Mitos, verdades, dudas y confusiones sobre las ondas de choque y su rol en la enfermedad musculoesquelética / Myths, truths, doubts and confusions about shockwave. Therapy and its role in musculoskeletal pathology

El advenimiento de la litotricia renal en la década de los 80 tuvo un efecto disruptivo en el tratamiento de los cálculos renales. El descubrimiento de los efectos biológicos de las ondas de choque expandió rápidamente el uso de este método terapéutico al campo de la Ortopedia y Traumatología. Si bien, en los últimos años, ha tenido un amplio desarrollo, persisten muchas confusiones y dudas en el ambiente de nuestra especialidad, sobre todo entre los profesionales que no están directamente involucrados en el tema. El objetivo de esta presentación es hacer un análisis de los puntos de controversia y las dudas más frecuentes, basado en la bibliografía científica. Nivel de Evidencia: V

The advent of renal lithotripsy in the 1980s had a disruptive effect on the treatment of kidney stones. The discovery of the biological effects of shock waves quickly expanded the use of this therapeutic method to the field of Orthopedics and Traumatology. Although the topic has advanced significantly in recent years, there are still many questions and confusions in our specialty's environment, particularly among professionals who are not directly involved in the field. The objective of this presentation is to provide a scientific analysis of the points of controversy and the most frequent doubts. Level of Evidence: V

Autocuidado digital en el manejo de los trastornos musculoesqueléticos de columna: revisión sistemática y metanálisis / Digital self-care in the management of spine musculoskeletal disorders: A systematic review and meta-analysis / Autocuidado digital no manejo de distúrbios musculoesqueléticos de coluna: revisão sistemática e metanálise

Objetivo: analizar la efectividad del autocuidado digital en el manejo del dolor y la discapacidad funcional en personas con trastornos musculoesqueléticos espinales. Método: revisión sistemática de la literatura, desarrollada con la checklist PRISMA, de ensayos clínicos aleatorizados sobre personas con trastornos musculoesqueléticos de columna e intervenciones digitales a las que se accede por computadora, smartphones u otro dispositivo portátil. Bases de datos consultadas: National Library of Medicine, Excerpta Médica dataBASE, SciVerse Scopus, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Science Citation Indexes, Cummulative Index to Nursing and Allied Health Literature y Physiotherapy Evidence Database. Síntesis de resultados descriptiva y por metanálisis (modelo de efectos fijos) realizada con el software Review Manager. Calidad metodológica evaluada mediante la escala Physiotherapy Evidence Database. Resultados: se seleccionaron 25 ensayos (5142 participantes) que mostraron mejoras estadísticamente significativas (p<0,05) del 54% (12/22) en los niveles de dolor y del 47% (10/21) en la discapacidad funcional en el grupo intervención. Los metanálisis mostraron efectos moderados sobre la intensidad del dolor y efectos pequeños sobre la discapacidad funcional. Predominaron los estudios de calidad media. Conclusión: las intervenciones de atención digital demostraron resultados beneficiosos para la intensidad del dolor y la discapacidad funcional, principalmente para el dolor lumbar crónico. Se ha demostrado que la atención digital es promisoria para favorecer el automanejo de las afecciones musculoesqueléticas de columna. Registro PROSPERO CRD42021282102.

Objective: to analyze the effectiveness of digital self-care in the management of pain and functional disability among people with spine musculoskeletal disorders. Method: a systematic literature review, developed with the PRISMA checklist, of randomized clinical trials of people with spine musculoskeletal disorders and digital interventions accessed by means of computers, smartphones or other portable devices. Databases researched: National Library of Medicine, Excerpta Médica dataBASE, SciVerse Scopus, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Science Citation Indexes, Cumulative Index to Nursing and Allied Health Literature and Physiotherapy Evidence Database. The descriptive synthesis of the results and by means of meta-analyses (fixed-effects model) was performed with the Review Manager software. The methodological quality was evaluated with the Physiotherapy Evidence Database scale. Results: a total of 25 trials were selected (5,142 participants), which showed statistically significant improvements (p <0.05) in 54% (12/22) in the pain levels and 47% (10/21) in functional disability in the Intervention Group. The meta-analyses showed moderate effects on pain intensity and small effects on functional disability. There was a predominance of medium quality studies. Conclusion: the digital care interventions showed a beneficial result in pain intensity and in functional disability, mainly for chronic low back pain. Digital care emerges as promising to support self-management of the spine musculoskeletal conditions. PROSPERO registry number CRD42021282102.

Objetivo: analisar a efetividade do autocuidado digital no manejo da dor e incapacidade funcional em pessoas com distúrbios musculoesqueléticos de coluna. Método: revisão sistemática da literatura, desenvolvida com o checklist PRISMA, de ensaios clínicos randomizados de pessoas com distúrbios musculoesqueléticos de coluna e intervenções digitais acessadas por computador, smartphones ou outro dispositivo portátil. Bases pesquisadas: National Library of Medicine, Excerpta Médica dataBASE, SciVerse Scopus, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Science Citation Indexes, Cummulative Index to Nursing and Allied Health Literature e Physiotherapy Evidence Database. Síntese dos resultados descritiva e por metanálises (modelo de efeitos fixos) com o software Review Manager. Qualidade metodológica avaliada pela escala Physiotherapy Evidence Database. Resultados: selecionaram-se 25 ensaios (5142 participantes) que revelaram melhoras estatisticamente significativas (p<0,05) em 54% (12/22) nos níveis de dor e 47% (10/21) na incapacidade funcional no grupo intervenção. As metanálises mostraram efeitos moderados na intensidade da dor e pequenos na incapacidade funcional. Houve predominância de estudos de média qualidade. Conclusão: intervenções de cuidados digitais mostraram resultado benéfico na intensidade da dor e na incapacidade funcional principalmente para dor lombar crônica. Evidenciam-se os cuidados digitais como promissores para apoiar o autogerenciamento das condições musculoesqueléticas de coluna. Registro PROSPERO CRD42021282102.

