ABSTRACT
RESUMEN Objetivo: Generar las recomendaciones para la atención de pacientes con enfermedades reumáticas que reciben terapias inmunomoduladoras e inmunosupresoras (fármacos convencionales, biológicos y moléculas pequeñas) durante la pandemia por COVID-19. Materiales y métodos: Las recomendaciones se realizaron utilizando el método Delphi como herramienta de acuerdo. Se conformó un panel de expertos con trayectoria académica y experiencia en investigación en reumatología. Se realizó la búsqueda de la literatura y se generó el cuestionario del ejercicio Delphi conformado por 42 preguntas. El grado de acuerdo se logró con el 80% de aprobación de los participantes. Resultados: Se conformó un grupo de 11 reumatólogos de 7 ciudades del país. La tasa de respuesta fue del 100% para las 3 rondas de consulta. En la primera ronda se logró acuerdo en 35 preguntas, en la segunda ronda 37 y en la tercera ronda se logró el acuerdo de las 42 preguntas. Conclusión: La recomendación para la mayoría de los tratamientos inmunomoduladores utilizados en reumatología es continuar con las terapias en pacientes que no tengan la infección y suspenderlas en aquellos con diagnóstico de SARS-CoV-2/COVID-19.
ABSTRACT Objective: To produce recommendations for patients with rheumatological diseases receiving immunomodulatory and immunosuppressive therapies (conventional drugs, biologicals, and small molecules) during the COVID-19 pandemic. Materials and methods: The recommendations were determined using the Delphi method as an agreement tool. A panel of experts was formed, with academic backgrounds and research experience in rheumatology. A literature search was conducted and 42 questions were generated. The level of agreement was made with 80% of approval by the participants. Results: A group of eleven rheumatologists from 7 cities in the country participated. The response rate was 100% for the three consultation rounds. In the first round, agreement was reached on 35 questions, on 37 in the second round, and on 42 questions in the third round. Conclusion: The recommendation for the majority of the pharmacological treatments used in rheumatology is to continue with immunomodulatory or immunosuppressive therapies in patients who do not have the infection, and to suspend it in patients with a diagnosis of SARS-CoV-2/COVID-19.
Subject(s)
Humans , Patients , Rheumatic Diseases , COVID-19 , Therapeutics , Delphi Technique , AdultABSTRACT
PURPOSE: The aim of this study was to describe the efficacy and safety of anti-interleukin 6 receptor antibody (tocilizumab [TCZ]) in patients with severe or refractory Takayasu arteritis (TA). METHODS: We describe 8 Colombian patients with severe and/or refractory TA treated with TCZ during a period of at least 9 months. Clinical, radiological, biological, and associated treatments were evaluated before, during, and after TCZ infusions. RESULTS: The median age at evaluation was 31 years (12-43 years). All patients were female and experienced clinical and biological improvement, in addition to a corticosteroid-sparing effect from a median dose of 50 mg/d at baseline (30-60 mg/d) to 6.25 mg/d (2.5-10 mg/d) at 9 months. In 4 cases, in which imaging studies were available, an improvement was observed. The median duration of TCZ infusions was 18 months (9-36 months). Major adverse effects related to TCZ were not evidenced during a period of at least 9 months of treatment. One relapse was observed. Tocilizumab was continued in all cases until the last follow-up. CONCLUSIONS: This study shows a clinical, biological, and radiological response in patients with refractory TA treated with TCZ.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal/therapeutic use , Receptors, Interleukin-6/immunology , Takayasu Arteritis/drug therapy , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Antibodies, Monoclonal/pharmacology , Antibodies, Monoclonal, Humanized/pharmacology , Child , Dose-Response Relationship, Drug , Female , Humans , Interleukin-6/blood , Interleukin-6/physiology , Receptors, Interleukin-6/antagonists & inhibitors , Receptors, Interleukin-6/drug effects , Retrospective Studies , Severity of Illness Index , Signal Transduction/drug effects , Signal Transduction/physiology , Takayasu Arteritis/blood , Treatment Failure , Treatment Outcome , Young AdultABSTRACT
