Técnica de doble injerto gingival libre para incremento de encía queratinizada / Double gingival free graft technique to increase keratinized gum

Introducción: La encía queratinizada es un componente importante del complejo mucogingival. Su ausencia puede deberse a recesiones gingivales, traumas, caries radicular, entre otras. La técnica de injerto gingival libre es considerada el estándar de oro, por ser una técnica óptima para aumentar la extensión del vestíbulo y el ancho del tejido queratinizado por sus altas tasas de éxito y predictibilidad clínica. Objetivo: El propósito de este caso clínico fue evaluar el uso de una modificación de la técnica del injerto gingival libre. Presentación de caso: El caso clínico incluyó aumento de la profundidad del vestíbulo y de la encía queratinizada en ambas zonas del sector anteroinferior, para lo cual se utilizaron las dos hemiarcadas del paladar como la zona dadora del injerto (doble injerto). El caso utilizó un doble injerto gingival libre como técnica novedosa para el aumento gingival. Después de dos meses de cicatrización, se observó reducción de la recesión gingival y un aumento notorio del ancho de la encía queratinizada. Conclusiones: La técnica modificada de doble injerto gingival libre, es una buena alternativa para aumentar el grosor de la encía queratinizada en el sector anteroinferior, además de reducir el tiempo posoperatorio y generar una cicatrización uniforme a nivel de la línea mucogingival(AU)

Introduction: Keratinized gingiva is an important component of the mucogingival complex. Its absence may be due to gingival recessions, trauma, root caries, among others. The free gingival graft technique is considered the gold standard, as it is an optimal technique to increase the extension of the vestibule and the width of the keratinized tissue due to its high success rates and clinical predictability. Objective: The purpose of this clinical case was to evaluate the use of a modification of the free gingival graft technique. Case report: The clinical case included an increase in the depth of the vestibule as well as the keratinized gingiva in both areas of the anteroinferior sector, for which the two hemiarchates of the palate were used as the graft donor area (double graft). The case used a free double gingival graft as a novel technique for gingival augmentation. After two months of healing, a reduction in the gingival recession was observed, as well as a noticeable increase in the width of the keratinized gingiva. Conclusions: The modified free double gingival graft technique is a good alternative to increase the thickness of the keratinized gingiva in the anteroinferior sector, in addition to reducing the post-operative time and generating uniform healing at the level of the mucogingival line(AU)

Efficiency of adalimumab, etanercept and infliximab in ankylosing spondylitis in clinical practice.

BACKGROUND: Information on the use of ankylosing spondylitis (AS) therapies in clinical practice is a key factor in decision making, as more efficient treatments may involve substantial savings while maintaining the clinical benefits for the patient. OBJECTIVE: To assess the mean annual doses and associated costs of the three main anti-tumour necrosis factor agents used in Spanish daily clinical practice in ankylosing spondylitis patients and to correlate these costs with disease activity. SETTING: This retrospective, observational study included adult ankylosing spondylitis patients over a 4-year period that had been treated for at least 6 months with adalimumab, etanercept or infliximab at two University Hospitals in Spain. METHODS: Disease activity was estimated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores at the start of anti-tumour necrosis factor (anti-TNF) therapy and in the last visit or whenever the drug was switched. Mean costs were estimated for a 52-week horizon from the delivered doses registered by pharmacy records. Outcomes were the doses and costs of anti TNFs administered to each patient, and the BASDAI score. RESULTS: A total of 119 patients (137 cases) were included (28 cases treated with adalimumab, 48 cases with etanercept and 61 with infliximab). Mean doses of adalimumab and etanercept were 92.8 and 88.8% of the initially prescribed doses, respectively, while the mean dose of infliximab administered was 102%. There were no statistical differences among treatments in terms of clinical effectiveness. Associated mean patient-year costs were significantly higher in the infliximab group (€14,235), compared to the other treatments [adalimumab €11,934; etanercept €10,516; (P < 0.05)]. CONCLUSION: In certain ankylosing spondylitis patients, doses and associated costs of biological therapies can be reduced while controlling disease activity. Mean doses used in our clinical practice vary from the recommended doses and are significantly lower for adalimumab and etanercept than for infliximab. These differences impact directly on associated patient-year costs, and, thus, on treatment efficiency.