Anos de vida perdidos ajustados pela incapacidade decorrentes de distúrbios musculoesqueléticos em profissionais de enfermagem oncológica / Disability adjusted life years due to musculoskeletal disorders in oncology nursing professionals / Años de vida perdidos ajustados por discapacidad por trastornos musculoesqueléticos en profesionales de enfermería oncologica

Objetivos: Estimar Anos de Vida Perdidos Ajustados pela Incapacidade - DALY decorrentes de distúrbios musculoesqueléticos em profissionais de enfermagem nas unidades hospitalares de uma instituição oncológica. Métodos: Estudo ecológico, utilizando banco de dados institucionais. Valores absolutos de DALY foram transformados em taxas por 100 mil habitantes, e calculadas por categoria profissional, sexo e faixa etária. Resultados: Estimou-se 3,78 DALY (2.136/100 mil) entre todos os profissionais de enfermagem; entre Técnicos de enfermagem 2,62 DALY (2186//100 mil); e entre Enfermeiros 1,15 DALY (2024/100mil). Maior DALY ocorreu entre técnicos de enfermagem, sexo feminino, faixa etária de 50 a 59 anos, cujo valor é 0,98 (3.161/100mil). As Dorsopatias geraram mais DALY (1,97 DALY), destacando-se as lombalgias e cervicalgias. Dos diagnósticos encontrados, 54% referiam-se a Doenças Osteomusculares Relacionadas ao Trabalho, e apresentaram 2,62 DALY (69% do total de DALY). Conclusão: Houve uma grande quantidade de DALY decorrente de doenças musculoesqueléticas entre os profissionais de enfermagem da instituição.

Objectives: To estimate Disability-Adjusted Life Years Lost - DALY due to musculoskeletal disorders in nursing professionals in the hospital units of an oncology institution. Methods: Ecological study, using institutional database. Absolute DALY values were transformed into rates per 100,000 inhabitants and calculated by professional category, sex and age group. Results: It was estimated 3.78 DALY (2,136/100 thousand) among all nursing professionals, among Nursing Technicians 2.62 DALY (2186//100 thousand) and among Nurses 1.15 DALY (2024/100 thousand). Higher DALYs occurred among female nursing technicians, aged 50 to 59 years with 0.98 DALY (3,161/100,000). Dorsopathies generated more DALY (1.97 DALY), especially low back pain and neck pain. Of the diagnoses found, 54% referred to Work-Related Musculoskeletal Diseases, and presented 2.62 DALYs (69% of the total DALY). Conclusion: There was a large amount of DALY due tomusculoskeletal disorders among nursing professionals at the institution.

Objetivos: Estimar los Años de Vida Ajustados en función de la Discapacidad (AVAD) derivada de los trastornos musculoesqueléticos entre los profesionales de enfermería en centros de una institución de oncología. Métodos: Estudio ecológico, basado en datos institucionales.Los valores absolutos de AVAD encontrados se transformaron en tasas por 100.000 habitantes, y se calcularon según categoría profesional, sexo y grupo de edad. Resultados:Se estimaron 3,78 AVAD (2.136/100.000) entre los profesionales de enfermería; 2,62 AVAD (2186/100.000) entre los técnicos de enfermería; y 1,15 AVAD (2.024/100.000) entre los enfermeros. El mayor AVAD ocurrió entre los técnicos de enfermería, del sexo femenino, de entre 50 y 59 años de edad, con el valor de 0,98 (3.161/100.000). Las dorsopatías generaron más AVAD (1,97 AVAD), especialmente lumbalgia y cervicalgia. El 54% de losdiagnósticos se refieren a Enfermedades Musculoesqueléticas Relacionadas con el Trabajo, con 2,62 AVAD (69% del total de AVAD). Conclusión: Existe una alta carga de enfermedad musculoesquelética entre los profesionales de enfermería de la institución en estudio.

Cultural adaptation and validation of the COPCORD questionnaire for the detection of rheumatic diseases in the indigenous Misak population

Introduction: The objective was to adapt and valídate in a culturally sensitive way the methodology of the community-oriented programme for the control of rheumatic diseases (COPCORD) in the indigenous Misak community of Colombia. Material and methods: A culturally sensitive validation of the COPCORD questionnaire in Spanish was carried out, translating into the nam trik wam language used by the Misak community of Guambia town. It was adapted to the context of this population and later a back-translation to Spanish was carried out. Finally, it was validated applying the survey with the support of bilingual translators. Participants with pain, stiffness or swelling in any joint in the previous 7 days and/or at any time in life were evaluated by physicians and physiotherapists and were then, upon confirming the diagnosis of a musculoskeletal disorder, subsequently examined by a rheumatologist. Results: In this population (n = 106), 58.5% were women with an average age of 45.5 years. In the last 7 days, 51 subjects (48.1%) reported having musculoskeletal pain and 7 (44.3%) reported pain at some time in their life. Of those who received treatment, 53.1% reported using traditional medicine, 34.4% homeopathic treatment, and 25% allopathic treatment. The COPCORD Misak demonstrated an adequate capacity to detect musculoskeletal disorders, with a sensitivity of 63.3% and a specificity of 80.3%, with a positive likelihood ratio of 3.2, and area under the curve of.71. Conclusion: The COPCORD methodology is a valid screening tool to detect musculoskeletal disorders in the Misak community.

Introducción: El objetivo fue adaptar y validar, de forma culturalmente sensible, la metodología del Programa orientado a la comunidad para el control de enfermedades reumáticas (COPCORD) en la comunidad indígena misak de Colombia. Material y métodos: Se realizó una validación culturalmente sensible del cuestionario Copcord en español, que se tradujo al nam trik wam, lengua usada por el pueblo misak del resguardo de Guambia. El cuestionario se adecuó al contexto de esta población y posteriormente se llevó a cabo una retrotraducción al español. Por último, se validó aplicando la encuesta con el apoyo de traductores bilingües. Los participantes con dolor, rigidez o hinchazón en cualquier articulación en los siete días previos, o en cualquier momento de la vida, fueron evaluados por médicos y fisioterapeutas. Al confirmarse el diagnóstico de una enfermedad musculoesquelética los participantes eran examinados por un reumatólogo. Resultados: De la población estudiada (n = 106) el 58,5% fueron mujeres, con una edad promedio de 45,4 arios. En los últimos siete días, 51 sujetos (48,1%) informaron tener dolor musculoesquelético y siete (44,3%) refirieron dolor en algún momento de su vida. Quienes recibieron tratamiento reportaron el uso de medicamentos tradicionales en un 53,1% de los casos, homeopáticos en el 34,4% y alopáticos en el 25%. El cuestionario COPCORD Misak demostró una adecuada capacidad para detectar los trastornos musculoesqueléticos, con una sensibilidad del 63,3%, una especificidad del 80,3%, una razón de verosimilitud positiva de 3,2 y un área bajo la curva de 0,71. Conclusión: La metodología COPCORD es una herramienta válida de cribado de enfermedades musculoesqueléticas en el pueblo misak.

