Efectos de la bromocriptina en pacientes con artritis reumatoide activa / Effects of bromocriptine in patients with active rheumatoid arthritis

Background: Neuroendocrine factors play an important role in the expression of autoimmune disease. Proclatin (PRL) can induce T-cell proliferation and macrophage activation. Elevated PRL levels have been described in patients with rheumatoid arthritis and (RA). Aim and Methods: We studiend immunological and clinical effects of PRL suppression in 9 RA patients with active disease, treated for 3 months with bromocriptiner (BRC), an inihibitor of PRL secretion. Results: BRC induced a significant depression of the peripheral blood mononuclear cells response to antigen (p=0.008) and mitogen (p=0.008) which was significantly correlated with improvements in the HAQ disability index (r=0.68; p=0.04) and grip strength (r=0.7; p=0.02). Also, the in-vitro production of IL-2, nitric oxide and poliamines -that are critical for the proliferative response of lymphoid cells- decreased significantly. The group experienced significant improvement of grip strength (p=0.028) and the HAQ disability index (p=0.025), whereas 4 individuals archieved clinical improvement according to the American College of Rheumatology preliminary definition. We conclude that BRC treatment induces a significant depression of in-vitro immune function in RA patients and these changes are related to parameters of disease activity. The effects of BRC on immune function and disease activity in RA patients warrant further investigation

Artritis seronegativas: reexamen del diagnóstico inicial y pronóstico al cabo de 10 años / Seronegative arthritis: diagnosis and prognostic reassessment after 10 years

Seronegative arthritides are a heterogeneous group of diseases that includes rheumatoid arthritis with negative rheumatoid factor. Between 1980 and 1984 we studied 38 patients with seronegative arthritis. Thirty of these patients were reassessed in 1994 after 9 or 20 years of evolution. Seventeen patients had a diagnosis of seronegative rheumatoid arthritis; this diagnosis was maintained in 12, changed to seropositive rheumatoid arthritis in 3, to psoriatic arthritis in 1 and connective tissue disease in 1. Thirteen patients had a diagnosis of undifferentiated arthritis; in 1994 the diagnosis was maintained in 3, 7 patients were diagnosed as having a sppondyloarthropathy, 2 as having a reactive arthritis and 1 as having a connective tissue disease. In 1994, nine patients fulfilled the 1991 criteria for spondyloarthritis and 6 of these did so on admission. Six of 12 patients with seronegative rheumatoid arthritis had an active disease or used antiinflammatory drugs and 64 percent had erosions on hand X ray examination. These figures are in contrast with the enigm evolution classically attributed to this disease and agree with recent reports. The usefulness of classification criteria for rheumatoid arthritis and spondyloarthritis in the initial assessment of patients with seronegative arthritis is emphasized

Infección y artritis reactiva: correlación clínico bacteriológica en artropatía seronegativa / Infection and reactive arthritis: clinical bacteriological correlation in seronegative arthropathies

The aim of this study was to search infections that trigger reactive arthritis. Eigthy-six patients with seronegative arthritis (SNA) were studied; 32 had reactive arthritis, 21 ankylosing spondylitis, 7 psoriatic arthritis and 26 undifferentiated seronegative oligoarthritis. As controls, 70 patients with connective tissue diseases (CTD) and 55 healthy volunteers (HV) were studied. Serological evidence for infection with Chlamydia trachomatis was studied with micro immunofluorescence, looking for L2 and BED serotypes and serological evidence for Yersinia infection, using a commercial kit. Stool cultures were done in seven patients with recent diarrhea and endourethral or endocervical cultures in 35 individuals. Serotypes L2 or BED were positive in 23 of 83 patients with SNA, 3 of 39 patients with CTD and 4 of 55 HV (p<0.03). IgG class antibodies against L2 were detected in 17 percent of SNA patients, 2.6 percent of CTD patients and 5.4 percent of HV (p<0.05). IgM class antibodies were detected in 6 SNA patients, 0 CTD patients and 2 HV (NS). 12 of 35 cultures were positive for Chlamydia. As a whole 30 percent of SNA patients has serological or bacteriological evidence for Chlamydia infection. Serology for Yersinia was positive in 39 of 81 SNA patients, 1 of 54 CTD patients and 3 of 51 HV (p<0.01). Rates of infections were similar among male, female, HLA B27 positive and HLA negative subjects. It is concluded that SNA patients have a high prevalence of infections by Chlamydia trachomatis or Yersinia enterocolitica

Bronquiectasia como forma de presentación de inmunodeficiencia común variable / Bronchiectasis as a common variable immunodeficiency

Se presentan 2 pacientes con bronquiectasia en los cuales se demostró inmunodefiencia común variable (IDCV). Ambos pacientes fueron tratados con gammaglobulina con buena respuesta. Consideramos que el estudio de pacientes con bronquiectasias debe investigarse la IDCV

Arteritis de la temporal y polimialgia reumática: estudio clínico / Temporal arteritis and polymyalgia rheumatica: a clinical study

La arteritis de la arteria temporal es una vasculitis granulomatosa cuya frecuencia aumenta en las personal de edad. Clínicamente puede manifestarse por compromiso del estado general, síndrome depresivo y síntomas derivados de la obstrucción vascular como claudicación de mandíbula, dolor en el trayecto arterial y ceguera. En el 50% puede presentarse como polimialgia reumática, la que se caracteriza por mialgias y artrialgias proximales, síndrome febril, eritrosedimentación elevada y compromiso del estado general. Se analizan 18 pacientes, diez con polimialgia reumática y ocho con arteritis de la temporal; los hallazgos clínicos más frecuentes son: mialgias proximales y decaimiento 83%, artralgias y cefalea 66%, rigidez 50% y dolor en la arteria temporal 38%. La alteración de laboratorio más frecuente fue eritrosedimentación elevada. Esta serie clínica confirma la presencia de arteritis de temporal y polimialgia reumática en nuestro medio, sugiriendo que son más frecuentes de lo que se ha reportado a la fecha