northern Italy that suffered a severe blow. Worldwide, more than 10 million people are infected with the virus that has impacted on health systems until it practically collapsed, resulting in thousands of deaths. Today the epicenter of the pandemic has shifted to the Americas. Alarming figures highlight the United States of North America with some 2,737,600 infected and more than 128,471 deaths, followed by the South American giant Brazil with 1.3 million infections and 57,659 deaths. The Caribbean has a better setting. In Cuba, by the end of June, 2,340 cases of patients infected with deaths from COVID-19 were reported. We conducted a review, analysis and evaluation study of more than 150 articles from international journals, update bulletins of the WEB sites, health pages of the MINSAP of Cuba, and summaries selected for their methodological quality, and reviews, on the subject COVID-19 and autoimmune-rheumatic diseases by MEDLINE: database prepared by the National Library of Medicine of The USA contains bibliographic references and abstracts from more than 4,000 biomedical journals published in the United States and in 70 other countries, We also use Latin American and Caribbean Center for Information on Health Sciences: System, in Latin America and the Caribbean, since 1982. Our objective and results achieved have been to develop the theoretical-practical bases in an updated scientific document that allow access in an essential and summarized way to current knowledge about the infection by SACOV-2, COVID-19, and its repercussion and impact on patients suffering from rheumatic autoimmune diseases, and thus outline a coping and action strategy with recommendations for the Cuban rheumatologists in their health care work, and for patients as a guideline, given their well-founded concerns and fears given their underlying condition and the immunosuppressive drugs prescribed in an unfavorable context of a pandemic. The information is based on international experiences with the most published scientific evidence and those treasured national experiences in the face of similar situations of epidemics, faced by the vast health system and achievements of Cuban science(AU)

Inflammation in Cardiovascular Disease: From Basic Concepts to Clinical Application

Abstract Although low-density lipoprotein cholesterol is central to the development and progression of atherosclerosis, the role of inflammation in the atherosclerotic process is becoming better understood and appreciated. Chronic inflammatory conditions such as rheumatoid arthritis, lupus, psoriasis, HIV infection, and inflammatory bowel disease have all been shown to be associated with an increased blood levels of inflammatory biomarkers and increased risk of cardiovascular events. Evidence from observational studies suggests that anti-inflammatory therapy decreases this risk in these conditions. Clinical trials of anti-inflammatory drugs in patients with coronary disease have yielded mixed results. Drugs that have failed in recent trials include the P38 MAP kinase inhibitor losmapimod, the phospholipase A2 inhibitors darapladib and varespladib, and methotrexate. Canakinumab, an interleukin-1β inhibitor, reduced cardiovascular events in patients with coronary disease in the Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS). Canakinumab increased the rate of fatal infections in CANTOS and is very expensive; it is thus unlikely to be widely used for risk reduction in cardiology. On the other hand, colchicine is a safe and inexpensive anti-inflammatory drug. In the Colchicine Cardiovascular Outcomes Trial (COLCOT), where patients within 30 days of a myocardial infarction were randomized to low-dose colchicine or placebo and followed for a median of almost 2 years, colchicine treatment was associated with a 23% reduction (p=0.02) in cardiovascular events. Newer studies with anti-inflammatory drugs have the potential to improve outcomes of patients with atherosclerosis, just as low-density lipoprotein cholesterol-lowering drugs have done over the past two decades.

Artrite reumatoide do tipo EORA com trombocitose significativa: relato de caso / Elderly-onset rheumatoid arthritis with significant thrombocytosis: a case report

Este relato teve como objetivo apresentar um caso de elderly onset rheumatoid arthritis associada à trombocitose reacional significativa. À admissão, o paciente apresentava quadro de poliartrite de pequenas e grandes articulações associado à rigidez matinal. Após exames solicitados, evidenciaram-se trombocitose de 1.697.000 cel./mm³ e anticorpos antipeptídeos citrulinados positivos, sendo diagnosticado com artrite reumatoide do tipo elderly onset rheumatoid arthritis.

This report aimed at presenting a case of elderly-onset rheumatoid arthritis associated with significant reactive thrombocytosis. On admission, the patient presented polyarthritis of small and large joints associated with morning stiffness. After the performance of the requested tests, thrombocytosis of 1,697,000 cells/mm3 and positive anti-CCP were evidenced, and the patient was diagnosed with elderly-onset rheumatoid arthritis.