Shared epitope classification methods according to Gregersen and de Vries allow adequate characterization of patients with rheumatoid arthritis in a Colombian population

Introduction: The most important genetic association in rheumatoid arthritis (RA) is presented with some alleles from the HLA-DRB1 gene that encode the shared epitope (SE). Objectives: To apply the SE classification methods of Gregersen, de Vries, Raychaudhuri, Mattey, and Tezenas du Montcel in a group of Colombian patients with RA and determine the most common HLA-DRB1 alleles in the population. Methods: RA diagnosis, genetic study of the HLA-DRB1 region using Luminex technology in 50 RA and 50 healthy subjects. For the classification analysis, Fisher's exact test and chi-squared test were applied. Tables were created to count the RA-related alleles. We used odds ratio to determine the risk between the presence of the shared epitope (SE) and anti-cyclic citrullinated peptides (Anti-CCP). Results: Gregersen and de Vries methods were suitable for the characterization of RA in this population (p = .006). The most prevalent HLA-DRB1 alleles in the RA group were 14:02,04:04, 08:02,04:05, and 10:01. High frequencies of the 07:01, 03:01,13:02,01:02, and 12:01 HLA-DRB1 alleles were found in the healthy population. HLA-DRB1 alleles with similar distribution in both populations were 04:07, 15:01, 11:01, 16:02, and 01:01. A high frequency of SE + was observed in Anti-CCP + individuals (63.15%); however, this was not statistically significant [OR2.4 (.63-9.01); p = .19]. Conclusion: The SE classification methods of Gregersen and de Vries were adequate in characterizing RA in a Colombian population group. An equivalence of 100% was verified between the susceptibility alleles defined by de Vries and the alleles assigned as SE according to Gregersen.

Introducción: La asociación genética más importante en artritis reumatoide (AR) se presenta con algunos alelos del gen HLA DRB1 que codifican el epítope compartido (EC). Objetivos: Aplicar los métodos de clasificación de EC de Gregersen et al., de Vries et al., Raychaudhuri et al., Mattey et al., y Tezenas du Montcel et al., en un grupo de pacientes colombianos con AR, y determinar los alelos HLA DRB1 más frecuentes en esta población. Métodos: Diagnóstico para AR, estudio genético de la región HLA DRB1 por tecnología Luminex® de 50 sujetos AR y 50 sanos. Para análisis comparativos de clasificaciones EC, se aplicaron las pruebas test exacto de Fisher y Chi-cuadrado y se realizaron tablas de conteos para los alelos relacionados con AR. Se estimó la razón de odds para determinar el riesgo entre la presencia de EC y los anticuerpos antipéptidos cíclicos citrulinados (anti-PCC). Resultados: Los métodos de Gregersen et al. y de Vries et al. fueron adecuados para la caracterización de AR en esta población (p = 0,006). Los alelos HLA DRB1 más prevalentes en el grupo AR fueron 14:02, 04:04, 08:02, 04:05 y 10:01. Se encontraron altas frecuencias de los alelos HLA DRB1 07:01, 03:01,13:02, 01:02 y 12:01 en población sana. Alelos HLA DRB1 con distribución similar en ambas poblaciones fueron: 04:07, 15:01, 11:01, 16:02 y 01:01. Se observó alta frecuencia de individuos EC+ en el grupo AR anti-PCC+ (63,15%); no obstante, sin asociación estadística (OR: 2,4 [0,63-9,01]; p = 0,19). Conclusión: Los métodos de clasificación para EC de Gregersen et al. y de Vries et al. fueron adecuados caracterizando AR en un grupo de población colombiana. Se corroboró equivalencia del 100% entre los alelos de susceptibilidad definidos por de Vries y los alelos asignados como EC según Gregersen et al.

Characterization of patients with dermatomyositis in a university hospital in Colombia

Introduction: Dermatomyositis is an idiopathic inflammatory myopathy characterized by the presence of skin lesions; it is considered a heterogeneous disease, due to its clinical presentation, course, and prognosis. In Colombia there are few records that describe the clinical characteristics of these patients. Methods: Cross-sectional study. Medical records of patients who consulted a university hospital in Colombia between January 2004 and December 2019 were reviewed. The records were obtained using databases from the dermatology, rheumatology, dermatopathology, and electrophysiology units, and CIE10 diagnostic codes. Results: Seventy patients with a dermatomyositis diagnosis were found, 63 (90%) fulfilled the Bohan and Peter diagnostic criteria and 7 (10%) had amyopathic dermatomyositis, with an average age of 43 years (SD ± 15.3). Forty-eight were women (68.5%). The most frequent clinical signs were Gottron's papules 80%, periorbital violaceous (heliotrope) erythema with edema 78.5% (n = 55) and poikiloderma 75.7% (n = 53). The most frequently found systemic manifestations were dysphagia (21.4%, n = 15), interstitial lung disease (11.4%, n = 8), and pulmonary hypertension (8.5%, n = 6). Cancer was documented in 8.5% (n = 6) of patients. Conclusion: We showed clinical information of patients with dermatomyositis in a referral hospital in Colombia. The data obtained is consistent with information from other case series worldwide.

Introducción: La dermatomiositis es una miopatía inflamatoria idiopática que se caracteriza por presentar lesiones en la piel; por su presentación clínica, su curso y su pronóstico, se la considera una enfermedad heterogénea. En Colombia existen pocos registros que describan las características clínicas de los pacientes afectados por esta enfermedad. Métodos: Estudio descriptivo de corte transversal, se revisaron las historias clínicas de pacientes que consultaron a un hospital universitario en Colombia entre enero del 2004 y diciembre del 2019. Los registros se obtuvieron utilizando bases de datos de las unidades de dermatología, reumatología, dermatopatología, electrofisiología y códigos diagnósticos CIE10 asociados con dermatomiositis. Resultados: Se obtuvieron 70 pacientes con diagnóstico de dermatomiositis, 63 (90%) de los cuales cumplían criterios de clasificación de Bohan y Peter, en tanto que 7 (10%) presentaban dermatomiositis amiopática. El promedio de edad fue de 43 arios (DS ± 15,3); 48 fueron mujeres (68,5%); los signos clínicos más frecuentes fueron: pápulas de Gottron (80%, n = 56), eritema heliotropo (78,5%, n = 55) y poiquilodermia (75,7%, n = 53). Las manifestaciones sistêmicas más comúnmente encontradas fueron: disfagia (21,4%, n = 15), enfermedad pulmonar intersticial (11,4%, n = 8) e hipertensión pulmonar (8,5%, n = 6). Se documentó cáncer en el 8,5% (n = 6) de los pacientes. Conclusión: Se presenta información clínica de pacientes con dermatomiositis en un centro hospitalario de referencia en Colombia; los datos obtenidos concuerdan con la información de otros estudios de series de casos a escala mundial.

