ABSTRACT
The objective of the study is to find predictors of remission, radiographic progression (RP), and erosive disease in a cohort of patients with early onset rheumatoid arthritis (EORA) that followed a therapeutic protocol aiming at remission, in a real world tight-control setting. EORA patients were enrolled in a 3-year follow-up study. Clinical, biological, immunogenetic, and radiographical data were analyzed. Radiographs were scored according to Sharp-van der Heijde (SvdH) method. RP was defined by an increase of 3 units in 36 months. Remission was defined as DAS28 <2.6. A stepwise multiple logistic regression model was used to identify independent predictors of the three target outcomes. One hundred twenty-nine patients were included. Baseline disease activity was high. Significant overall improvement was observed, but only 33.3 % achieved remission. At 36 month, 50.4 % (65) of patients showed erosions. RP was observed in 62.7 % (81) of cases. Statistical analysis showed that baseline SvdH score was the only predictive factor associated with the three outcomes evaluated. Lower HAQ-DI and absence of autoantibodies were predictive of remission. Higher levels of ESR and presence of erosions at entry were predictive of RP. Independent baseline predictors of incident erosive disease were anti-CCP and RF positivity, symptom duration at baseline >3 months, and presence of HLA-DRB1 shared epitope. Radiographic damage at baseline was the main predictor of outcomes. Autoantibodies, HAQ and ESR at baseline, symptom duration before diagnosis, and HLA-DRB1 status had influence on clinical course and development of structural joint damage in Colombian RA patients.
Subject(s)
Arthritis, Rheumatoid/diagnostic imaging , Arthritis, Rheumatoid/pathology , Adult , Antirheumatic Agents/administration & dosage , Arthritis, Rheumatoid/drug therapy , Autoantibodies/blood , Colombia , Disease Progression , Female , Follow-Up Studies , HLA-DRB1 Chains/genetics , Humans , Logistic Models , Male , Methotrexate/administration & dosage , Middle Aged , Peptides, Cyclic/immunology , Prospective Studies , Radiography , Remission Induction , Rheumatoid Factor/immunology , Severity of Illness IndexABSTRACT
INTRODUCTION: Late-onset systemic lupus erythematosus (SLE) represents a specific subgroup that is defined as onset after 50 years of age. Late-onset lupus may have a different clinical course and serological findings, which may delay diagnosis and timely treatment. OBJECTIVES: The objective of this paper is to determine the clinical, serologic, and immunogenetic differences among Colombian patients with late-onset SLE versus conventional SLE patients. METHODOLOGY: This was a cross-sectional study in a Colombian population. Patients and their medical records were analyzed from the services of Rheumatology in Bogotá and met the criteria for SLE, according to the American College of Rheumatology (ACR) revised criteria for the classification of SLE.In a reference group of late-onset SLE patients (98 participants, with an onset after 50 years of age) and a group of conventional SLE patients (72 participants, with an onset of age of 49 years or less), multiple clinical variables (age, clinical criteria for lupus, alopecia, weight loss, fever, Raynaud's phenomenon) and multiple serological variables (blood count, blood chemistry profile, autoantibodies) were analyzed. Additionally, the HLA class II (DRB1) of all the patients was genotyped, including an additional group of patients without the autoimmune disease. Statistical analysis was performed using the STATA 10.0 package. RESULTS: In the group of late-onset lupus, there was a higher frequency of pleurisy (p = 0.002), pericarditis (p = 0.026), dry symptoms (p = 0.029), lymphopenia (p = 0.007), and higher titers of rheumatoid factor (p = 0.001) compared with the group of conventional SLE. Late-onset SLE patients had a lower seizure frequency (p = 0.019), weight loss (p = 0.009), alopecia (p < 0.001), and Raynaud's phenomenon (p = 0.013) compared to the conventional SLE group. In late-onset SLE, HLA DR17 (DR3) was found more frequently compared with individuals without autoimmune disease (OR 3.81, 95% CI 1.47 to 10.59) (p = 0.0016). CONCLUSION: In the Colombian SLE population analyzed, there may be a probable association of several clinical and serologic variants, which would allow the differentiation of variables in the presentation of the disease among patients with late-onset SLE vs. conventional SLE.