Cambio de diagnóstico y de categoría diagnóstica en pacientes con artritis idiopática juvenil en 7 años de seguimiento / Change of diagnosis and diagnostic category in patients with juvenile idiopathic arthritis within 7 years of follow-up

Resumen: Introducción: Al menos 50% de los pacientes pediátricos portadores de artritis idiopática juvenil (AIJ) continuará control en reumatología adulto. La clasificación de la Liga Internacional de Asociaciones de Reumatología (ILAR) vigente, actualmente en revisión, difiere de la clasificación de las artritis inflamatorias del adulto. Se ha reportado cambios de categoría en 10,8% de los pacientes durante el seguimiento. Objetivo: Analizar los pacientes con AIJ seguidos al menos 7 años para objetivar cambios de diagnós tico en la transición, e identificar factores de mal pronóstico funcional. Pacientes y Método: Estudio retrospectivo en base a registros clínicos. Se incluyó a la totalidad de los pacientes con AIJ controla dos en policlínico pediátrico del Hospital de Puerto Montt entre el año 2005 y 2017, que cumplieron siete o más años de seguimiento. Se realizó análisis descriptivo en base a variables clínicas: categoría diagnóstica, tiempo de evolución al diagnóstico, actividad clínica y serológica, y tiempo de evolución al inicio de la terapia farmacológica. Resultados: Se evaluaron 18 pacientes, 3 Oligo-articular (OA) persistente, 1 OA extendida, 4 Poli-articular (PA) factor reumatoide (FR) negativo, 4 PA FR positivo, 5 Sistémicas, 1 Psoriática, todos con seguimiento mayor a 7 años. Once de 18 niños fueron transfe ridos a adultos. Tres de 11 cambiaron de diagnóstico a Artritis Reumatoide (AR) más otra enferme dad autoinmune: Síndrome de Sjögren + Lupus eritematoso sistémico, Púrpura trombocitopénico inmune, Enfermedad autoinmune no clasificada y cinco de 11 niños de categoría ILAR: OA a Artritis reumatoide juvenil, OA extendida a PA FR negativo, 3 Sistémicas a PA FR negativo. Edad de inicio, formas poli-articulares, retrasos en diagnóstico y comienzo de terapia se asociaron a secuelas e infla mación persistente. Conclusiones: Ocho de once pacientes transferidos cambiaron denominación diagnóstica y/o presentaron otras enfermedades autoinmunes. Algunos factores de mal pronóstico deben mejorar.

Abstract: Introduction: At least 50% of pediatric patients with Juvenile Idiopathic Arthritis (JIA) will require continued fo llow-up in adult rheumatology. The present International League of Associations for Rheumatology (ILAR) classification, currently under revision, differs from its classification of inflammatory arthritis in adults. Category changes have been reported in 10.8% of patients during follow-up. Objective: To analyze JIA patients in follow-up for at least 7 years to detect diagnosis changes during transition to adult care, identifying factors of poor functional prognosis. Patients and Method: Retrospective study based on medical records of JIA patients seen at the pediatric polyclinic of the Puerto Montt Hospital between 2005 and 2017, who were monitored for at least 7 years. Descriptive analysis was performed according to clinical variables: diagnostic category, evolution before diagnosis, clinical and serological activity, and evolution before starting drug therapy. Results: We evaluated 18 pa tients, corresponding to 3 patients with persistent oligoarticular arthritis (OA), 1 with extended OA, 4 with polyarticular arthritis (PA) rheumatoid factor (RF) negative, 4 with PA RF positive, 5 with syste mic JIA, and 1 with psoriatic arthritis, all have had follow-up more than 7 years. 11 out of 18 patients transitioned to adult care. Three out of 11 patients changed diagnosis to Rheumatoid Arthritis (RA) plus another autoimmune disease such as Sjögren's Syndrome + Systemic Lupus Erythematosus, Immune thrombocytopenia, or unclassified autoimmune disease, and 5 out of 11 children changed ILAR category from OA to Juvenile Rheumatoid Arthritis, extended OA to PA RF negative, and 3 from Systemic arthritis to PA RF negative. Age of onset, polyarticular forms, delay in diagnosis, and the start of therapy were associated with sequelae and persistent inflammation. Conclusions: Eight of the eleven JIA patients who transitioned to adult care changed their diagnosis or presented other autoimmune diseases. Some factors of poor prognosis must improve.