Analyzing complaints of arm, neck, and shoulder pain among academicians in Malaysia: a cross-sectional study on prevalence and contributing factors / Analisando queixas de dores nos braços, pescoço e ombros entre acadêmicos na Malásia: um estudo transversal sobre prevalência e fatores contribuintes

OBJECTIVES: Complaints of arm, neck, and shoulder (CANS) have been recognized as an important cause of work disability. Therefore, it is essential to identify those health risk factors for the development of CANS before they escalate into a disabling musculoskeletal condition. This study aims to ascertain the association between individual, physical, and psychosocial risk factors and the occurrence of CANS among academics in Malaysia. METHODS: A cross-sectional study design was adopted, enrolling 296 academic staff working at a private university in Malaysia using a convenient sampling approach. A content-validated questionnaire was distributed among selected academic staff to gather their feedback on the prevalence and contributing factors of CANS, and the survey was conducted for a period of six months. The chi-square test was used to analyze the association between risk factors and CANS, and multiple logistic regression was used to predict the risk factors of CANS. This study links all the health risk factors to CANS in Malaysian academicians. RESULTS: Of the academic staff who participated in this study, 63.5% reported an annual prevalence of CANS. Physical risk factors, including work experience, adopting a static head-down posture, time spent per day in teaching, and the number of hours spent in front of a computer, are associated with CANS (p<0.05). However, the utility of back support (p=0.878) and footrests (p=0.078) does not show any association with the occurrence of CANS (p>0.05). Besides job demand, other psychosocial factors do not show any significant association with CANS. DISCUSSION: The study found that 63.5% of academic staff suffer from arm, shoulder and neck pain, which is linked to physical risk factors such as work experience, static posture, teaching time and computer use. Back support and footrests had no significant influence on the complaints. Addressing physical risk factors is key to reducing these conditions among academic staff.

OBJETIVOS: As queixas do braço, pescoço e ombro (CANS, na sigla em inglês) foram reconhecidas como uma importante causa de incapacidade no trabalho. Portanto, é essencial identificar aqueles fatores de risco para a saúde para o desenvolvimento de CANS antes que elas se tornem uma condição musculoesquelética desabilitante. Este estudo visa determinar a associação entre fatores de risco individuais, físicos e psicossociais e a ocorrência de CANS entre acadêmicos na Malásia. METODOS: Um projeto de estudo transversal foi adotado, matriculando 296 funcionários acadêmicos que trabalham em uma universidade privada na Malásia usando uma abordagem de amostragem conveniente. Um questionário validado pelo conteúdo foi distribuído entre os funcionários acadêmicos selecionados para reunir os seus comentários sobre a prevalência e os fatores que contribuíram para a doença, e o inquérito foi conduzido por um período de seis meses. O teste Chi-square foi usado para analisar a associação entre os fatores de risco e as CANS, e regressão logística múltipla foi utilizada para predizer os fatores de risco de CANS. Este estudo vincula todos os fatores de risco para a saúde às CANS em acadêmicos da Malásia. RESULTADOS: Dos acadêmicos que participaram deste estudo, 63.5% relataram uma prevalência anual de CANS. Os fatores de risco físicos, incluindo a experiência de trabalho, a adoção de uma postura estática de cabeça para baixo, o tempo gasto por dia no ensino e o número de horas passadas na frente de um computador, estão associados com CANS (p<0.05). No entanto, a utilidade do suporte traseiro (p=0.878) e dos suportes de rodapé (p =0.078) não mostra nenhuma associação com a ocorrência de CANS (p>0.05). Além da procura de emprego, outros fatores psicossociais não mostram qualquer associação significativa com a CANS. CONCLUSÃO: O estudo constatou que 63,5% dos docentes sofrem de dores nos braços, ombros e pescoço, o que está ligado a fatores de risco físicos, como experiência de trabalho, postura estática, tempo de ensino e uso do computador. O apoio para as costas e os apoios para os pés não tiveram influência significativa nas queixas. Abordar os fatores de risco físicos é fundamental para reduzir estas condições entre o pessoal acadêmico.

Qualidade de Vida no Trabalho (QVT) e sintomas osteomusculares em Agentes Comunitários de Saúde / Quality of Work Life (QWL) and the musculoskeletal symptoms in Community Health Workers

INTRODUÇÃO: O Agente Comunitário em Saúde, em seu ambiente de trabalho, lida com vários desafios, tais como: as inúmeras tarefas, a exigência de produtividade, a falta de recursos, os conflitos interpessoais e as condições salariais inadequadas, implicando assim em sobrecarga física e mental, aspectos que podem repercutir na qualidade de vida e no aparecimento de distúrbios osteomusculares. OBJETIVO: Avaliar a Qualidade de Vida no Trabalho (QVT) e a presença dos sintomas osteomusculares dos Agente Comunitário de Saúde (ACS). MÉTODOS: Trata-se de um estudo transversal, com amostragem por conveniência, cujos participantes foram os ACS atuantes nas Unidades de Saúde da Família do Segundo Distrito Sanitário de Saúde em Maceió - Alagoas. Coletou-se os dados por meio dos seguintes instrumentos: questionário sociodemográficos; questionário de avaliação da qualidade de vida no trabalho (QWLQ-bref); e o questionário de sintomas osteomusculares (QNSO). RESULTADOS: Participaram 38 ACS, sendo a maioria do sexo feminino (86,8%). Obtiveram um escore médio de QVT de 59,84, o que representa uma posição de satisfação. Já na análise por domínios, o pessoal, psicológico e físico também se encontram na faixa de satisfação, exceto o domínio profissional com escore de 53,44, classificado como neutro. Em relação aos sintomas osteomusculares, o pescoço (55,3%) e a coluna lombar (47,4%) foram as regiões mais acometidas nos últimos 12 meses. CONCLUSÃO: Os resultados deste estudo, sinalizam a necessidade de adoção de melhorias nas condições de trabalho, tanto no sentido de repensar as questões que repercutem na QVT quanto no manejo dos problemas musculoesqueléticos.

