III Actualización del Consenso de la Sociedad Española de Reumatología sobre terapia biológica en la artritis reumatoide / No disponible

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[Treatment of bone mass loss in postmenopausal women]. / Tratamiento de la pérdida de masa ósea en la mujer postmenopáusica.

In this revision, the results of different controlled clinical trials and metaanalyses on the efficacy in the increase of bone mineral density (BMD) and reduction of risk of fracture on postmenopausal osteoporosis treatments are summarized. Most of the drugs studied produce significant BMD increases but with significant differences regarding fracture risk reduction, especially regarding extravertebral fractures. Bisphosphonates and selective estrogen receptor modulators would constitute the first line of treatment of postmenopausal osteoporosis with previous fractures. Head to head studies would be necessary to know its true efficacy since some results are based on post hoc analysis. Possible side effects, risks, treatment comfort and price in addition to the demonstrated efficacy in fracture prevention must be considered in the selection of treatment.

Tratamiento de la pérdida de masa ósea en la mujer postmenopáusica / Treatment of bone mass loss in postmenopausal women

En esta revisión se resumen los resultados de diferentes ensayos clínicos controlados y metaanálisis sobre la eficacia en el incremento de la densidad mineral ósea (DMO) y en la reducción del riesgo de fractura de los tratamientos de la osteoporosis postmenopáusica. La mayor parte de los fármacos estudiados producen aumentos significativos de la DMO, pero con notables diferencias en cuanto a la reducción del riesgo de fractura, particularmente las relativas a las fracturas extravertebrales. Los bisfosfonatos y los moduladores selectivos de los receptores de estrógenos constituirían la primera línea del tratamiento de la osteoporosis postmenopáusica con fracturas previas. Serían necesarios estudios head to head para conocer su verdadera eficacia ya que algunos resultados están basados en análisis post hoc. En la selección del tratamiento, además de la eficacia demostrada en la prevención de fractura, hay que considerar los posibles efectos secundarios, los riesgos, la comodidad del tratamiento y el precio

In this revision, the results of different controlled clinical trials and metaanalyses on the efficacy in the increase of bone mineral density (BMD) and reduction of risk of fracture on postmenopausal osteoporosis treatments are summarized. Most of the drugs studied produce significant BMD increases but with significant differences regarding fracture risk reduction, especially regarding extravertebral fractures. Bisphosphonates and selective estrogen receptor modulators would constitute the first line of treatment of postmenopausal osteoporosis with previous fractures. Head to head studies would be necessary to know its true efficacy since some results are based on post hoc analysis. Possible side effects, risks, treatment comfort and price in addition to the demonstrated efficacy in fracture prevention must be considered in the selection of treatment

Rituximab en la artritis reumatoide / Rituximab in rheumatoid arthritis

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Tuberculosis con prueba cutánea de tuberculina negativa en un paciente con artritis reumatoide / Tuberculosis in a patient with rheumatoid arthritis and negative tuberculin skin test

La artritis reumatoide es una enfermedad grave que necesita tratamiento adecuado y temprano utilizando el arsenal terapéutico que incluye fármacos como la leflunomida y los anticuerpos antifactor de necrosis tumoral alfa (TNF-alpha). Se presenta un paciente con artritis reumatoide de muchos años de evolución en el que han fracasado tratamientos previos habituales. Se describe la respuesta al tratamiento con infliximab (fármaco anti-TNF-alpha) y la aparición de tuberculosis hepatoesplénica con prueba cutánea negativa, lo que obligó a la suspensión del fármaco y a la introducción de leflunomida como medicación inmunomoduladora de la enfermedad. Se describen los aspectos de interés del caso clínico en relación con los mecanismos de defensa inmunológicos, el manejo farmacológico de estos medicamentos y su uso racional así como profilaxis adecuada (AU)

Rheumatoid arthritis is a severe disease that requires appropriate and early treatment using a therapeutic arsenal that includes drugs such as leflunomide and anti-tumor necrosis factor (TNF) alpha antibodies. We describe a patient with long-standing rheumatoid arthritis refractory to commonly used treatments. The response to infliximab (an anti- TNF alpha drug) is described. This treatment was discontinued due to the development of hepatosplenic tuberculosis with negative skin test and leflunomide was introduced as an immunomodulatory drug. Features of this case are described in relation to mechanisms of immunological defense, the pharmacological management of these drugs and their rational use, as well as appropriate prophylaxis (AU)

Simultaneous identification of various antinuclear antibodies using an automated multiparameter line immunoassay system.

