Aortitis no infecciosa: experiencia con tocilizumab en un hospital comarcal / Noninfectious aortitis: experience with tocilizumab in a regional hospital

OBJETIVOS: Describir pacientes con aortitis no infecciosa y su respuesta al tratamiento de un hospital comarcal. MÉTODOS: Revisión de pacientes con aortitis no infecciosa, técnica diagnóstica utilizada y tratamiento inmunosupresor recibido. RESULTADOS: Se encontraron 8 pacientes (7 mujeres y un hombre) diagnosticados de aortitis mediante tomografía por emisión de positrones (PET). La mediana de edad fue de 69 años (IQR62-72,2). Tocilizumab (TCZ) mejoró los síntomas, la VSG y la PCR a los 3meses del tratamiento (p < 0,001 y p < 0,012, respectivamente) en los 6 pacientes en que se utilizó. CONCLUSIÓN: TCZ fue eficaz y seguro en los pacientes que fueron refractarios a esteroides y a otros tratamientos inmunosupresores

OBJECTIVES: Describe patients with noninfectious aortitis and their response to treatment in a regional hospital. METHODS: Review of patients with noninfectious aortitis, diagnostic technique used and immunosuppressive therapy received. RESULTS: We report 8 patients (7 women and one man) diagnosed with aortitis by positron emission tomography (PET). The mean age was 69 years (interquartile range [IQR] 62-72.2). Three months of treatment with tocilizumab improved symptoms, erythrocyte sedimentation rate and C-reactive protein level (P<.001 and P<.012, respectively) in the 6 patients in whom it was used. CONCLUSIONS: Tocilizumab was an effective and safe treatment in those patients diagnosed with aortitis refractory to steroids and conventional immunosuppressive therapy

Noninfectious aortitis: Experience with tocilizumab in a regional hospital. / Aortitis no infecciosa: experiencia con tocilizumab en un hospital comarcal.

OBJECTIVES: Describe patients with noninfectious aortitis and their response to treatment in a regional hospital. METHODS: Review of patients with noninfectious aortitis, diagnostic technique used and immunosuppressive therapy received. RESULTS: We report 8 patients (7 women and one man) diagnosed with aortitis by positron emission tomography (PET). The mean age was 69years (interquartile range [IQR] 62-72.2). Three months of treatment with tocilizumab improved symptoms, erythrocyte sedimentation rate and C-reactive protein level (P<.001 and P<.012, respectively) in the 6 patients in whom it was used. CONCLUSIONS: Tocilizumab was an effective and safe treatment in those patients diagnosed with aortitis refractory to steroids and conventional immunosuppressive therapy.

High prevalence of subclinical atherosclerosis in psoriatic arthritis patients: a study based on carotid ultrasound.

Analyse the presence of subclinical atherosclerosis in psoriatic arthritis patients (PsA). A cross-sectional study of 53 patients with PsA and 53 controls matched for age and sex was designed. Carotid intima-media thickness (IMT) and the presence of carotid plaques (CP) were assessed with carotid ultrasound. Data on cardiovascular (CV) risk factors were collected. Patients with PsA had a higher prevalence rate of obesity and tobacco smoking. CP were detected more frequently in patients with PsA than in controls with an OR of 4.15, 95% CI 1.4-12.1, which adjusted for smoking and those with history of CV disease gave an OR of 3.9, 95% CI 1.2-12.7, p = 0.026. Carotid IMT was significantly higher in patients with PsA adjusted for age and tobacco smoking. According to ultrasound data, 30.2% of patients with PsA had carotid atherosclerosis (presence of CP and/or carotid IMT > 0.90 mm) compared with 9.4% of controls. The SCORE index (Systematic Coronary Risk Evaluation) underestimated the CV risk in these patients: most patients with CP had an intermediate CV risk. According to carotid ultrasound data, PsA patients have a high prevalence of subclinical atherosclerosis. These results support the importance of screening for CV risk and to include carotid ultrasound in CV prevention strategies in these patients.

Utilidad clínica de la cuantificación de infliximab y anticuerpos antiquiméricos humanos / Clinical usefulness in measuring infliximab and human anti-chimeric antibodies

Introducción: El infliximab (IFX), un anticuerpo quimérico contra el factor de necrosis tumoralalfa, es utilizado en el tratamiento de pacientes con diversas enfermedades inflamatorias, pero puede originar la formación de anticuerpos antiquiméricos humanos (HACA). La presencia de HACA y niveles séricos de IFX bajos se han asociado con falta o pérdida de respuesta y con laaparición de reacciones infusionales. Evaluamos la utilidad de la cuantificación de IFX y HACA. Material y métodos: IFX y HACA se midieron utilizando una técnica ELISA relativamente nueva en una cohorte de 110 pacientes tratados con IFX. Se recogieron muestras de suero inmediatamente antes de la siguiente infusión del fármaco. Los pacientes habían recibido una mediana de dosis de 5 mg/kg, con intervalos de dosis ajustados a la actividad de la enfermedad, habitualmente cada 8 semanas. La mediana del número de infusiones fue 17. Resultados: Los HACA se detectaron en 10 pacientes y se midieron concentraciones terapéuticas de IFX en 37 casos. Ocho de los 10 pacientes con HACA positivos tenían trastornos digestivos y en 9 de ellos el tratamiento fue suspendido. El uso concomitante de inmunosupresores no redujo el riesgo de formación de HACA. Entre los 100 pacientes sin HACA, 79 continuaron con la misma dosis, 16 requirieron un ajuste de dosis, en 2 se suspendió el tratamiento y 3 pacientes fueron cambiados a otro agente biológico. Conclusiones: Las concentraciones de IFX y HACA en sangre deberían ser monitorizadas en pacientes que reciben IFX, ya que puede ser útil para optimizar los regímenes de dosis o evitar el uso de terapias inadecuadas (AU)

