Esclerodèrmia localitzada infantil / Esclerodermia infantile localizada / Juvenile localized scleroderm

L'esclerodèrmia localitzada infantil és una malaltia rara que pot tenir diferents formes de presentació i graus d'afectació. El seu diagnòstic és eminentment clínic i in-clou la història clínica, l'anàlisi de l'aspecte de les lesions i la seva evolució. En cas de dubte es pot fer una biòpsia cutània que confirma la sospita diagnòstica. El tractament més acceptat i amb més bons resultats en l'actualitat és la corticoteràpia endovenosa en combinació amb el meto-trexat. L'objectiu del tractament és tant aturar la progressió de la lesió com reduir les seqüeles, per exemple les con-tractures articulars o les alteracions estètiques. A més del tractament farmacològic també s'aconsella un tractament rehabilitador, especialment en les lesions extenses

La esclerodermia localizada infantil es una enfermedad rara que puede tener diferentes formas de presentación y grados de afectación. Su diagnóstico es clínico e incluye la historia clínica, el análisis del aspecto de las lesiones y su evolución. En caso de duda se puede hacer una biopsia cutánea que confirma la sospecha diagnóstica. El tratamiento más aceptado y con mejores resultados en la actualidad es la corticoterapia endovenosa en combinación con el metotrexato. El objetivo del tratamiento es tanto detener la progresión de la lesión como reducir las secuelas, por ejemplo las contracturas articulares o las alteraciones estéticas. Además del tratamiento farmacológico también se aconseja un tratamiento rehabilitador, especialmente en las lesiones extensas (AU)

Juvenile Localized Scleroderma is a rare disease that can present in various different forms and degrees of involvement. The diagnosis is eminently clinical and medical history includes analysis of the appearance of the lesions and their evolution. If there is any doubt you can do a skin biopsy to confirm the suspected diagnosis. Nowadays the most accepted and successful treatment is intravenous steroids in combination with methotrexate. The treatment goal is to stop the progression of the injury and also reduce the consequences, for example joint contractures o aesthetic alterations. Besides pharmacological treatment, rehabilitation is also advisable, especially in extensive lesions (AU)

¿Cómo hacer buen uso del metotrexato en artritis reumatoide? / How to effectively use methotrexate in rheumatoid arthritis?

El metotrexato (MTX) es el fármaco modificador de la enfermedad de primera elección en artritis reumatoide. A pesar del uso casi generalizado por reumatólogos en todo el mundo, hay mucha discordancia entre la forma de iniciar la dosis, la vía de administración y la forma de realizar el incremento de dosis. En este artículo se planteamos un esquema simplificado del uso de este fármaco a individualizar en cada caso, basado en los aspectos farmacológicos, guías y protocolos de manejo publicados en revistas de impacto de nuestra especialidad en los últimos años. Se revisa además las reacciones adversas y efectos secundarios y cómo realizar el seguimiento de éstos (AU)

Methotrexate (MTX) is the first choice disease modifying anti-rheumatic drugs for rheumatoid arthritis. In spite of its generalized use by rheumatologists worldwide, there is a general lack of agreement regarding the route of administration, the start-up dose and the way to increase the same. In this article we propose a simplified outline for the use of the drug that should be individualized, based on it's pharmacological aspects, guidelines and recommendations published in high impact factor journals during the past few years. Adverse reactions and side effects, as well as their follow up are also reviewed (AU)

[How to effectively use methotrexate in rheumatoid arthritis?]. / ¿Cómo hacer buen uso del metotrexato en artritis reumatoide?

Methotrexate (MTX) is the first choice disease modifying anti-rheumatic drugs for rheumatoid arthritis. In spite of its generalized use by rheumatologists worldwide, there is a general lack of agreement regarding the route of administration, the start-up dose and the way to increase the same. In this article we propose a simplified outline for the use of the drug that should be individualized, based on it's pharmacological aspects, guidelines and recommendations published in high impact factor journals during the past few years. Adverse reactions and side effects, as well as their follow up are also reviewed.

Risk factors associated with renal lithiasis during uricosuric treatment of hyperuricemia in patients with gout.

OBJECTIVE: To find factors associated with the development of renal colic during uricosuric therapy. METHODS: We performed a prospective cohort followup study of patients with gout and no previous history of kidney stones who had been treated with uricosurics. Clearance of creatinine and urate, 24-hour urinary uric acid (UA), undissociated urinary UA concentration, 24-hour undissociated urinary UA, and pH and urine sediment were obtained. Cox proportional hazards regression analysis was used to identify variables associated with renal colic as the outcome. The rate of renal colic was compared with that of control patients receiving allopurinol who had no previous history of renal stones. RESULTS: We analyzed a 784 patient-year exposure from 216 patients: 206 with renal underexcretion of UA and 10 with normal excretion. There were 21 clinical events. Two variables showed increased risk hazard for developing lithiasis: clearance of UA at baseline and undissociated urinary UA concentration during followup. When only patients with underexcretion of UA were included in the analysis, undissociated urinary UA during followup remained the only statistically significant variable. Patients who showed an undissociated UA concentration < 20 mg/dl did not show an increase in the rate of lithiasis or events compared with patients receiving allopurinol. CONCLUSION: Clearance of UA at baseline may be useful for selecting patients suitable for uricosuric treatment. The estimation of the concentration of undissociated urinary UA is useful for evaluating the risk of lithiasis during followup.