Síndrome neurológico seudotumoral de la enfermedad de Behçet en un paciente tratado con antagonistas del factor de necrosis tumoral / Pseudotumoral neurobehçet in a patient treated with anti-tumor necrosis factor alpha

No disponible

Idiopathic recurrent pericarditis treated successfully with tumour necrosis factor alpha blocking agents (anti-TNF-α).

Idiopathic recurrent pericarditis (IRP) is defined by 2 or more episodes of acute pericarditis of unknown etiology. Either auto-immune or auto-inflammatory diseases are suspected. Usually, non-steroidal anti-inflammatory drugs, colchicine or low dose steroid treatments are effective, however, side effects and/or non-response patients are frequent. We report on three paediatric patients with IRP from our paediatric rheumatology unit. The patients were non-responders to standard therapy and were treated with tumour necrosis factor alpha blocking agents (anti-TNF-α) and showed significant improvement. In two patients, the treatment was tapered and then stopped following several years of therapy. Symptoms flared in the last patient when therapy was tapered more quickly. We conclude that anti-TNF-α can be useful in selected cases of IRP.

Modelo de excelencia en el Hospital de Día de Reumatología en España: proyecto HD-Reumatolex / Model of excellence in Rheumatology Day Hospitals in Spain: the HD-Reumatolex project

Objetivos. Los tratamientos biológicos han superado en eficacia a los tratamientos tradicionales de la artritis reumatoide, aunque algunos no pueden administrarse de forma ambulatoria. La hospitalización de día supone la asistencia hospitalaria durante unas horas para aquellos tratamientos que no pueden realizarse en la consulta externa ni justifican el ingreso del paciente. Existen pocos estudios que analicen la situación de los Hospitales de Día de Reumatología (HDR) en España. El proyecto HD-Reumatolex tiene como objeto evaluar la situación de distintos HDR españoles desde una óptica estratégica, formativa, de gestión y de calidad asistencial. Material y métodos. Se diseñó un «Modelo de excelencia en HDR» que sirvió como base para realizar un análisis comparativo y anónimo (benchmarking) entre 21 Servicios de Reumatología. Se valoraron 19 criterios, clasificados en 3 categorías: Procesos estratégicos, Procesos clave y Procesos de soporte. Resultados. Los aspectos con peor puntuación media fueron los de seguimiento de guías de práctica clínica y existencia de un plan de calidad (Procesos estratégicos), formación de los profesionales del HDR (Procesos de soporte), y admisión de pacientes y procedimiento de alta (Procesos clave). Cinco HDR alcanzaron el benchmark al representar gráficamente su posición en los Procesos clave frente a los estratégicos y a los de soporte. Un HDR se posicionó como líder indiscutible en el análisis comparativo. Conclusiones. Ninguno de los HDR consiguió la puntuación máxima total, ni a nivel de categoría ni de resultados totales. Esto significa que existen oportunidades de mejora hacia la excelencia para todos los HDR participantes(AU)

Objectives: Biologics have shown greater efficacy than traditional treatments in patients with rheumatoid arthritis, although some cannot be administered on an outpatient basis. Day hospitalization requires the patient to attend the hospital for a few hours to receive those treatments that cannot be administered on an outpatient basis or that do not justify admission to hospital. Few studies have analyzed the situation of Rheumatology Day Hospitals (RDH) in Spain. The HD-Reumatolex project aims to evaluate the situation of Spanish RDHs in terms of strategy, training, management, and quality of care. Material and methods: The project was based on a “model of excellence in RDH” design, which made it possible to perform a comparative analysis (benchmarking) of 21 Rheumatology Departments. The 19 criteria evaluated were divided into 3 categories: Strategic processes, Key processes, and Support processes. Results: The lowest mean scores were recorded for follow-up of clinical practice guidelines/ recommendations and existence of a quality plan (Strategic processes), criteria for training among RDH professionals (Support processes), and admission and discharge (Key processes). Five RDH achieved the benchmark when the position obtained by the RDH in Key processes was plotted against the one obtained in Strategic processes and Support processes. One RDH emerged as a clear leader in the comparison. Conclusions: None of the RDH obtained the total maximum score at the category level or at the total results level, thus revealing room for improvement in the attainment of excellence for all the participating centers(AU)

Model of excellence in Rheumatology Day Hospitals in Spain: the HD-Reumatolex project.