INTRODUCTION: The Community Health Agent, in their work environment, deals with several challenges, such as the numerous tasks, the demand for productivity, the lack of resources, interpersonal conflicts and inadequate salary conditions, thus implying physical and mental overload; aspects that can affect the quality of life and the onset of musculoskeletal disorders. OBJECTIVE: Evaluate the Quality of Life at Work (QWL) and the presence of musculoskeletal symptoms in Community Health Agents (CHA). METHODS: This is a cross-sectional study, with convenience sampling, in which the participants were the CHA servers working in the Family Health Units of the Second Health Health District in Maceió - Alagoas. Data were collected using the following instruments: a sociodemographic questionnaire; a quality of work life assessment questionnaire (QWLQ-bref); and the musculoskeletal symptoms questionnaire (QNSO). RESULTS: Thirty-eight CHAs participated, most of them female (86.8%). It was obtained an average QWL score of 59.84, which represents a satisfactory position. In the analysis by domains, the personal, psychological and physical are also in the range of satisfaction, except for the professional domain with a score of 53.44, classified as neutral. Regarding musculoskeletal symptoms, the neck (55.3%) and lumbar spine (47.4%) were the most affected regions in the last 12 months. CONCLUSIONS: The results of this study indicate the need to adopt improvements in working conditions, both in the sense of rethinking the issues that affect QWL, as well as in the management of musculoskeletal problems.

Síntomas de trastornos musculoesqueléticos percibidos por estudiantes de la facultad de odontología­UNA, en el año 2021 / Symptoms of musculoskeletal disorders perceived among students of the school of dentistry ­UNA,in the year 2021

Introducción.Los trastornos musculoesqueléticos (TME) se definen como lesiones que afectan las diferentes estructuras que componen el sistema musculoesquelético. Existe una alta incidencia y prevalencia de los TME en los profesionales de la salud oral.Objetivo.Determinar la frecuencia de estudiantes del 3°, 4° y 5° año de la Facultad de Odontología, Universidad Nacional de Asunción con síntomas de los trastornos musculoesqueléticos. Material y Método.El presente trabajo posee un diseño observacional descriptivo de corte transversal que incluyó a 120 estudiantes elegidos por medio de un muestreo de conveniencia. El instrumento utilizado estuvo basado en el cuestionario nórdico estandarizado de percepción de síntomas musculoesqueléticos de Kuorinka. Resultados.Se excluyeron a 31 sujetos quedando el tamaño de la muestra en 89 sujetos (70 del sexo femenino). El 88,8 % (79 estudiantes) reportó haber percibido alguna vez sintomatología compatible con TME enal menos una región anatómica. El sexo femenino se vio más afectado (92.9 %) que el sexo masculino (73.7 %) (p = 0,033). No se observó diferencia significativa de la frecuencia de síntomas de TME entre los estudiantes de diferentes cursos. Las regiones anatómicas donde más se reportaron sintomatología fueron en el cuello (73 %) y en la región lumbar (69,7 %) seguido por la muñeca y las manos (50,6 %). Conclusión. Existe una alta proporción de estudiantes que reportan síntomas compatibles con trastornos musculoesqueléticos, más común entre las mujeres. Las zonas más afectadas fueron el cuello y la región lumbar.Palabras clave:enfermedades musculoesqueléticas;dolor musculoesquelético; estudiantes de odontología;encuestas y cuestionarios

Introduction.Musculoskeletal disorders (MSDs) are defined as injuries that affect the different structures that make up the musculoskeletal system. There is a high incidence and prevalence of MSDs among oral healthprofessionals.Objetive.To determine the frequency of students in the 3rd, 4th and 5th year of the School of Dentistry, National University of Asuncion with symptoms of musculoskeletal disorders. Material and Method. The present work has a descriptive cross-sectional observationaldesign that included 120 students chosen by means of convenience sampling. The instrument used was based on Kuorinka's standardized Nordic musculoskeletal symptom perception questionnaire. Results.Thirty-one subjects were excluded, resulting in a final sample size of 89 subjects (70 female). Seventy-nine 79 students (88,8%) reported having ever perceived symptoms compatible with MSDs in at least one anatomical region. Females were more affected (92.9%) than males (73.7%) (p = 0.033). There was no significant difference in frequency of perceived symptoms of MSDs between students in different courses. The anatomical regions where most symptoms were reported were in the neck (73%) and in the lumbar region (69.7%) followed by the wrist and hands (50.6%). Conclusion.There is a high proportion of students who report symptoms compatible with musculoskeletal disorders, more common among women. The most affected areas were the neck and lumbar region.Keywords:musculoskeletal disease; musculoskeletal pain; dental students; surveys and questionnaires

Meta analysis of the prevalence and influencing factors of WMSDs among dentists in China / 中华劳动卫生职业病杂志

Objective: To explore the relevant factors of work-related musculoskeletal disorders (WMSDs) among dentists through Meta analysis, providing a basis for the prevention and control of WMSDs among dentists. Methods: In April 2022, cross-sectional research literatures on the prevalence correlation of WMSDs among Chinese dentists were searched in databases such as China National Knowledge Infrastructure, Wanfang, VIP, PubMed, Web of Science, and Em Base database. The search was conducted from the establishment of the database until April 2022, literatures were selected using keywords such as musculoskeletal disorders and dentists. To extract gender, age, length of service, disease classification and other related influencing factors as indicator, and prevalence was selected as the outcome indicator. After evaluating the quality of the literatures, RevMan 5.3 software was used to calculate the combined RD (95%CI) values of the included literatures. Results: A total of 15 articles were included, with a total sample size of 3646 people. Meta analysis results showed that the prevalence of WMSDs among dentists in China was 80%, and the top three parts of the incidence rates were 65% of the waist, 58% of the neck, and 50% of the back. Gender, age, length of service, region and disease classification all increased the risk of WMSDs, and the combined effect size were 75%, 78%, 71%, 77% and 82% respectively (P<0.05) . Conclusion: The occurrence of WMSDs among dentists in China is related to multiple factors such as gender, age, length of service and disease classification. The above risk factors should be taken into account in the workplace and preventive measures should be actively implemented to prolong the working life of dentists.