Afectación bucal en pacientes con artritis reumatoide / Oral involvement in patients with rheumatoid arthritis

Introducción: La artritis reumatoide es una enfermedad reumática que genera distintos grados de discapacidad y afectación de la calidad de vida. A pesar de ello, no se describe como causa de lesiones en la cavidad bucal. Objetivo: Identificar las principales afectaciones de la cavidad bucal en pacientes con artritis reumatoide. Métodos: Estudio descriptivo, correlacional y de corte longitudinal que incluyó a 103 pacientes con diagnóstico de artritis reumatoide atendidos en la Unidad Móvil número 2 de Alausi en el periodo de enero a diciembre de 2019. A cada paciente se le realizó un examen estomatológico inicial y seguimiento mensual durante 6 meses para identificar las lesiones bucales, su tratamiento y rehabilitación. Resultados: Hubo un promedio de edad de 56,67 años, con predominio de pacientes entre 40 y 59 años (49,51 por ciento), del sexo femenino (71,84 por ciento) y con tiempo de evolución menor de 3 años (57,28 por ciento). El 44,66 por ciento de los casos presentó comorbilidades asociadas; el sobrepeso fue la más frecuente (41,30 por ciento). El 84,47 por ciento de los pacientes tenía lesiones de la cavidad bucal: adentia parcial (33,33 por ciento) y gingivitis crónica (19,54 por ciento). El 43,69 por ciento tenía un nivel de conocimiento bajo acerca de la prevención de lesiones bucales. Conclusiones: Existió una elevada prevalencia de lesiones de la cavidad bucal en pacientes con artritis reumatoide. La adentia parcial, las caries dentales, la gingivitis crónica y las lesiones premalignas fueron las más frecuentes. Se halló una correlación positiva media entre el tiempo de evolución de la enfermedad y la presencia de lesiones de la cavidad bucal(AU)

Introduction: Rheumatoid arthritis is a rheumatic, autoimmune, inflammatory and chronic disease that, due to the varied number of clinical manifestations and complications, generates different degrees of disability and impaired quality of life. Objective: To identify the main effects of the oral cavity in patients with rheumatoid arthritis. Methodology: Descriptive, correlational and longitudinal sectional study that included 103 patients diagnosed with rheumatoid arthritis treated in the Mobile Unit number 2 of Alausi. Each patient underwent an initial stomatological examination and monthly follow-up for a period of 6 months that allowed the identification of oral lesions, their treatment and oral rehabilitation. Results: Average age of 56.67 years with a predominance of patients between 40 and 59 years (49.51 percent), of the female sex (71.84 percent) and with evolution time less than 3 years (57.28 percent). 44.66 percent of the cases presented associated comorbidities, being overweight the most frequent (41.30 percent). 84.47 percent of the patients presented oral cavity lesions, with partial adentia (33.33 percent) and chronic gingivitis (19.54 percent) being the most represented. 43.69 percent of the patients presented low level of knowledge about prevention of oral lesions. Conclusions: There was a high prevalence of lesions of the oral cavity in patients with rheumatoid arthritis. Partial adentia, dental caries, chronic gingivitis, and premalignant lesions were the most significant. A mean positive correlation was found between the evolution time of the disease and the presence of lesions of the oral cavity(AU)

