ABSTRACT
Therapeutic management of the vasculitides is closely linked to modern rheumatologic advances, particularly as it relates to the discovery and first clinical use of glucocorticoids. These compounds were introduced in the late-1940s for the treatment of rheumatoid arthritis, but soon after, clinicians in Europe and the United States realized that they could have a significant positive impact in systemic vasculitides. However, once it was realized that glucocorticoid use was associated with a high degree of morbidity, the search for better immunosuppressive agents with similar efficacy but improved safety profiles was on. During the past several years, several agents have been utilized for the therapeutic management of systemic vasculitides, and the list keeps growing with the development of newer compounds that have retained efficacy but with a better safety profile.
Subject(s)
Glucocorticoids/history , Immunosuppressive Agents/history , Rheumatology/history , Vasculitis/history , Drug-Related Side Effects and Adverse Reactions , Glucocorticoids/adverse effects , Glucocorticoids/therapeutic use , History, 20th Century , History, 21st Century , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Remission Induction , Vasculitis/drug therapyABSTRACT
A 45-year-old female with a 4-week history of psoriatic arthritis developed cough, fever, and progressive shortness of breath 2 weeks following initiation of methotrexate therapy. High resolution CT of chest revealed bilateral basal interstitial involvement and diffuse ground glass opacities. Patient, though, died despite immediate discontinuation of methotrexate and initiation of treatment with IV methylprednisolone and cyclophosphamide. Post-mortem examination showed diffuse interstitial pulmonary fibrosis. Methotrexate-induced pulmonary toxicity is a serious event, unpredictable, and unusual, especially in patients with psoriatic arthritis, and although reversible, it may be fatal.
Subject(s)
Antirheumatic Agents/adverse effects , Arthritis, Psoriatic/drug therapy , Methotrexate/adverse effects , Pulmonary Fibrosis/chemically induced , Acute Disease , Arthritis, Psoriatic/complications , Fatal Outcome , Female , Humans , Middle Aged , Pulmonary Fibrosis/diagnosisABSTRACT
Presentamos, en esta primera parte de la historia de la artritis psoriática, los eventos que llevaron al conocimiento de esta enfermedad, de cómo se separó de las otras y cómo se generaron los primeros criterios clasificatorios de esta patología.Palabras clave: historia, espondioartropatía, psoriasis, artritis psoriática.
In this first part of the history of psoriatic arthritis, we present the most important events that led to the knowledge of this disease, how it was separated from other inflammatory arthropathies, as well as how the first classificatory criteria in this disease were developed.Key words: history, spondyloarthropathy, psoriasis, psoriatic arthritis.
