Dermatomyositis post vaccine against SARS-COV2.

BACKGROUND: Dermatomyositis belongs to an infrequent group of diseases predominantly found in patients older than 40 years old and is characterized by dermal and muscular findings. This disease presents itself as proximal, ascending and symmetric weakness and typical dermatosis with findings such as elevated muscle enzymes, altered electromyography and typical changes in muscle biopsy; as of today, the etiology of the disease in unknown. The COVID-19 vaccine has been a fundamental tactic to achieve control of the coronavirus (SARS CoV2), and it's clear that the benefits of getting the vaccine overweight the risks that might come along with it. Although rare, all adverse effects should be reported, this could help us to understand the elusive pathophysiology of inflammatory idiopathic myopathy. CASE PRESENTATION: In this text we will describe the case of a patient with dermatomyositis who was vaccinated against SARS CoV2 with BNT162b2 mRNA (Pfizer-BioNTech), showing a temporal relation between the vaccination and the beginning of her symptoms. We realized all the diagnostic approach to the suspected disease including electromyography, muscle biopsy and laboratory findings, corroborating the diagnosis. The patient received standard treatment for this disease (steroid therapy) and have a classic slow improvement. CONCLUSIONS: Although it´s not possible to confirm a direct correlation between the vaccine and the onset of the disease, we considered that there are enough data to suspect that this could be a trigger event and therefore should always be considered a possible cause for a case of inflammatory idiopathic myopathy.

Hallazgos radiográficos de la afectación del hombro en espondilitis anquilosante / Radiographic findings of shoulder involvement in ankylosing spondylitis

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Isolation of IgG antibodies to Toxocara in ankylosing spondylitis patients with acute anterior uveitis.

PURPOSE: Since few reports had been published on the prevalence of toxocariasis in ankylosing spondylitis (AS) patients with acute non-granulomatous anterior uveitis (ANGAU), the aim of this work was to determine the presence of antibodies against Toxocara canis in AS patients with ANGAU. METHODS: Thirty-six patients (14 female and 22 male) with AS were enrolled in the study. The history of ANGAU was accepted only if diagnosed by an ophthalmologist. The detection of IgG antibodies to T. canis was determined by enzyme-linked immunosorbent assay. In addition, antibodies to Ascaris lumbricoides were also tested to verify non-specific reactions. RESULTS: The prevalence of ANGAU in the AS patients was 58% (21 / 36), and 38% (8 / 21) of the patients with ANGAU were positive for antibodies to Toxocara, while 7% (1 / 15) of AS patients without ANGAU were positive for T. canis (p = 0.038, two tails; mid-p exact). No antibodies were detected to A. lumbricoides antigens in the serum samples of patients with AS. CONCLUSIONS: These data suggest that the seroprevalence of antibodies to T. canis is high in Mexican patients with AS-associated uveitis, suggesting a chronic asymptomatic toxocariosis, which could be associated with the pathogenesis of ANGAU; however, further larger-scale studies are needed to confirm this observation.

Uveitis in adult patients with rheumatic inflammatory autoimmune diseases at a tertiary-care hospital in Mexico City.

OBJECTIVE: Our aim is to describe the frequency of uveitis associated with rheumatic inflammatory autoimmune diseases (RIAD) in adult patients admitted to the Rheumatology Department at a tertiary-care hospital in Mexico City. We also describe the clinical features, seasonal distribution, treatment, and ocular complications associated with this disease. METHODS: We reviewed 1332 charts of patients with RIAD and selected those that had a diagnosis of uveitis. We obtained the following data: age, sex, type of uveitis and relationship with diagnosis of RIAD, recurrences, seasonal distribution, treatment, and residual visual deficit. RESULTS: We found 57 (4.27%) cases of uveitis in 1332 charts, including 38 men and 19 women (M:F ratio 2:1), aged 47 ± 16 years. Nongranulomatous acute anterior uveitis (NGAAU) comprised 90.52% of cases (52/57). In 64.91% of cases (37/57), uveitis preceded the diagnosis of RIAD by 12 ± 9 years, more frequently in winter (35.96%; p = NS). Uveitis was found in 40/93 patients with ankylosing spondylitis (AS), in 7/11 patients with relapsing polychondritis (RP), in 8/16 patients with Behçet's disease, in 1/16 patients with polyarteritis nodosa, and in 1/590 patients with rheumatoid arthritis (RA). Ninety-six percent of the patients were treated with steroids. Upon a mean followup of 60 days (range 7-4745 days), reduction of visual acuity (≤ 20/200) was associated with recurrence of uveitis in 3/7 cases with AS, in 4/8 cases with Behçet's disease, in 3/7 with RP, and in 1 case of uveitis and seronegative RA. CONCLUSION: NGAAU frequently precedes RIAD and is found predominately in men, with a tendency to occur in winter.