Clinical characteristics and related factors of rheumatoid arthritis complicated with tuberculosis infection / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical characteristics and high risk factors of Rheumatoid arthritis (RA) complicated with tuberculosis infection.@*METHODS@#Patients with rheumatoid arthritis diagnosed in the hospital of Sichuan Provincial People's Hospital from January 2007 to January 2017 was retrospectively collected, who were enrolled in the study group. A control group was randomly selected from the RA patients hospitalized in the same period without co-infection at a ratio of 1 :2. The general data, clinical data, laboratory test data, treatment plan, etc. of the two groups were collected in detail for single factor statistical analysis. Then multivariate Logistic regression was used to analyze the independent risk factors of RA complicated with tuberculosis infection with statistical significance in univariate analysis.@*RESULTS@#The clinical manifestations of fever (83.3%) were most common, followed by cough (69%) and body mass loss (45.2%). In the infected group, pulmonary tuberculosis accounted for 73.3%. In the infected group the chest CT showed two or more cases, accounting for 59%. There were 9 cases (33.3%) occurring in the typical tuberculosis occurrence site. Compared with the control group, the erythrocyte sedimentation rate (ESR), C-reaction protein (CRP) levels, and the daily average dose of glucocorticoid in 1 year in the infected group were higher than those in the control group. And those differences were statistically significant(P < 0.05). There were no significant differences in gender, age, disease duration, disease activity score, white blood cell (WBC), platelet (PLT), hemoglobin (Hb), immunoglobulin G (IgG), complement (C), Anti cyclic citrullinated peptide antibody (anti-CCP), CD4+T cell count, and immunosuppressant use (P > 0.05). Multivariate Logistic regression analysis showed that CRP levels(OR=1.016, 95%CI:1.002-1.031) and the daily average dose of glucocorticoid in 1 year(OR=1.229, 95%CI:1.066-1.418)were the independent risk factors of RA complica-ted with tuberculosis infection.@*CONCLUSION@#RA patients with tuberculosis infection are mainly phthisis. The clinical manifestations of RA combined with tuberculosis infection are lack of specificity, and the chest imaging features of pulmonary tuberculosis are diverse, which are easy to be misdiagnosed. CRP levels and the daily average dose level of glucocorticoid in 1 year were risk factors for RA and tuberculosis infection.

Factores de riesgo para la aparición de aterosclerosis en pacientes con artritis reumatoide / Risk factors for the development of atherosclerosis in patients with rheumatoid arthritis

Introducción: la artritis reumatoide es una enfermedad sistémica, de etiología desconocida, caracterizada por provocar inflamación crónica, cursa con manifestaciones articulares, extrarticulares y comportamiento clínico variable. Objetivo: caracterizar los factores de riesgo para la aparición de aterosclerosis en pacientes con artritis reumatoide e identificar su relación con el tiempo de diagnóstico, actividad inflamatoria y tratamiento. Método: se realizó estudio descriptivo transversal, en pacientes con artritis reumatoide atendidos en el Centro de Reumatología del Hospital Docente Clínico Quirúrgico 10 de Octubre entre febrero 2016 y junio 2017. Resultados: la mayor frecuencia fue para el sexo femenino, el rango etario 45-54 años. Se observó placa ateromatosa en 37.2 por ciento y engrosamiento complejo íntima media en el 15.4 por ciento. Los factores de riesgo que mostraron asociación con la presencia de placa fueron: hipertrigliceridemia (p= 0.000), hipercolesterolemia (p= 0.000), Diabetes Mellitus (p= 0.027) y los niveles elevados de proteína C Reactiva (p= 0.003). Conclusiones: los factores de riesgo tradicionales que presentaron significación estadística fueron la hipercolesterolemia, hipertrigliceridemia y la Diabetes Mellitus. La presencia de más de un factor elevó la frecuencia de alteraciones en el eco doppler; existió asociación entre la elevación de los niveles de PCR y la presencia de alteraciones del eco doppler. Se constató en aquellos pacientes con alteraciones eco doppler carotídeo relación con el tiempo de evolución, actividad de la enfermedad y dosis acumulada de esteroides(AU)

Introduction: rheumatoid arthritis is a systemic disease, of unknown etiology, characterized by chronic inflammation; It presents with joint, extra-articular manifestations and variable clinical behavior. Objective: to characterize the risk factors for the appearance of atherosclerosis in patients with rheumatoid arthritis and to identify their relationship with the time of diagnosis, inflammatory activity and treatment. Method: a cross-sectional, descriptive study was conducted in patients with rheumatoid arthritis treated at the Rheumatology Center of the Surgical Clinical Teaching Hospital 10 de Octubre in the period between February 2016 and June 2017. Results: the highest frequency was for the female sex, the age range 45-54 years. Atheromatous plaque was observed in 37.2 percent and intimal complex thickening in 15.4 percent. The risk factors that showed association with the presence of plaque were: hypertriglyceridemia (p= 0.000), hypercholesterolemia (p= 0.000), Diabetes Mellitus (p= 0.027) and high levels of C-reactive protein (p= 0.003) Conclusions: the traditional risk factors that presented statistical significance were hypercholesterolemia, hypertriglyceridemia and Diabetes Mellitus. The presence of more than one traditional risk factor increased the frequency of alterations in Doppler echo; There was an association between the elevation of C-Reactive Protein levels and the presence of Doppler echo alterations. It was found in those patients with carotid echo Doppler alterations, relationship with the time of evolution, activity of the disease and cumulative dose of steroids(AU)