Climacteric and fibromyalgia: a review.

Fibromyalgia (FM) and climacteric conditions share common epidemiological and clinical features, with FM symptoms often beginning during menopause. Musculoskeletal pain, arthralgia, myalgia and other symptoms are frequently seen in both conditions. Some research suggests a link between the cessation of sex hormones and FM symptoms. Women with FM tend to experience more severe symptoms after menopause, and the severity of FM symptoms can worsen in women who have had a hysterectomy with or without oophorectomy. Despite these similarities, it is essential to treat FM and climacteric conditions separately and follow established guidelines for management. However, it is also important to recognize that both conditions can coexist in the same patient. It is crucial to note that there is limited evidence supporting the effectiveness of menopausal hormone therapy for primary FM management. Therefore, menopausal hormone therapy should not be recommended for FM unless the patient also has climacteric syndrome.

First Ecuadorian statement consensus for the evaluation and treatment of osteoporosis.

Osteoporosis management has become more relevant as the life expectancy increases. In Ecuador, approximately 19% of adults over 65 years of age have been diagnosed with osteoporosis. There is no national consensus for the management and prevention of the disease being this proposal the first Ecuadorian consensus. INTRODUCTION: In Ecuador, it is estimated that around 19% of adults over 65 years of age have osteoporosis. Due to the increase in life expectancy in the world population, the evaluation and management of osteoporosis has become more relevant. Currently, there is no national consensus for the management and prevention of the disease. The Ecuadorian Society of Rheumatology presented the project for the elaboration of the first Ecuadorian consensus for the management and prevention of osteoporosis. METHODS: A panel of experts in multiple areas and extensive experience was invited to participate. The consensus was carried out using the Delphi method. Six working dimensions were created: definition and epidemiology of osteoporosis, fracture risk prediction tools, non-pharmacological treatment, pharmacological treatment, calcium and vitamin D, and glucocorticoid-induced osteoporosis. RESULTS: The first round was held in December 2021, followed by the second round in February 2022 and the third round in March 2022. The data was shared with the specialists at the end of each round. After three rounds of work, a consensus was reached for the management and prevention of osteoporosis. CONCLUSION: This is the first Ecuadorian consensus for the management and treatment of postmenopausal osteoporosis.

D-Dimer trend in a long-term rheumatoid arthritis patient with tofacitinib treatment and recent COVID-19 infection

The SARS-CoV-2 virus was first identified in December 2019, the infection was named COVID-19. The initial symptoms and evolution of the disease have been described over the past year. The virus has been shown to increase the risk of thromboembolic events due to the hypercoagulable state triggered by systemic endothelial inflammation. We present the case of a patient with a history of rheumatoid arthritis under prolonged treatment with tofacitinib, who presented COVID-19 and subsequently developed a hypercoagulable state of approximately 6 months' duration. The possible association between viral infection and the use of tofacitinib is debated.

El virus SARS-CoV-2 se identificó por primera vez en diciembre de 2019; la infección se denominó COVID-19. Los síntomas iniciales y la evolución de la enfermedad se han descrito durante el último anno. Se ha demostrado que el virus aumenta el riesgo de eventos trom-boembólicos debido al estado de hipercoagulabilidad desencadenado por la inflamación endotelial sistêmica. Se presenta el caso de un paciente con antecedente de artritis reuma-toide en tratamiento prolongado con tofacitinib, que presentó COVID-19 y posteriormente desarrolló un estado de hipercoagulabilidad de aproximadamente seis meses de duración. Se debate la posible asociación entre la infección viral y el uso de tofacitinib.

Nailfold capillaroscopy in diabetes mellitus: a case of neo-angiogenesis after achieving normoglycemia.

Diabetes mellitus (DM) is a disease process characterized by a chronic hyperglycemic milieu that leads to micro and macrovascular complications, including diabetic retinopathy, diabetic nephropathy and diabetic neuropathy. During the last decade, researchers have used nail-fold capillaroscopy to study the microvascular alterations in rheumatologic diseases; however, the technology is gaining momentum in other disease processes that alter microvascular architecture. We observed a drastic improvement in the nail-fold capillary architecture in a patient with uncontrolled DM. After achieving excellent glycemic control 6 months after diagnosis, increased capillary density and evident rearrangement of the capillaries replaced the avascular areas and giant capillaries found at the time of diagnosis.

Burnout in Rheumatologists in Latin America.