Zooming in and out of ferroptosis in human disease / 医学前沿

Ferroptosis is defined as an iron-dependent regulated form of cell death driven by lipid peroxidation. In the past decade, it has been implicated in the pathogenesis of various diseases that together involve almost every organ of the body, including various cancers, neurodegenerative diseases, cardiovascular diseases, lung diseases, liver diseases, kidney diseases, endocrine metabolic diseases, iron-overload-related diseases, orthopedic diseases and autoimmune diseases. Understanding the underlying molecular mechanisms of ferroptosis and its regulatory pathways could provide additional strategies for the management of these disease conditions. Indeed, there are an expanding number of studies suggesting that ferroptosis serves as a bona-fide target for the prevention and treatment of these diseases in relevant pre-clinical models. In this review, we summarize the progress in the research into ferroptosis and its regulatory mechanisms in human disease, while providing evidence in support of ferroptosis as a target for the treatment of these diseases. We also discuss our perspectives on the future directions in the targeting of ferroptosis in human disease.

Intervenciones ergonómicas y su impacto en la profesión odontológica / Ergonomic interventions and their impact on the dental profession / Intervenções ergonômicas e seu impacto sobre a profissão odontológica

Introducción: los desórdenes músculoesqueletales tienen una alta prevalencia en la población general y en particular, en el área salud, los profesionales de la odontología representan una población altamente vulnerable, debido a características particulares del ejercicio de su profesión. Es creciente el estudio de diferentes intervenciones ergonómicas y el impacto que estas pueden tener sobre la reducción de la sintomatología muscular y en el desarrollo y/o la perpetuación de estos cuadros disfuncionales. Materiales y método: se realizó una revisión, de tipo narrativa, entre los meses de abril de 2022 y agosto de 2022. Se consultaron base de datos tales como MedLine/PubMed y Scielo, incluyendo artículos publicados en los últimos diez años. Resultados: se obtuvieron un total de 71 artículos, de los cuales, se excluyeron 30 trabajos, resultando en 41 los artículos incluidos en la presente síntesis cualitativa. Conclusiones: las intervenciones ergonómicas están dirigidas básicamente, a cambios en los ambientes de trabajo de los profesionales y/o a la implementación de programas que tienen como objetivo instruir y concientizar a los profesionales sobre criterios ergonómicos para su incorporación en el desempeño de su trabajo. Ambos enfoques intervencionistas, han sido evaluados con herramientas validadas de autopercepción, exámenes clínicos y evaluaciones instrumentales. Las estrategias que focalizan el problema, en los espacios de trabajo, y aquellas que, incluyen educación y formación en ergonomía, disminuyen el impacto de los desórdenes músculoesqueletales en esta población. Estas últimas, tienen la potencialidad de provocar cambios en los hábitos de los profesionales, con conductas que se mantienen a mediano plazo.

Introduction: musculoskeletal disorders have a high prevalence in the general population and in particular, in the health area, dental professionals represent a highly vulnerable population, due to the particular characteristics of the practice of their profession. The study of different ergonomic interventions and the impact they can have on the reduction of muscular symptomatology and on the development and/or perpetuation of these dysfunctional conditions is growing. Method: a narrative review was carried out between April 2022 and August 2022. Databases such as MedLine/PubMed and Scielo were consulted, including articles published in the last ten years. Results: a total of 71 articles were obtained, of which 30 were excluded, resulting in 41 articles included in this qualitative synthesis. Conclusions: ergonomic interventions are basically aimed at changes in the working environments of professionals and/or the implementation of programs aimed at instructing and making professionals aware of ergonomic criteria for their incorporation in their work performance. Both interventionist approaches have been evaluated with validated self-perception tools, clinical examinations and instrumental evaluations. Strategies that focus the problem in the workplace and those that include education and training in ergonomics reduce the impact of musculoskeletal disorders in this population. The latter have the potential to provoke changes in the habits of professionals, with behaviors that are maintained in the medium term.

Introdução: os distúrbios músculo-esqueléticos são altamente prevalentes na população em geral e, em particular, na área da saúde, os profissionais da odontologia representam uma população altamente vulnerável, devido às características particulares do exercício de sua profissão. O estudo de diferentes intervenções ergonômicas e o impacto que elas podem ter na redução dos sintomas musculares e no desenvolvimento e/ou perpetuação dessas condições disfuncionais está crescendo. Materiais e métodos: foi realizada uma revisão narrativa entre abril de 2022 e agosto de 2022. Bases de dados como MedLine/PubMed e Scielo foram consultadas, incluindo artigos publicados nos últimos dez anos. Resultados: foram obtidos um total de 71 artigos, dos quais 30 foram excluídos, resultando em 41 artigos incluídos nesta síntese qualitativa. Conclusões: as intervenções ergonômicas visam basicamente a mudanças nos ambientes de trabalho dos profissionais e/ou a implementação de programas que visam instruir e conscientizar os profissionais sobre critérios ergonômicos para sua incorporação em seu trabalho. Ambas as abordagens intervencionistas foram avaliadas com ferramentas validadas de autopercepção, exames clínicos e avaliações instrumentais. As estratégias que visam o problema no local de trabalho e aquelas que incluem educação e treinamento em ergonomia reduzem o impacto dos distúrbios músculo-esqueléticos nesta população. Estes últimos têm o potencial de provocar mudanças nos hábitos dos profissionais, com comportamentos que são mantidos a médio prazo.

Terapia biológica en artritis reumatoidea: una revisión de reacciones adversas / Biological therapy in rheumatoid arthritis: A review of adverse reactions

RESUMEN Introducción: La relación entre eventos adversos y aplicación de medicamentos biológicos en pacientes con diagnóstico de artritis reumatoide ha sido documentada a escala mundial, pero con escasa evidencia en Colombia. Si se asume que los eventos adversos o reacciones medicamentosas con hallazgos clínicos relevantes en la salud, como consecuencia de este tratamiento terapéutico, recaen sobre la calidad de vida del paciente e influyen en los indicadores de salud a escala nacional y en los recursos del sistema, se hace importante evaluar su impacto. Objetivos: Determinar la frecuencia de eventos adversos o reacciones adversas relacionados con el uso de medicamentos biológicos en una cohorte de pacientes con diagnóstico de artritis reumatoide de una aseguradora nacional, en el periodo comprendido entre los arios 2000 y 2019. Metodología: Se realizó un estudio descriptivo, transversal y retrospectivo, con alcance analítico, en pacientes diagnosticados de artritis reumatoide, con terapia biológica, en una aseguradora a escala nacional, con registros en historias clínicas del año 2000 al 2019. Resultados: Se analizaron 252 registros clínicos de usuarios con diagnóstico de artritis reumatoide y terapia biológica. El 62,7% presentó al menos una reacción adversa y se evaluaron 9 fármacos: tocilizumab, etanercept, adalimumab, abatacept, certolizumab, golimumab, infliximab, rituximab y tofacitinib. Este último es un fármaco incluido en este estudio por solicitud de la aseguradora fuente de la información. Conclusiones: En la terapia biológica de pacientes con artritis reumatoide las reacciones adversas son frecuentes, y en un 27,3% resultan severas, lo cual describe una situación previamente desconocida en Colombia.

