Osteoporosis: Parte I - Generalidades / Osteoporosis: Part I - Basic concepts

This review corresponds to a general analysis of osteoporosis, with emphasis in calcium metabolism, the role of Vitamin D, as well as osteoporosis physiopathology, diagnosis and treatment. The second part (Osteoporosis. Part II) will describe the importance of osteoporosis in several digestive diseases (liver and gastrointestinal tract).

En esta revisión abordamos el tema osteoporosis en forma general, desarrollando principalmente el metabolismo del calcio, el rol de la vitamina D; así como la fisiopatología, el diagnóstico y tratamiento de la osteoporosis. En la segunda parte (Osteoporosis. Parte II ) se describirá la importancia de la osteoporosis en diversas enfermedades digestivas (hepáticas y del tubo digestivo).

Osteoporosis: parte II: en enfermedades hepáticas y del tubo digestivo / Osteoporosis: part II: in liver and digestive tract diseases

The present review addresses liver and gastrointestinal diseases that are more frequently associated to osteopenia and osteoporosis. For each disease, we describe the prevalence and physiopathology of these bone metabolism conditions. The purpose is to create awareness of this scenario and prompt early analysis if these patients, and in other cases, to provide prophylaxis and treatment of these disorders.

En esta revisión se abordan las enfermedades hepáticas y del tubo digestivo que con mayor frecuencia se asocian a osteopenia y osteoporosis. En cada patología describimos la prevalencia y fisiopatología de estas afecciones del metabolismo óseo. El objetivo es dar a conocer esta realidad e inducir a que estos pacientes sean estudiados precozmente, en otros casos aplicar la profilaxis y tratar estos desórdenes.

Síndrome antifosfolípido catastrófico: caso clínico / Catastrophic antiphospholipid syndrome: clinical case

El síndrome antifosfolípido (SAF) fue descrito y caracterizado durante la segunda mi-tad del siglo XX inicialmente como un fenómeno protrombótico secundario en con-texto de otras enfermedades del tejido conectivo, principalmente lupus. Sin embargo, el estudio de pacientes con enfermedad primaria impulsó a distintos consensos, tan-to clínicos como de laboratorio para su correcta identificación. Entre los pacientes con SAF destaca la forma de presentación catastrófica, de baja prevalencia, pero impor-tante por su mal pronóstico, caracterizada por el compromiso de múltiples sistemas en corto tiempo. Presentamos el caso de una paciente del Hospital Clínico San Borja-Arriarán con diag-nóstico de SAF primario, que presentó en su evolución la forma catastrófica. Este caso sirve de base para una revisión del proceso diagnóstico del SAF en relación a otras patologías reumatológicas y las características propias del SAF catastrófico.

Antiphospholipid syndrome (APS) was described and characterized during the second half of the 20th century initially as a secondary prothrombotic phenome-non in the context of other connective tissue diseases, mainly lupus. However, the study of patients with primary disease prompted different consensus, both clin-ical and laboratory for their correct identification. Among patients with APS, the catastrophic presentation is of low prevalence, but important because of its poor prognosis, characterized by the commitment of multiple systems in a short time. We present the case of a patient from the San Borja-Arriaran Clinic Hospital with di-agnosis of primary APS, which presented the catastrophic form in its evolution. This case serves as a basis for a review of the diagnostic process of APS in relation to other rheumatologic pathologies and the characteristics of catastrophic APS.

Fracturas vertebrales: ¿Son inocuas? / Vertebral fractures: are harmless?

La masa ósea disminuye y el riesgo de fracturas aumenta con la edad, especialmente en la posmenopausia. Las fracturas vertebrales son las fracturas osteoporóticas más frecuentes, y se asocian a deformidad de columna, reducción de estatura, dolor de espalda, dificultad respiratoria, morbilidad y mortalidad aumentadas; y pueden predecir futuras fracturas vertebrales y de cadera.

Bone mass declines and the risk of fractures increases as people age, specially in postmenopausal women. Vertebral fractures are the most frequent osteoporotic fractures and associated to spine deformity, height loss, back pain, impaired breathing, increased morbidity and mortality; and predict future spine and hip fractures.

Estudio de la eficacia del condroitín 4 y 6 sulfato en los síntomas de la artrosis de rodilla / Study of the effectiveness of condroitín 4 and 6 sulphate in the symptoms of the artrosis of knee

We developed a prospective, open study to evaluate the efficacy of chondroitin sulfate in the treatment of kneeosteoarthritis. Methodology: We studied 61 patients with primary knee osteoarthritis. They were given 800mg/day chondroitin 4-and 6- sulfate (Condrosulf, IBSA, Switzerland) for a period of three months. Patients were controlled every 30 days using the Lequesne index and the visual analogue pain scale. Medication was suspended after 90 days and patients were reevaluated 90 days later. Only Paracetamol was allowed as analgesic. Results: After 90 days a significant improvement of45 percent was observed in the Lequesne index, and 59 percent for knee pain. Once medication is suspended, the effect tends to slowly revert, with final study results significantly better than basal levels. Residual effect is better in patients under age 65 and in those with less basal radiological damage. Subjective opinion of both patient and doctor concurs with results. Conclusions: Chondroitin 4-and 6- sulfate is effective for the symptomatic treatment of knee osteoarthritis. Its effect lasts several months after drug suspension.

Artritis idiopática juvenil de inicio sistémico y síndrome de activación macrofágica / Juvenile idiopathic arthritis of sistemic beginning and syndrome of macrophage activation

The macrophage activation syndrome (MAS) i a rare pediatric condition characterized by enhanced activation of the macrophage and T-cell system, with increased liberation of T-cell cytokines. Clinically it resembles a multiorgan failure syndrome of infectious etiology. There is still some debate as to the nomenclature of this syndrome, hemato-oncologists usually classify this syndrome as a histiocytic disorder, while rheumatologists define it as MAS. We review a patient in which MAS was diagnosed during the early stages of the disease. The patient had juvenile idiopathic arthritis (systemic presentation).