Introduction: infliximab (IFX), a chimeric antibody against tumour necrosis factor-alpha, is used in the treatment of patients with several inflammatory diseases, but it can lead to the formation of human anti-chimeric antibodies (HACA). HACA and low IFX serum levels have been associated with lack or loss of response, and infusion reactions. The usefulness of measuring the IFX and HACA concentrations is evaluated. Material and methods: IFX and HACA were measured using a relatively new ELISA technique in a cohort of 110 patients treated with IFX. Serum samples were collected immediately before patients were given the next drug infusion. The patients had received a median dose of 5 mg/kg, with dose intervals adjusted to the patient’s disease activity, usually every 8 weeks. The median number of infusions was 17. Results: HACA were identified in 10 patients, and therapeutic IFX concentrations were observedin 37 patients. Eight out of 10 positive HACA patients had gastrointestinal disorders, and thetherapy was discontinued in 9 of them. The concomitant use of immunosuppressants did not reduce the risk of HACA formation. Among 100 patients with no HACA, 79 continued on the same dose, 16 required a dose adjustment, 2 discontinued treatment, and 3 were switched toanother biological agent. onclusions: Blood IFX and HACA concentrations should be monitored in patients receiving IFX, as it may be useful to optimize dose regimens or avoid use of inadequate therapy (AU)

Cognitive impairment in patients with fibromyalgia syndrome as assessed by the mini-mental state examination.

BACKGROUND: This study evaluated the frequency of cognitive impairment in patients with Fibromyalgia syndrome (FMS) using the Mini Mental State Examination (MMSE). METHODS: We analyzed baseline data from all 46 patients with FMS and 92 age- and sex-matched controls per diagnosis of neuropathic (NeP) or mixed pain (MP) selected from a larger prospective study. RESULTS: FMS had a slight but statistically significant lower score in the adjusted MMSE score (26.9; 95% CI 26.7-27.1) than either NeP (27.3; 95% CI 27.2-27.4) or MP (27.3; 27.2-27.5). The percentage of patients with congnitive impairment (adjusted MMSE

Riesgo cardiovascular en relación con AINE: ¿aumentado o disminuido? / No disponible

No disponible

Tratamiento de situaciones clínicas difíciles en pacientes que presentan artritis reumatoide con hepatitis / Management of difficult clinical situations in rheumatoid arthritis: hepatitis

El tratamiento de los pacientes con artritis reumatoide (AR) que presentan en forma concomitante infección crónica por el virus de la hepatitis B o el virus de la hepatitis C plantea un reto terapéutico debido a la posibilidad de que los tratamientos usados en la AR puedan agravar o reactivar la hepatitis, ya sea debido a hepatotoxicidad de los fármacos o al aumento de la replicación vírica con los inmunosupresores. El problema de la reactivación de la hepatitis ha surgido con mayor fuerza en los últimos 5 años con la publicación de diversos casos de reactivación de hepatitis B asociados al tratamiento con antifactor de necrosis tumoral. En el presente artículo se revisan ambos problemas, la hepatotoxicidad y el aumento de la replicación vírica, así como las estrategias más adecuadas para tratar a estos pacientes (AU)

Treatment of patients with Rheumatoid Arthritis (RA) who also present a chronic infection by the hepatitis B or C virus represents a therapeutic challenge due to the possibility that treatments used for RA can aggravate or reactivate hepatitis, either due to the drugs hepatic toxicity or the increase in viral replication after immunosuppresive treatment. The problem of reactivation of hepatitis has assumed a larger importance in the past 5 years with the publication of several cases of reactivation of hepatitis B associated with anti-TNF therapy. In this article we revise both problems, hepatotoxicity and the increase of viral replication, as well as the better strategies to treat these patients (AU)

[Management of difficult clinical situations in rheumatoid arthritis: hepatitis]. / Tratamiento de situaciones clínicas difíciles en pacientes que presentan artritis reumatoide con hepatitis.

Treatment of patients with Rheumatoid Arthritis (RA) who also present a chronic infection by the hepatitis B or C virus represents a therapeutic challenge due to the possibility that treatments used for RA can aggravate or reactivate hepatitis, either due to the drugs hepatic toxicity or the increase in viral replication after immunosuppresive treatment. The problem of reactivation of hepatitis has assumed a larger importance in the past 5 years with the publication of several cases of reactivation of hepatitis B associated with anti-TNF therapy. In this article we revise both problems, hepatotoxicity and the increase of viral replication, as well as the better strategies to treat these patients.