OBJECTIVES: Biologics have shown greater efficacy than traditional treatments in patients with rheumatoid arthritis, although some cannot be administered on an outpatient basis. Day hospitalization requires the patient to attend the hospital for a few hours to receive those treatments that cannot be administered on an outpatient basis or that do not justify admission to hospital. Few studies have analyzed the situation of Rheumatology Day Hospitals (RDH) in Spain. The HD-Reumatolex project aims to evaluate the situation of Spanish RDHs in terms of strategy, training, management, and quality of care. MATERIAL AND METHODS: The project was based on a "model of excellence in RDH" design, which made it possible to perform a comparative analysis (benchmarking) of 21 Rheumatology Departments. The 19 criteria evaluated were divided into 3 categories: Strategic processes, Key processes, and Support processes. RESULTS: The lowest mean scores were recorded for follow-up of clinical practice guidelines/recommendations and existence of a quality plan (Strategic processes), criteria for training among RDH professionals (Support processes), and admission and discharge (Key processes). Five RDH achieved the benchmark when the position obtained by the RDH in Key processes was plotted against the one obtained in Strategic processes and Support processes. One RDH emerged as a clear leader in the comparison. CONCLUSIONS: None of the RDH obtained the total maximum score at the category level or at the total results level, thus revealing room for improvement in the attainment of excellence for all the participating centers.

Actualización del Documento de Consenso de la Sociedad Española de Reumatología sobre el uso de terapias biológicas en la artritis reumatoide / Update of the Consensus Statement of the Spanish Society of Rheumatology on the management of biologic therapies in rheumatoid arthritis

Objetivo Servir de referencia para reumatólogos e implicados en el tratamiento de la artritis reumatoide que vayan a utilizar o consideren la utilización de terapias biológicas en su manejo. Métodos Las recomendaciones se emitieron siguiendo la metodología de grupos nominales y basadas en revisiones sistemáticas. El nivel de evidencia y el grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford y el grado de acuerdo se extrajo por técnica Delphi. Resultados Se realizan recomendaciones sobre el uso de los siete agentes biológicos disponibles para la artritis reumatoide en la actualidad en nuestro país. El objetivo del tratamiento es lograr la remisión de la enfermedad lo más precozmente posible. Se revisan las indicaciones y matizaciones del uso de terapias biológicas y cuál debe ser la evaluación previa y la vigilancia del paciente con estos fármacos. Conclusiones Se presentan las actualizaciones a las recomendaciones SER para el uso de terapias biológicas en pacientes con artritis reumatoide(AU)

Objective To provide a reference to rheumatologists and to those involved in the treatment of RA who are using, or about to use biologic therapy. Methods Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Results We have produced recommendations on the use of the seven biologic agents available for RA in our country. The objective of treatment is to achieve the remission of the disease as quickly as possible. Indications and nuances regarding the use of biologic therapy were reviewed as well as the evaluation that should be performed prior to administration and the follow up of patients undergoing this therapy. Conclusions We present an update on the SER recommendations for the use of biologic therapy in patients with RA(AU)

[Update of the Consensus Statement of the Spanish Society of Rheumatology on the management of biologic therapies in rheumatoid arthritis]. / Actualización del Documento de Consenso de la Sociedad Española de Reumatología sobre el uso de terapias biológicas en la artritis reumatoide.

OBJECTIVE: To provide a reference to rheumatologists and to those involved in the treatment of RA who are using, or about to use biologic therapy. METHODS: Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. RESULTS: We have produced recommendations on the use of the seven biologic agents available for RA in our country. The objective of treatment is to achieve the remission of the disease as quickly as possible. Indications and nuances regarding the use of biologic therapy were reviewed as well as the evaluation that should be performed prior to administration and the follow up of patients undergoing this therapy. CONCLUSIONS: We present an update on the SER recommendations for the use of biologic therapy in patients with RA.

Long-term remission of severe refractory dermatopolymyositis with a weekly-scheme of immunoglobulin followed by rituximab therapy.

We report on a 44-year-old woman affected by dermatopolymyositis resistant to conventional therapies who experienced long-term clinical improvement and remission after treatment with intravenous polyvalent immunoglobulin in a weekly schedule followed by rituximab therapy.

Enfermedad de Still del adulto / Adult onset Still’s disease

No disponible