BACKGROUND: Rheumatology is considered a low-risk specialty, but studies have shown a prevalence of burnout between 42% and 51%. OBJECTIVES: The aim was to determine the prevalence of burnout in rheumatologists in Latin America and the factors associated with it. METHODS: Cross-sectional study based on a survey completed through Google Forms platform that was sent by the national rheumatology associations of Latin America. Burnout was assessed with the Maslach Burnout Inventory. Data were analyzed using the statistical program SPSS v.22. RESULTS: Two hundred ninety-seven rheumatologists from 15 countries were included, mainly Argentina (28.3%), Brazil (26.3%), and Mexico (12.8%). The majority were women 62%, 42.4% worked in public hospitals with an average of 40.1 ± 14.2 hours per week; 31.3% did research, 13.1% clinical trials, 56.6% teaching, and 42.8% administrative work; 36% received an annual income less than $25,000; 56.6% had burnout in at least 1 dimension. Only 20.2% thought they had burnout, 9.1% were currently receiving professional help, and 15.8% had sought help in the past; 72.1% said they were willing to participate in a program to reduce burnout. The rheumatologists with burnout were younger than those without burnout (46.5 vs 49.9 years, p = 0.015). CONCLUSIONS: Burnout affects near half of rheumatologists in Latin America and was associated with younger age, long working hours, low satisfaction, less happiness, higher Patient Health Questionnaire-9, suicidal thoughts, anxiety, income, presence of comorbidities, and low self-esteem.

Autoinflammatory/Autoimmunity Syndrome Induced By Adjuvants (ASIA) Due to Silicone Incompatibility Syndrome.

The adjuvant-induced autoimmune syndrome (ASIA) is associated with a dysregulation of the innate and adaptive immune system after exposure to chemical compounds, including liquid paraffin, silicone gel, acrylamides, and hyaluronic acid. Due the increase of the use of these compounds in cosmetic procedures, the prevalence of this syndrome is increasing. We present the first report in Ecuador associated to ASIA after an elective silicone breast prosthesis procedure, manifested as polyarthralgia, positive antinuclear antibody, anticentromere antibody, and a moderate positive Sclero-70.

Beyond Rheumatoid Arthritis Evaluation: What are We Missing?

Rheumatoid Arthritis (RA) is a chronic inflammatory autoimmune systemic disease that preferentially affects small and large joints with a progressive course and can become deforming and disabling. In recent years, much progress has been made in the evaluation of inflammation and disease activity, however, there are other factors that have a high impact on the quality of life of these patients, such as depression, anxiety, fatigue, sleep disorders, suicidal behavior, fibromyalgia, sexual activity, sarcopenia, frailty, cachexia and obesity that are not always evaluated by rheumatologists. This review shows that the evaluation and timely detection of these aspects in patients with RA could interfere with the prognosis and improve their quality of life.

LARS study: Latin American rheumatologist survey.

BACKGROUND/OBJECTIVE: Latin America has scarce information related to rheumatologist's education, working conditions, productivity, and job satisfaction. The purpose of this survey was to describe the training and clinical practice characteristics of the rheumatology community in Latin America. METHODS: This is a cross-sectional study. A digital survey was created, approved, and endorsed by the scientific committee of the Pan-American League of Associations for Rheumatology (PANLAR) and later sent to the rheumatology associations of the region. The data was analyzed in the statistical program SPSS v.22. RESULTS: We included 600 surveys of rheumatologists from 19 Latin American countries. The majority were females (53%) and mestizos (58%). The mean age was 46.8 ± 11.7 years. The most frequent workplace was public/government hospitals 33.5% followed by private practice 28.8%, private hospital 20.8%, and university hospital 15.5%. The average number of weekly working hours was 37.8 ± 17.7. 87.5% worked in adult rheumatology, 12.7% pediatric rheumatology, and 23.5% internal medicine. Average satisfaction with practice as a rheumatologist was 5.3/7, career options 4.3/7, location 4.7/7, income 3.5/7, job security 3.7/7, and colleagues and co-workers 4.5/7. Finally, 69.7% had an annual compensation of < 50,000 US dollars. CONCLUSIONS: The majority of the rheumatologists in the region who responded were women, worked in public hospitals, and were satisfied with their clinical practice. There was a low level of income for the region. Key Points • This is the first study that showed the demographic and clinical practice characteristics of rheumatologists in Latin America. • The challenges faced by Latin rheumatologists are like those faced by the region: ethnic diversity, gender differences, migration, difficult access to education, limited research, and low income. • Due to the high prevalence of rheumatic diseases and the shortage of professionals in this area, it is essential to analyze the current workforce and the projections of supply and demand in rheumatology that are expected in the future.

