Evaluación del tratamiento con infliximab en enfermos con artritis inflamatoria refractaria a drogas habituales / Effectiveness of infliximab in patients with inflammatory arthritis refractory to conventional treatment

BACKGROUND: Tumor necrosis factor antagonists are useful in the treatment of several chronic inflammatory immune mediated diseases. AIM: To assess the effects of infliximab in 21 patients with inflammatory arthropaties, refractary to conventional treatment. PATIENTS AND METHODS: Eleven patients with rheumatoid arthritis, seven with psoriatic arthritis and three with spondyloarthritis were treated. The mean duration of the diseases was 10 years. Infliximab was administered intravenously in a dose of 3 mg/kg body weight. A median of 6 doses in 8 months was administered. Effectiveness was assessed in 19 patients that received three or more doses. RESULTS: Infliximab was effective in 16 patients (10 with rheumatoid arthritis, four with psoriasis and two with spondyloarthritis) and ineffective in three. In responsive patients, a reduction in the number of inflammed joints and morning stiffness and an improvement in functional capacity was observed. Fifteen of the 16 patients perceived an improvement in their health status. This answer was concordant with concomitant medical evaluation in 15. Patients that maintained the treatment felt very well, well or regular, whereas five of six patients that discontinued the treatment felt ill. Thirteen patients had adverse effects. Treatment was discontinued in two patients due to drug induced lupus, allergy in 2, hypertension in one, high costs in three and lack of response in three. CONCLUSIONS: Infliximab reduced arthritic activity in 16 of 19 patients with severe treatment refractary arthritis.

Enfermedad de Paget en Chile: una serie de 15 pacientes / Paget disease of bone in Chile: report of 15 cases

BACKGROUND: Paget disease of bone (PD) is a localized disorder of bone remodeling, which leads to bone fragility and deformity. In Chile PD is uncommon. AIM: To study clinical and demographic characteristics of patients with PD seen in the Clinical Hospital of the Catholic University. PATIENTS AND METHODS: Patients with typical radiological and clinical features of PD referred to our institution during the last decade were included in this review. RESULTS: We obtained data from 15 patients with PD (ten males, eight Chilean, six European and one Asian), eleven of them were diagnosed during the last 3 years. The mean age at diagnosis was 68.7 +/- 11.1 years old. No one had first degree relatives with PD. Bone pain was the main complaint in 13 patients and elevated total alkaline phosphatases in the other two. The average duration of the symptoms prior to diagnosis was 38.8 months. Eight patients had monostotic lesions; the most commonly involved sites were the pelvis, spine and femur. Radiological evaluation disclosed sclerotic changes in all patients as well as bone deformity and osteoarthritis in eight patients. Total alkaline phosphatases were elevated in 14 cases (mean: 4 times over the upper normal limit). CONCLUSIONS: When compared to series of the Northern hemisphere, PD in Chile is characterized by an older age at diagnosis, a higher frequency of symptomatic presentation, advanced radiological involvement and greater proportion of complications. PD should be suspected in every patient, Chilean or foreigner, with bone pain or elevated alkaline phosphatases.

Anemia autoinmune y trombopenia en enfermedad mixta del tejido conectivo. / Autoimmune anemia and thrombocytopenia in mixed connective tissue disease

Se presenta un varon de seis anos, portador de enfermedad mixta del tejido conectivo (EMTC). Las manifestaciones iniciales fueron: anemia hemolitica Coomb positivo, trombopenia, artritis y hepatoesplenomegalia. La busqueda de anticuerpos dirigidos contra un antigeno soluble (ENA) dio resultados positivos contra una ribonucleoproteina (RNP) de origem nuclear. El paciente mejoro en coincidencia con el empleo de prednisona. No encontramos en la literatura otra comunicacion de EMTC con esta forma de comienzo en ninos. Se revista las manifestaciones clinicas, examenes de laboratorio y tratamiento de la EMTC en ninos