The objective was to determine the sensitivity and specificity of an automated multiparameter line immunoassay system compared with other techniques for the identification of autoantibodies in rheumatic diseases. We studied sera from 90 patients. Anti-U1RNP, anti-Sm, anti-Ro/SS-A, anti-La/SS-B, anti-Jo 1 and anti-Scl 70 antibodies were identified by counterimmunoelectrophoresis (CIE) techniques, enzyme-linked immunosorbent assay (ELISA), immunoblotting (IB) using extracts of rabbit thymus and human placenta, and an automated multiparameter line immunoassay system (INNO-LIA ANA UPDATE K-1090) that detects nine different antibodies simultaneously (anti-U1RNP, anti-Sm, anti-Ro/SS-A, anti-La/SS-B, anti-Scl 70, anti-Jo 1, anticentromere, antihistone, and antiribosomal P protein). The line immunoassay system equaled or surpassed the other techniques in the identification of anti-Sm, anti-La/SS-B, anti-Jo 1 and anti-Scl 70 antibodies (sensitivity 100%, specificity 94-100%) and was similarly effective in the case of anti-U1RNP (sensitivity 87.5%, specificity 93.9%) and anti-Ro/SS-A (sensitivity 91.4%, specificity 87.2%) antibodies. In addition, this technique detected more 52 and 60 kD anti-Ro/SS-A sera than IB. Nine antibodies can be detected with this method at a cost of 25.38 Euros per serum sample. In five hours, 19 sera can be studied. The approximate cost of detecting these nine antibodies with an automated ELISA system would be 28.93 Euros, which allows 10 sera to be studied in four hours. In conclusion, the automated multiparameter line immunoassay system is a valid method for the detection of autoantibodies in rheumatic diseases. Its most notable advantages are automated simultaneous detection of several autoantibodies in the same serum and its lower cost compared with ELISA techniques.

Enfermedad de Behçet / Behçet's disease

No disponible

Artritis crónica juvenil / Juvenile chronic arthritis

No disponible

Laboratorio y líquido sinovial en la artritis reumatoide / The laboratory and synovial fluid in rheumatoid arthritis

No disponible

Leflunomida: un nuevo tratamiento para una vieja enfermedad / Leflunomide: a new therapy for an old disease

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Clinical significance of abdominal scintigraphy using 99mTc-HMPAO-labelled leucocytes in patients with seronegative spondyloarthropathies.

Abdominal scintigraphy shows silent gut inflammation in patients with spondyloarthropathies (Sp) without clinical evidence of gut inflammation. Abdominal scintigraphy images are different than those obtained in patients with ulcerative colitis or Crohn's disease and are not related to the anti-inflammatory drugs administered. The aim of this study was to examine the clinical associations of findings on abdominal scintigraphy in patients with Sp. A total of 204 Sp patients (European Spondylarthropathy Study Group 1991 criteria) and 54 non-Sp controls receiving non-steroidal anti-inflammatory drugs were studied. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes. 99mTc-HMPAO-labelled leucocyte scans were positive in 104 Sp patients (50.9%) and in six non-Sp controls (2.9%) (P<0.001; OR=8.32; 95% CI=3.23-22.67). Silent gut inflammation was not associated with any of the following: age of onset, duration of evolution, sex, family history of Sp or psoriasis, articular manifestations, extra-articular manifestations, radiological findings or HLA-B27 positivity. Positive abdominal scintigraphy was associated with active disease (P < 0.0001; OR=52.7; 95% CI=19-145.6) and an increase in the C-reactive protein (P < 0.005; OR = 3.4; 95% CI = 1.5-7.4). It is concluded that (a) abdominal scintigraphy using 99mTc-HMPAO-labelled leucocytes is of value in detecting the silent gut inflammation in Sp patients, and (b) silent gut inflammation is related to the clinical activity, but is not associated with any particular type of illness or with HLA-B27.