Rol de la homocisteína y vitamina B en el metabolismo óseo / Role of homocysteine and vitamin B in bone metabolism

RESUMEN Se han propuesto varios estudios que sugieren que el grupo de vitaminas B posee un rol en la fisiología ósea. Se realizó una revisión bibliográfica sobre la interacción de este con la homocisteína y la relación de ambos con el metabolismo óseo y la osteoporosis. Algunos estudios han sugerido que los niveles de vitamina B, sobre todo las vitaminas B12 y B9, se han asociado a una baja densitometría ósea y a un aumentado riesgo a fractura, y que estos, a su vez, intervienen en el metabolismo de la homocisteína, por lo que su déficit puede ocasionar un estado de hiperhomocisteinemia. Publicaciones recientes proponen que la hiperhomocisteinemia se encuentra asociada a desmineralización ósea, baja calidad de masa ósea y aumento de biomarcadores de recambio óseo, dado que influye en la actividad osteoclástica y en los enlaces cruzados de colágeno. Por lo tanto, la hiperhomocisteinemia puede ser un factor que reduce la densidad y la calidad ósea. Se necesita más información para determinar el papel que tiene cada vitamina directamente en la salud ósea, o si estas solo influyen a través de las concentraciones séricas de homocisteína.

ABSTRACT Several studies have suggested a role for B-vitamins in bone physiology. A systematic review is presented on the interaction of B-vitamins with homocysteine and the relationship of both in bone metabolism and osteoporosis. The levels of vitamin-B, particularly B12 and B9, have been associated with a low bone mineral density and an increased risk of fracture. At the same time, its deficit affects the metabolism of homocysteine, which can then result in a high serum homocysteine. Recent findings have proposed that high serum homocysteine is linked to bone demineralisation, low quality of bone mass, and an increase in bone turnover biomarkers, given the influence over the osteoclastic activity and the cross-linking of collagen molecules. Therefore, high serum homocysteine could be a factor that reduces bone density and quality. More information is needed to determine whether there is a direct role of each vitamin in bone health, or if they are just influenced by homocysteine serum concentrations.

FRAX-based assessment and intervention threshold curves for osteoporosis evaluation in Ecuador / Curvas de intervención y evaluación basadas en FRAX Ecuador

RESUMEN Introducción: La herramienta FRAX ha sido validada y adaptada a diferentes países, cubriendo a casi el 80% de la población mundial, incluido Ecuador, donde fue adaptada en 2009. El objetivo de este estudio fue elaborar curvas de evaluación e intervención basadas en FRAX Ecuador. Métodos: Utilizando el modelo FRAX Ecuador, calculamos la probabilidad de fractura osteoporótica mayor y fractura de cadera femenina sin ningún factor de riesgo y sin la inclusión de DMO. Las probabilidades se calcularon en intervalos de 5 años de 40 a 90 años. Las probabilidades de fractura mayor y de cadera se calcularon en 3 escenarios diferentes: 1. Historia de fractura previa sin la inclusión de DMO, 2. T-Score de -2,5 SD sin otros factores de riesgo clínico, 3. T-Score -1,5 SD sin otros factores de riesgo clínico. Resultados: En mujeres sin factores de riesgo, la probabilidad de fractura osteoporótica mayor aumentó con la edad del 0,4% a los 40 años al 7,3% a los 90 años. La probabilidad de fractura de cadera aumentó con la edad de 0% a los 40 años a 3,6% a los 90 anos. La probabilidad de fractura osteoporótica mayor aumentó en mujeres con un puntaje T de -2,5 SD de 0,9% a los 40 años a 5,5% a los 90 años; con puntaje T de -1,5 DE, de 0,6% a los 40 años a 3,9% a los 90 anos. Conclusión: Los datos muestran la importancia de aplicar herramientas como FRAX, específicas para cada país y también la creación de curvas de evaluación e intervención que permitan discernir según cada paciente la necesidad de utilizar recursos como DXA y tratamientos específicos.

ABSTRACT Introduction: FRAX has been validated and adapted to different countries, covering almost 80% of the world's population, including Ecuador where it was adapted in 2009. The purpose of this study is to elaborate evaluation and intervention curves based on FRAX Ecuador. Methods: Using the FRAX Ecuador model, we calculated the probability of a major osteoporotic fracture and a female hip fracture without any risk factor and without the inclusion of BMD. The probabilities were calculated in 5-year intervals from 40 to 90 years. The probabilities of major fractures and hip fractures were calculated in 3 different scenarios: 1. History of previous fracture without the inclusion of BMD, 2. T score -2.5 SD without other clinical risk factors, 3. T score -1.5 SD without other clinical risk factors. Results: In women without risk factors, the probability of a major osteoporotic fracture increased with age from 0.4% at 40 years to 7.3% at 90 years. The probability of hip fracture increased with age from 0% at 40 years to 3.6% at 90 years. The probability of a major osteoporotic fracture increased in women with a T score of -2.5 SD from 0.9% at 40 years to 5.5% at 90 years; with a T-score of -1.5 SD, from 0.6% at 40 years to 3.9% at 90 years. Conclusion: Data shows the importance of applying tools such as FRAX, specific for each country and also the creation of evaluation and intervention curves that allow discerning according to each patient the need for the use of resources such as DXA and specific treatments.