ABSTRACT Introduction: The relationship between adverse events and the application of biological drugs in patients with a diagnosis of rheumatoid arthritis has been documented worldwide, but with little evidence of the situation in Colombia. If adverse events and / or drug reactions with relevant clinical findings in health because of this therapeutic treatment affect the patient's quality of life and influence health indicators at the national level and system resources, it is important to assess their impact. Objectives: To determine the frequency of adverse events and / or adverse reactions related to the use of biological drugs in a cohort of patients diagnosed with rheumatoid arthritis from a national insurer, in the period from 2000 to 2019. Methodology: A descriptive, cross-sectional, and retrospective study with analytical scope was carried out in patients diagnosed with rheumatoid arthritis, on biological therapy, under a nationwide insurer, with records in their medical records from 2000 to 2019. Results: 252 clinical records of users with a rheumatoid arthritis diagnosis and biological therapy were analysed; 62.7% had at least one adverse reaction; nine drugs were evaluated in this study: Tocilizumab, Etanercept, Adalimumab, Abatacept, Certolizumab, Golimumab, Infliximab, Rituximab, and Tofacitinib. Tofacitinib was included in this study at the request of the insurer providing the information. Conclusions: Adverse reactions with biological therapy in patients with rheumatoid arthritis are frequent and were severe in 27.3%. This is a situation previously unknown in Colombia.

Fibromialgia en la nueva era de la infección por SARS-CoV-2 y el síndrome post-COVID-19: una revisión exploratoria / no

Introducción: La fibromialgia es un síndrome caracterizado por dolor crónico generalizado, rigidez articular, trastornos del sueno, fatiga, ansiedad y episodios depresivos, cuyas manifestaciones clínicas comienzan después de un trauma físico o emocional. Pese a ello, son escasas las publicaciones que describen el impacto clínico de la COVID-19 en los síntomas de fibromialgia. Objetivo: Mapear la evidencia médica disponible sobre el impacto de la COVID-19 y el síndrome post-COVID en pacientes con y sin diagnóstico de fibromialgia previo a la infección. Materiales y métodos: Revisión sistemática exploratoria en PubMed y Scopus, considerando artículos en inglés y en español, con datos sobre la fibromialgia en población sobreviviente a la infección por SARS-CoV-2. Se revisaron los registros de ensayos clínicos de las bases de datos de la Organización Mundial de la Salud. Resultados: Se incluyeron 12 artículos publicados: estudios retrospectivos (n = 4), transversales (n = 2), casos y controles (n = 2), estudios cualitativos (n = 2), cohorte prospectiva (n = 1) y corte longitudinal (n = 1). La población total fue de 3.060 pacientes. Además, se incluyeron registros de un ensayo clínico controlado aleatorizado, un estudio observacional tipo transversal y uno de casos y controles. La suma total de la población estudiada fue de 173 participantes. Conclusión: Los pacientes sobrevivientes a la COVID-19 con o sin diagnóstico previo de fibromialgia pueden presentar un aumento del dolor crónico, insomnio, rigidez articular y deterioro en la calidad de vida. La población con antecedente de fibromialgia puede verse más afectada por estrés psicológico, lesión tisular a estructuras neuromusculares e inflamación por la infección por SARS-CoV-2.

Introduction: Fibromyalgia is a syndrome characterized by chronic generalized pain, joint stiffness, sleep disorders, fatigue, anxiety and depressive episodes, whose clinical manifestations begin after a physical or emotional trauma. However, few publications describe the clinical impact of COVID-19 on fibromyalgia symptoms. Objective: To map the available medical evidence on the impact of COVID-19 and PCS in patients with and without a diagnosis of fibromyalgia prior to infection. Materials and methods: Exploratory systematic review in PubMed and Scopus, considering COVID-19 Fibromyalgia SARS-CoV-2 articles in English and Spanish, with data on fibromyalgia in the population surviving SARS-CoV-2 infection. The clinical trial records of the World Health Organization databases were reviewed. Results: Twelve published articles were included: retrospective studies (n = 4), cross-sectional (n = 2), cases and controls (n = 2), qualitative studies (n = 2), a prospective cohort (n = 1) and a longitudinal section study (n = 1). The total study population of the included publications was 3,060 patients. In addition, one randomized controlled clinical trial and two observational cross-sectional and case-control studies were included. The total sum of the study population was 173 participants. Conclusion: Survivors of COVID-19 with or without a previous diagnosis of fibromyalgia may present an increase in chronic pain, insomnia, joint stiffness, and deterioration in quality of life. The population with a history of fibromyalgia may be more affected by psychological stress, tissue damage to neuromuscular structures, and inflammation due to SARS-CoV-2 infection.

Manifestaciones pulmonares de la artritis reumatoide, una revisión en tiempos de pandemia por SARS-CoV-2 / no

La artritis reumatoide (AR) es una de las patologías crónicas de origen autoinmune más frecuentes. Su prevalencia varía del 0,5 al 1%, con un compromiso primario a nivel articular, generando gran discapacidad por las deformidades secundarias derivadas de un estado inflamatorio persistente. Considerando el alto impacto en la calidad de vida de quienes la padecen, sumado al alto costo de las intervenciones terapéuticas, se vuelve imperativo para el personal de salud sumar todos los esfuerzos para promover un diagnóstico temprano y reconocer las potenciales complicaciones con el fin de impactar positivamente en los desenlaces clínicos. Alrededor del 50% de los pacientes con AR pueden tener compromiso extra articular, siendo el pulmón uno de los órganos más afectados. En época de pandemia por el virus SARS-CoV-2 es necesario recordar los tipos de compromiso pulmonar en pacientes con AR y tener en cuenta la susceptibilidad de estos pacientes a cuadros infecciosos que pueden generar una gran morbimortalidad.