Clinical significance of abdominal scintigraphy using (99m)Tc-HMPAO-labelled leucocytes in patients with seronegative spondyloarthropathies.

Abdominal scintigraphy shows silent gut inflammation in patients with spondyloarthropathies (Sp) without clinical evidence of gut inflammation. Abdominal scintigraphy images are different than those obtained in patients with ulcerative colitis or Crohn's disease and are not related to the anti-inflammatory drugs administered. The aim of this study was to examine the clinical associations of findings on abdominal scintigraphy in patients with Sp. A total of 204 Sp patients (European Spondylarthropathy Study Group 1991 criteria) and 54 non-Sp controls receiving non-steroidal anti-inflammatory drugs were studied. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of technetium-99m hexamethylpropylene amine oxime ((99m)Tc-HMPAO)-labelled leucocytes. (99m)Tc-HMPAO-labelled leucocyte scans were positive in 104 Sp patients (50.9%) and in six non-Sp controls (2.9%) (P<0.001; OR=8.32; 95% CI=3.23-22.67). Silent gut inflammation was not associated with any of the following: age of onset, duration of evolution, sex, family history of Sp or psoriasis, articular manifestations, extra-articular manifestations, radiological findings or HLA-B27 positivity. Positive abdominal scintigraphy was associated with active disease (P<0.0001; OR=52.7; 95% CI=19-145.6) and an increase in the C-reactive protein (P<0.005; OR=3.4; 95% CI=1.5-7.4). It is concluded that (a) abdominal scintigraphy using (99m)Tc-HMPAO-labelled leucocytes is of value in detecting the silent gut inflammation in Sp patients, and (b) silent gut inflammation is related to the clinical activity, but is not associated with any particular type of illness or with HLA-B27.

Septic arthritis.

Septic arthritis is a direct invasion of the joints by pathogenic micro-organisms. These micro-organisms and their products stimulate the release of pro-inflammatory cytokines and proteolytic enzymes that induce an inflammatory response and degradation of the cartilage. Staphylococcus aureus remains the most prevalent micro-organism, and the most important aetiological change has been the decreased incidence of gonorrhoea, which is related to changes in sexual behaviour as a result of the HIV epidemic. Diagnostic suspicion is based on clinical symptoms, imaging findings and examination of synovial fluid. Scintigraphy and magnetic resonance imaging are useful methods for localizing and defining the extent of infection. The definitive diagnosis is based on the isolation and culture of the pathogen from synovial fluid. Optimal cultures are obtained by inoculating the synovial fluid immediately into blood culture bottles. Treatment includes initial empirical antibiotics, which are modified according to the synovial fluid culture. It is recommended that 3-4 weeks of intravenous antibiotic therapy are followed by 2 or 3 more weeks of an oral regimen. Adequate drainage may be performed by means of repeated needle aspiration, arthroscopy or surgery. Recent studies on the pathogenic mechanisms of septic arthritis have led to the simultaneous use of intra-articular steroids and antibiotics in order to reduce articular damage.

[Hypertransaminemia and methotrexate: not always a toxic effect?]. / Hipertransaminemia y metotrexato: es siempre un efecto tóxico?

Serial measurement of liver enzymes is useful to detect liver toxicity due to methotrexate in patients with rheumatoid arthritis or other rheumatic diseases. We have reviewed retrospectively 141 adult patients treated with methotrexate from 1988 to 1991. The more common diagnoses included rheumatoid arthritis (120 cases) and psoriatic arthritis (12 cases). In periodic studies carried our every 2-3 months, a transient increase in transaminase values associated with methotrexate in 13 patients (9.2%) was observed. Two patients developed a viral infection during therapy, one due to cytomegalovirus and the other due to the Epstein-Barr virus. Both patients had a favorable outcome once methotrexate was withdrawn.