Subject(s)
Age of Onset , HLA-DRB1 Chains/genetics , Lupus Erythematosus, Systemic/epidemiology , Lupus Erythematosus, Systemic/genetics , Adolescent , Adult , Aged , Aged, 80 and over , Autoantibodies/blood , Colombia , Cross-Sectional Studies , Female , Genotype , Humans , Immunogenetics , Male , Middle Aged , Young AdultABSTRACT
La osteopoiquilia y osteopatía condensante diseminada es una rara entidad, de carácter hereditaria-familiar, que afecta especialmente al sexo masculino y de curso asintomático, caracterizada por el hallazgo radiológico de pequeños focos ovoides o lenticulares entre 2 mm y 2 cm, paralelos al eje longitudinal del hueso. Se ha descrito asociada a la dermatofibrosis conocida como síndrome de Buschke-Ollendorff. Se describe una serie de 12 pacientes, con diagnóstico de osteopoiquilia de acuerdo a los criterios diagnósticos establecidos, observando en todos ellos adecuado modelado óseo, razón por la que se propone clasificar esta entidad en un grupo diferente al de las llamadas enfermedades displásicas de hueso. Se describe la primera asociación en la literatura mundial entre osteopoiquilia, dermatofibrosis lenticular y condrocalcinosis (AU)
Subject(s)
Adolescent , Adult , Female , Male , Middle Aged , Humans , Osteopoikilosis/diagnosis , Prospective Studies , Osteopoikilosis/complications , Chondrocalcinosis/complicationsABSTRACT
Las acro-osteólisis son un proceso de resorción ósea y se clasifican en primarias y secundarias. La etiopatogénesis de la acro-osteolisis primaria es desconocida, presenta un grupo de manifestaciones clínicas heterogéneas asociadas, la consideramos como un síndrome con múltiples expresiones clínicas, y por ello debemos considerarla como una enfermedad multifactorial y poligénica. Presentamos un caso de una mujer con acro-osteólisis primaria y poliartritis simétrica similar a artritis reumatoidea (AU)
Subject(s)
Adult , Female , Humans , Bone Resorption/physiopathology , Diagnosis, Differential , Prednisone/therapeutic useABSTRACT
La calcificación y osificación extraesquelética son patologías que observamos frecuentemente en la práctica clínica. En este artículo presentamos tres casos de calcinosis universalis, una con dermatomiositis, una con lupus y otra con esclerodermia sin esclerodermia. Aun cuando la patogénesis del proceso inflamatorio es diferente en las tres enfermedades, existe una vía común que conduce al depósito de sales de calcio en los tejidos. El proceso inflamatorio deja un sustrato tisular lesionado que predispone al desarrollo de calcificaciones distróficas (AU)
Subject(s)
Adolescent , Adult , Female , Middle Aged , Humans , Calcinosis/diagnosis , Lupus Erythematosus, Systemic/complications , Dermatomyositis/complications , Prednisone/therapeutic use , Scleroderma, Localized/complicationsABSTRACT
No disponible
Subject(s)
Female , Male , Humans , Rickets/history , Osteomalacia/history , Colombia/epidemiology , Vitamin D Deficiency/history , Protein-Energy Malnutrition/history , Cod Liver Oil/therapeutic use , Densitometry/trends , Alkaline Phosphatase/blood , Osteomalacia/epidemiology , Rickets/epidemiology , Bone Demineralization, Pathologic/physiopathology , Parathyroid Hormone/bloodABSTRACT
Se presenta un caso de sobreposición de una distrofia mixta no esclerosante de paquidermoperiostosis y una displasia diafisaria tipo Engelmann-Camurati. Se realiza una revisión extensa de la literatura, destacando los aspectos históricos sobre las características clínicas radiológicas y el posible origen de esta sobreposición no descrita en la literatura (AU)