Prevalence and factors associated with metabolic syndrome in patients with rheumatoid arthritis and systemic lupus erythematosus.

PURPOSE: To assess the frequency and factors associated with metabolic syndrome in adult female patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). METHODS: During January and June 2006, 192 consecutive adult female patients seen during their scheduled appointment at the out-patient rheumatology clinic and meeting the American College of Rheumatology classification criteria for RA and SLE were invited to participate in this study. Sociodemographic, menopausal status, personal history of coronary heart disease, and physical activity were evaluated. According to the National Cholesterol Education Program Adult Treatment III (NCEP/ATP III), metabolic syndrome was defined as >or=3 of the following criteria: increased waist circumference (>88 cm or 35 inches), hypertriglyceridemia (>or=150 mg/dL), low (<40 mg/dL) high-density lipoprotein, hypertension, and high fasting glucose (>or=110 mg/dL). RESULTS: : One hundred-seven RA and 85 SLE patients with a mean age of 43 +/- 13 years were included in this study. The frequency of obesity and abnormal waist circumference were similar in RA and SLE patients. Two percent were underweight, 35% had a normal weight, 37% were overweight, and 25% were obese. The frequency of metabolic syndrome in RA and SLE patients was 17%. Metabolic syndrome was significantly associated with greater age, less education, lower income, and smoking. In RA patients, metabolic syndrome was significantly associated with a shorter treatment period with methotrexate, with pain, and with health assessment questionnaire scores. By multivariate logistic regression, the only statistically significant predictor of metabolic syndrome was smoking. CONCLUSIONS: The frequency of metabolic syndrome in RA and SLE patients was similar and associated with smoking. In RA patients, metabolic syndrome was related with pain and functional status, suggesting disease activity. A better control of disease activity may reduce the presence of metabolic syndrome and the risk of cardiovascular disease.

[Guide for appropriate using of the non-opioid analgesics in the management of pain]. / Guía para la utilización de analgésicos no opioides en el manejo del dolor.

The purpose of this guide is to provide for general practitioners or physicians of primary care a comprehensive, evidence based tool that permits them to take an adequate decision about the appropriate use of the non-opioid analgesics in the management of pain.

Avascular necrosis of bone associated with primary antiphospholipid syndrome: case report and literature review.

We describe, the case of a 34-year-old mestizo Mexican woman with previous history of fetal loss, deep vein thrombosis that developed avascular necrosis (AVN) of the right knee with strong positive levels of anticardiolipin antibodies (aCL) IgG and IgM. AVN of bone in association with aCL has been seen principally in systemic lupus erythematosus patients. However, few cases have been reported of AVN as a clinical manifestation of primary antiphospholipid syndrome. A review of the association of aCL and AVN in patients with systemic lupus erythematosus, primary antiphospholipid syndrome, and idiopathic osteonecrosis is presented.

[Risk factors associated with systemic lupus erythematosis in a Mexican population]. / Factores de riesgo relacionados con lupus eritematoso sistémico en población mexicana.

OBJECTIVE: To assess risk factors associated with systemic lupus erythematosus (SLE) in the Mexican population. MATERIAL AND METHODS: A case-control study was conducted on June 1996, at the Reumathology Clinic of Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HE CMN), Instituto Mexicano del Seguro Social, in Mexico City. Cases were one hundred thirty subjects with four or more SLE criteria and disease evolution of +/- 5 years. Controls were hospitalized patients with acute diseases but without autoimmune diseases. Cases and controls were matched 1:1 by age and gender; both groups were evaluated by direct interview through a structured questionnaire. The following risk factors were assessed: genetic family history of SLE and connective tissue disease; socioedemographic (ethnicity, geographic distribution, education, monthly income); hormonal (use of oral contraceptives, replacement therapy and gynecoobstetric background); environmental (use of hair products, living with dogs, bacterial/viral infections, and allergies). Statistical analysis consisted of odd ratios (OR) with 95% confidence intervals (CI) and multivariate analysis using logistic regression. RESULTS: The multivariate model showed association with family history of SLE (OR 4.2, CI 95% 1.17-15.2), family history of connective tissue disorder (OR 2.6, CI 95% 1.15-4.5), use of oral contraceptives for more than one year (OR 2.1, CI 95% 1.13-4.3), repetitive pharyngitis (OR 2.1, CI 95% 1.18-3.6), and use of medications (OR 5.0 IC 95% 1.62-21.6). No association was found with socieconomic status, hair dye products, asthma, or allergies. CONCLUSIONS: Genetic factors, such as family history of SLE and connective tissue disease in first-degree relatives, persist as important factors in the development of SLE. Other factors, such as use of some drugs, oral contraceptives, and repetitive pharyngitis, may also favor the onset of disease in genetically susceptible hosts. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Factores de riesgo relacionados con lupus eritematoso sistémico en población mexicana / Risk factors associated with systemic lupus erythematosus in Mexican population