Rheumatoid arthritis (RA) is one of the most frequent chronic autoimmune pathologies. It's prevalence varies from 0.5 to 1%, with a primary involvement at the joint, generating disability due to deformities secondary to persistent inflammation. Considering the high impact on the quality of life of those who suffer it, added to the high cost of therapeutic interventions, it becomes imperative for health personnel to join forces to promote early diagnosis and recognize potential complications, in order to impact positively on clinical outcomes. Around 50% of patients with RA may have extra-articular involvement, the lung being one of the most affected organs. In times of SARS-CoV-2 pandemic, it's necessary to remember the types of lung involvement in patients with RA and take into account the susceptibility of these patients to infectious conditions that can generate great morbidity and mortality.

Inicio de artritis reumatoide posterior a infección por SARS-CoV-2 / no

Se han descrito casos de patologías autoinmunes de inicio posterior a la infección por el virus SARS-CoV-2. La relación causal aún no es clara, por lo que es importante la construcción de la literatura frente a esta incógnita. Reportamos el caso de una mujer de 44 años que 18 días luego de cursar con infección por SARS-CoV-2 sin hipoxemia, presenta poliartralgias inflamatorias y paraclínicos compatibles con un diagnóstico de artritis reumatoide. Este caso refuerza la posibilidad de una relación causal entre ambas entidades.

Cases of autoimmune pathologies with onset after infection by the SARS-CoV-2 virus have been described. The causal relationship is not yet clear. We report the case of a 44-year-old woman who, 18 days after presenting with SARS-CoV-2 infection without hypoxaemia, presented with a clinical picture compatible with a diagnosis of rheumatoid arthritis. This case reinforces the possibility of a causal relationship between both entities.

Isotretinoin-induced arthritis: A rare but feasible diagnosis. Case report

Many medications and vaccines have had implications in the development of musculoskeletal and joint symptoms, and among them the use of retinoids has been associated with the development of musculoskeletal symptoms, as well as axial symptoms suggestive of spondyloarthritis, with sacroiliitis, and to a lesser extent the development of peripheral symptoms. We describe the debut of peripheral inflammatory symptoms with the use of isotretinoin, in a previously healthy patient.

Muchos medicamentos y vacunas han tenido implicaciones en el desarrollo de síntomas osteomusculares y articulares. Entre ellos, el uso de retinoides se ha asociado con el desarrollo de síntomas musculoesqueléticos, así como síntomas axiales sugestivos de espondiloartritis con sacroileítis, y en menor proporción el desarrollo de síntomas periféricos. Describimos el inicio de síntomas inflamatorios periféricos con el uso de isotretinoína en una paciente previamente sana.

Sjögren's syndrome: Epidemiology and clinical manifestations

Sjögren's syndrome is an entity of rheumatic origin, with complex autoimmune characteristics, in which the salivary and lacrimal glands are mainly compromised. It has two forms of presentation, one primary and the other secondary, and in both forms there is evidence of exocrine glands involvement. The clinical spectrum of Sjögren's syndrome is very heterogeneous and is classified into glandular and extra-glandular manifestations, but not mutually exclusive. It is recommended that all patients with parotid inflammation, purpura, hypergammaglobulinaemia, anti-SSa, and anti-SSb should be seen to have a greater risk of presenting with a severe systemic presentation, and it is recommended to carry out a more strict medical control. Population studies that have attempted to describe the incidence and prevalence of Sjögren's syndrome in various countries throughout the world are to some extent discordant between one registry and another. Although Sjögren's syndrome is more common in women, ocular involvement predominates in men, and it can occur in all ages, mainly between the third and fifth decades of life. In children it is rare. It is also considered as a common connective tissue disease, where the data on the global incidence rate and prevalence are underestimated.

El síndrome de Sjögren es una entidad de origen reumático, con características autoinmune complejas, en la que se ven comprometidas principalmente las glándulas salivales y las lagrimales. Tiene 2 formas de presentación, una primaria y otra secundaria, y en ambas se observa una afección de las glándulas exocrinas. El espectro clínico del síndrome de Sjögren es muy heterogéneo y se clasifica en manifestaciones glandulares y extraglandulares, no excluyentes entre sí. Se recomienda que se haga un control médico más estricto a todo paciente que curse con una inflamación parotídea, púrpura, hipergammaglobulinemia y anticuerpos anti-SSa, anti-SSb, puesto que presenta mayor riesgo de cursar con una presentación sistémica grave. Los estudios poblacionales que han intentado describir la incidencia y la prevalencia del síndrome de Sjögren en diferentes países son hasta cierto punto discordantes entre un registro y otro. El síndrome de Sjögren es más frecuente en mujeres, pero en hombres predomina más la afectación ocular; puede presentarse en todas las edades, principalmente entre la tercera y la quinta décadas de la vida; en niños es raro. Se considera además como una conectivopatía frecuente, en la cual los datos de la tasa de incidencia global y de prevalencia se encuentran subestimados.

Systemic sclerosis in a patient with Turner syndrome: A case report and a review of associated autoimmune diseases

Turner's syndrome (TS) is one of the most common sex chromosome disorders caused by numeric or structural abnormalities of the X chromosome. A case of TS and Systemic Sclerosis (SSc) is reported, along with a summary of all associated TS/autoimmune diseases described in English literature from 1948 to 2020, using a search in MEDLINE (Pubmed). A 32-year-old woman affected by TS was seen due to inflammatory arthralgia in small joints and dysphagia, as well as a two-year history of Raynaud's phenomenon and puffy hands. Biohumoural laboratory tests and severity scales revealed changes that allowed us to diagnose SSc. This case report emphasises the role played by sex hormones and chromosomal abnormalities in the pathogenesis of autoimmune disorders, and to our knowledge, this is the only case described in literature of a TS patient who developed SSc.

El síndrome de Turner (TS) es uno de los trastornos cromosómicos sexuales más comunes causados por anomalías numéricas o estructurales del cromosoma X. En este documento informamos de un caso de TS y esclerosis sistémica (SSc) y resumimos toda la asociación de TS/enfermedades autoinmunes descrita en la literatura inglesa de 1948 a 2020, encontrada buscando en MEDLINE (PubMed). Una mujer de 32 arios afectada por TS acudió a nuestra observación debido a la artralgia inflamatoria en pequenas articulaciones y disfagia y 2 anos de historia del fenómeno de Raynaud y las manos hinchadas. El laboratorio biohumoral y las pruebas instrumentales revelaron alteraciones que nos permitieron diagnosticar SSc. Nuestro informe de caso hace hincapié en el papel desempefíado por las hormonas sexuales y las anomalías cromosómicas en la patogénesis del trastorno autoinmune; y hasta nuestro conocimiento, este es el único caso descrito en la literatura de un paciente TS que desarrolló SSc.