Functional Disability and Its Determinants in Ecuadorian Patients with Rheumatoid Arthritis.

INTRODUCTION: Disability in RA is associated with loss of workdays, greater use of health resources and a higher prevalence of depression. The purpose of this study was to determine the prevalence of functional disability and the factors associated with it. METHODS: A cross-sectional study was carried out during January-June 2019 at a rheumatology clinic in the city of Guayaquil. Patients with pre-established RA were included. Functional disability was measured using the HAQ-DI. Data were analyzed using the statistical program SPSS v22. We compared characteristics between patients with and without disability using Student's t-test and chi-square. A multiple logistic regression model for functional disability was made. RESULTS: We included 395 patients, 87.8% female and 12.2% male with a mean age of 51.4±12 years and mean duration of disease 13.8±7 years. Most patients had extra-articular manifestations (80.8%) and comorbidities (81.3%). The mean HAQ-DI was 0.8±0.9, with a prevalence of disability of 26.6%. We found a statistically significant relationship between disability and female sex (p=0.018), age (p=0.020), presence of extra-articular manifestations (p=0.008), myalgia (p<0.001) and fatigue (p<0.001). In addition, patients with disabilities had a lower employment rate (26.7%) compared to those without disability (45.5%, p=0.001). In the multivariate logistic analysis, only depression (p=0.029), diabetes (p=0.003), SJC (p=0.001) and VAS of pain (p=0.004) were significantly related to functional disability. CONCLUSION: Disability affects a quarter of patients with RA. Among the determinants of disability, we found female sex, older age, grade of pain, inflammatory markers and the level of disease activity.

Vitamin D Megadose: Definition, Efficacy in Bone Metabolism, Risk of Falls and Fractures.

INTRODUCTION: Currently, approximately more than one billion people around the world are considered to have deficient levels of vitamin D. International consensus recommends vitamin D supplementation to high-risk patients (advanced age, osteoporosis, liver failure, malabsorption syndromes, etc.) and those with levels below 30 ng/mL. There are several vitamin D formulations and dosages available, including megadoses. At the moment, there is no consensus on the definition of megadoses. The purpose of this review is to define what is a megadose and analyze its effectiveness in bone metabolism, risk of fractures and falls. CONCLUSION: The administration of doses higher than 100,000 IU of vitamin D is considered a megadose. It is evident that the use of megadoses increases serum concentrations of vitamin D; however, there has been no evidence of a decrease in the risk of falls, vertebral fractures or changes in bone mineral density.

Common errors in dual-energy X-ray absorptiometry scans in imaging centers in Ecuador.

Dual-energy X-ray absorptiometry is recognized for measuring bone mineral density. The lack of knowledge can lead to errors both in the acquisition of information and in its analysis and subsequent interpretation. The main errors in Ecuadorian Centers were positioning of the patient to the equipment and incorrect analyzed area. PURPOSE/INTRODUCTION: Dual-energy X-ray absorptiometry (DXA) is recognized as the gold standard for measuring bone mineral density (BMD) with acceptable errors, good precision, and reproducibility. However, the training of operators in different centers and countries is not standardized, and the lack of knowledge can lead to errors both in the acquisition of information and in its analysis and subsequent interpretation. The purpose was to determine the most common errors in the performance of bone densitometry from different imaging centers in Ecuador. METHODS: Cross-sectional descriptive study. We collected DXA scans from different imaging centers in Ecuador. Data from the DXA scan included city of origin, type of specialist that requested it, and densitometry diagnosis. The DXA images provided were analyzed double blind by experts in the field from Argentina. RESULTS: From a total of 141 patients with a mean age of 61 ± 10 years, 93.6% were women. About 78% of the DXA scans came from private imaging centers and 22% from public centers, 95% of all came from the city of Guayaquil. The machines used were Hologic 50.4% and Lunar 49.6%. The densitometric diagnosis was 16.3% normal, 46.1% osteoporosis, and 37.6% osteopenia. A total of 112 left hip and 49 right hip scans were analyzed from which 31.2% and 22.4% had errors in patient positioning, respectively, mainly internal or external rotation. About 140 lumbar scans were analyzed from which 21.4% had patient positioning errors (not centered or not straight). Also in 38.5% the vertebral area did not correspond to L1-L4. About 3.5% had artifacts such as a metal bar or implant. The region of interest was misplaced in 24.1% of the lumbar scans and 19.9% of the femur. CONCLUSIONS: DXA quality standards exist but are often not implemented in clinical practice. When studies are performed incorrectly, it can lead to important errors in diagnosis and therapy. Physicians interested in the management of osteoporosis, although not directly involved in the performance and interpretation of DXA, should be familiar with the protocols to minimize errors and allow the proper use of bone densitometry.