Objetivo. Evaluar los factores de riesgo asociados con el desarrollo de lupus eritematoso sistémico en población mexicana. Material y métodos. Estudio de casos y controles, efectuado en junio de 1996 en el Departamento de Reumatología del Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HE CMN), del Instituto Mexicano del Seguro Social, de la Ciudad de México. Se estudiaron 130 pacientes (casos) que presentaban cuatro o más criterios de clasificación de lupus eritematoso sistémico (LES) y con una evolución de la enfermedad menor de cinco años. Los controles fueron pacientes hospitalizados por enfermedades agudas no autoinmunes. Fueron pareados 1:1 por edad y sexo; ambos grupos se evaluaron a través de una entrevista directa y la aplicación de un cuestionario estructurado. Se estudiaron los siguientes factores de riesgo: genéticos (historia familiar de LES o enfermedad de tejido conjuntivo), sociodemográficos (raza, lugar de residencia, educación, ingreso mensual); hormonales (anticonceptivos orales, terapia hormonal de remplazo y ginecobstétricos); ambientales (productos para el cabello, cohabitación con perros, infecciones, alergias). El análisis estadístico fue hecho con razón de momios (RM) IC 95 por ciento y regresión logística. Resultados. El análisis estadístico multivariado mostró asociación con el antecedente familiar de LES (RM 4.2, IC 95 por ciento 1.17-15.2) u otra ETC (RM 2.6, IC 95 por ciento 1.15-4.5), uso de anticonceptivos orales por más de un año (RM 2.1, IC 95 por ciento 1.13-4.3), faringoamigdalitis de repetición (RM 2.1, IC 95 por ciento 1.18 - 3.6) y fármacos (RM 5.0, IC 95 por ciento 1.62 - 21.6). No hubo relación con factores socieconómicos, el uso de productos para el cabello, con asma o con antecedentes alérgicos. Conclusiones. Factores genéticos como el antecedente heredo-familiar de LES o enfermedad de tejido conjuntivo en familiares de primer grado continúan siendo factores importantes en el...

Objective. To assess risk factors associated with systemic lupus erythematosus (SLE) in the Mexican population. Material and Methods. A case-control study was conducted on June 1996, at the Reumathology Clinic of Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HE CMN), Instituto Mexicano del Seguro Social, in Mexico City. Cases were one hundred thirty subjects with four or more SLE criteria and disease evolution of ± 5 years. Controls were hospitalized patients with acute diseases but without autoimmune diseases. Cases and controls were matched 1:1 by age and gender; both groups were evaluated by direct interview through a structured questionnaire. The following risk factors were assessed: genetic family history of SLE and connective tissue disease; socioedemographic (ethnicity, geographic distribution, education, monthly income); hormonal (use of oral contraceptives, replacement therapy and gynecoobstetric background); environmental (use of hair products, living with dogs, bacterial/viral infections, and allergies). Statistical analysis consisted of odd ratios (OR) with 95 percent confidence intervals (CI ) and multivariate analysis using logistic regression. Results. The multivariate model showed association with family history of SLE (OR 4.2, CI 95 percent 1.17-15.2), family history of connective tissue disorder (OR 2.6, CI 95 percent 1.15-4.5), use of oral contraceptives for more than one year (OR 2.1, CI 95 percent 1.13-4.3), repetitive pharyngitis (OR 2.1, CI 95 percent 1.18-3.6), and use of medications (OR 5.0 IC 95 percent 1.62 - 21.6). No association was found with socieconomic status, hair dye products, asthma, or allergies. Conclusions. Genetic factors, such as family history of SLE and connective tissue disease in first-degree relatives, persist as important factors in the development of SLE. Other factors, such as use of some drugs, oral contraceptives, and repetitive pharyngitis, may also favor the onset...