El calcio (Ca2+) es un catión con capacidad multifuncional como segundo mensajero en diferentes grupos celulares del sistema inmunitario que incluyen los linfocitos T y B, los macrófagos, los mastocitos, entre otras. Los recientes descubrimientos en relación con la entrada de Ca2+ dependiente de depósito (SOCE por su sigla en inglés, store operated calcium entry) han abierto nuevos caminos en la investigación de cómo este catión dirige el destino celular, en especial en los linfocitos T y B. La SOCE actúa a través de canales CRAC (del inglés Ca2+ release-activated Ca2+ channels) y su mecanismo de activación depende de la interacción de dos moléculas reguladoras: un sensor del Ca2+ del retículo endoplásmico o molécula de interacción estromal (STIM-1, del inglés stromal interaction molecule) y una subunidad poro del canal CRAC (Orai1). Esta revisión se centra principalmente en las funciones del Ca2+ en los linfocitos B y T, así como las alteraciones de estas vías implicadas en el desarrollo de enfermedades autoinmunes (AU)
Calcium (Ca2+) is an important cation able to function as a second messenger in different cells of the immune system, particularly in B and T lymphocytes, macrophages and mastocytes, among others. Recent discoveries related to the entry of Ca2+ through the store-operated calcium entry (SOCE) has opened a new investigation area about the cell destiny regulated by Ca2+ especially in B and T lymphocytes. SOCE acts through calcium-release-activated calcium (CRAC) channels. The function of CRAC depends of two recently discovered regulators: the Ca2+ sensor in the endoplasmic reticulum or stromal interaction molecule (STIM-1) and one subunit of CRAC channels called Orai1. This review focuses on the role of Ca2+ signals in B and T lymphocytes functions, the signalling pathways leading to Ca2+ influx, and the relationship between Ca2+ signals and autoimmune diseases (AU)
Subject(s)
Humans , Male , Female , Autoimmunity , Autoimmunity/immunology , Autoimmunity/physiology , Stromal Cells/pathology , Calcium , Calcium/isolation & purification , Calcium Signaling/immunology , Calcium Signaling/physiology , Autoimmune Diseases/epidemiology , Autoimmune Diseases/prevention & control , Intracellular Space/physiology , Intracellular SpaceABSTRACT
Calcium (Ca²âº) is an important cation able to function as a second messenger in different cells of the immune system, particularly in B and T lymphocytes, macrophages and mastocytes, among others. Recent discoveries related to the entry of Ca²âº through the store-operated calcium entry (SOCE) has opened a new investigation area about the cell destiny regulated by Ca²âº especially in B and T lymphocytes. SOCE acts through calcium-release-activated calcium (CRAC) channels. The function of CRAC depends of two recently discovered regulators: the Ca²âº sensor in the endoplasmic reticulum or stromal interaction molecule (STIM-1) and one subunit of CRAC channels called Orai1. This review focuses on the role of Ca²âº signals in B and T lymphocytes functions, the signalling pathways leading to Ca²âº influx, and the relationship between Ca²âº signals and autoimmune diseases.
Subject(s)
Autoimmunity/physiology , B-Lymphocytes/metabolism , Calcium Channels/immunology , Calcium/immunology , T-Lymphocytes/metabolism , Autoimmune Diseases/immunology , Autoimmune Diseases/metabolism , Calcium/metabolism , Calcium Channels/metabolism , Humans , Signal TransductionABSTRACT
Se presenta el caso de un paciente de sexo masculino con compromiso poliarticular agudo secundario a Neisseria gonorrhoeae, cuyos aspectos ecográficos fueron la presencia de tenosinovitis en los compartimentos extensores del carpo y del flexor del tercer dedo de la mano derecha. La punción articular confirmó el diagnóstico.
A case is presented of a male patient with acute polyarticular manifestation, secondary to N. Gonorrhoeae. The ultrasound showed the presence of tenosynovitis in extensor compartments of carpal joint and the flexor compartments of third finger of the right hand. Joint puncture aspiration confirmed the diagnosis.
