ABSTRACT
La artritis reumatoide es una enfermedad grave que necesita tratamiento adecuado y temprano utilizando el arsenal terapéutico que incluye fármacos como la leflunomida y los anticuerpos antifactor de necrosis tumoral alfa (TNF-alpha). Se presenta un paciente con artritis reumatoide de muchos años de evolución en el que han fracasado tratamientos previos habituales. Se describe la respuesta al tratamiento con infliximab (fármaco anti-TNF-alpha) y la aparición de tuberculosis hepatoesplénica con prueba cutánea negativa, lo que obligó a la suspensión del fármaco y a la introducción de leflunomida como medicación inmunomoduladora de la enfermedad. Se describen los aspectos de interés del caso clínico en relación con los mecanismos de defensa inmunológicos, el manejo farmacológico de estos medicamentos y su uso racional así como profilaxis adecuada (AU)
Rheumatoid arthritis is a severe disease that requires appropriate and early treatment using a therapeutic arsenal that includes drugs such as leflunomide and anti-tumor necrosis factor (TNF) alpha antibodies. We describe a patient with long-standing rheumatoid arthritis refractory to commonly used treatments. The response to infliximab (an anti- TNF alpha drug) is described. This treatment was discontinued due to the development of hepatosplenic tuberculosis with negative skin test and leflunomide was introduced as an immunomodulatory drug. Features of this case are described in relation to mechanisms of immunological defense, the pharmacological management of these drugs and their rational use, as well as appropriate prophylaxis (AU)
Subject(s)
Humans , Male , Middle Aged , Arthritis, Rheumatoid/complications , Tuberculin Test/methods , Tuberculosis/complications , Infliximab/therapeutic use , Tumor Necrosis Factor-alpha/analysis , Indomethacin/therapeutic use , Methotrexate/therapeutic use , Mycobacterium tuberculosis , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use , Tomography, Emission-Computed/methods , Rheumatoid Factor/analysisABSTRACT
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Subject(s)
Humans , Male , Female , Arthritis, Juvenile/epidemiology , Arthritis, Juvenile/prevention & control , Rheumatoid Factor/administration & dosage , Rheumatoid Factor/analysis , Rheumatoid Factor/therapeutic use , Arthritis/complications , Arthritis, Juvenile/physiopathology , Arthritis, Juvenile/classification , Drug Hypersensitivity/complications , Drug Hypersensitivity/diagnosis , Psoriasis/complicationsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Arthritis, Rheumatoid/pathology , Synovial Fluid , Anemia/complications , Anemia/diagnosis , Leukopenia/complications , Leukopenia/diagnosis , Bone Remodeling/immunology , Bone Remodeling/physiology , Sensitivity and Specificity , Polymerase Chain Reaction/methods , Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/diagnosis , Anemia, Aplastic/complications , Thrombocytopenia/complications , Thrombocytopenia/diagnosisABSTRACT
No disponible