Rheumatologists in Ecuador: Results of a Survey.

INTRODUCTION: Currently, there are no records of the current status of rheumatologists in Ecuador. OBJECTIVE: The purpose of this study is to get to know the current status of rheumatologists in Ecuador, focusing on education, working conditions, productivity, distribution of time between work activities, and job satisfaction. MATERIALS AND METHODS: A digital survey was created using the Google Forms platform. It was distributed to all rheumatologist members of the Ecuadorian Society of Rheumatology. The data analysis was carried out using the statistical program SPSS v.23®. RESULTS: A total of 64 surveys were received. The response rate was 86.48%. 62.5% were men and 37.5% women, with an average age of 40.76 ± 9.18. The main workplace was state/public hospital (56.3%). The average working hours per week were 40.35 ± 25.72. Most rheumatologists in Ecuador (62.5%) received their training abroad. 79.7% of rheumatologists earn less than $ 49,000 annually. The mean retirement age was 66.51 ± 6.7, and 54.7% have a retirement plan. The average satisfaction of Ecuadorian rheumatologists was 5.4 ± 1.33 [0-7]; 17.2% are very dissatisfied with their annual income. CONCLUSIONS: This is the first recorded data on the characteristics of rheumatologists in Ecuador. Most rheumatologists obtained their specialist degree abroad. In general, rheumatologists in Ecuador are satisfied with their clinical practice and dissatisfied with their annual income and job security.

Schwannoma Con Una Localización Cervical Infrecuente En Un Paciente Pediátrico: Reporte De Caso / Schwannoma With A Non-Frequent Location In Pediatric Patient. Case Report

Resumen Los schwannomas son tumores usualmente benignos, de crecimiento lento y generalmente propios de adultos. Son muy raros en la población pediátrica y su diagnóstico requiere un alto índice de sospecha clínica. Se presenta el caso de un paciente de sexo masculino de 9 años con historia de una masa cervical asintomática, sin otros antecedentes clínicos relevantes. La escisión total de la masa fue posible e histopatología confirmó el diagnóstico de schwannoma. El paciente se recuperó completamente, con excelente pronóstico. Es necesario tener presente a los schwannomas en el diagnóstico diferencial en casos de masas cervicales en pacientes pediátricos.

Abstract Schwannomas are usually benign, slow-growing tumors, usually found in adults. They are very rare in the pediatric population and their diagnosis requires a high index of clinical suspicion. We present the case of a 9-year-old male patient with a history of an asymptomatic cervical mass, with no other relevant clinical history. Total excision of the mass was possible, and histopathology confirmed the diagnosis of schwannoma. The patient recovered completely, with excellent prognosis. It is necessary to keep in mind schwannomas in the differential diagnosis in cases of cervical masses in pediatric patients.

Quality of life in Ecuadorian patients with established rheumatoid arthritis.

PURPOSE: To evaluate quality of life in patients with established rheumatoid arthritis (RA) and identify the factors that negatively affect it. METHODS: This was a cross-sectional study with patients with established RA from a rheumatology center in Ecuador. The RA Quality of Life (RAQoL) questionnaire was used to assess QoL and the Health Assessment Questionnaire - disability index (HAQ-DI) questionnaire for functional capacity. In addition, demographics, clinical characteristics, and markers of disease activity were included. Data were analyzed using SPSS 22. RESULTS: Of 186 patients, 89.8% were women, with a mean age of 51 years, 86.6% had symmetrical polyarticular involvement, 40.3% erosions, 46.8% morning stiffness, 46.8% xerophthalmia, and 39.2% fatigue. Depression was the most frequent comorbidity - 42.5%. The mean HAQ-DI score was 0.8, and 26.9% had functional disability. The mean RAQoL score was 7.2. Xerophthalmia, xerostomia, fatigue, morning stiffness, and depression were related to higher scores in the RAQoL (p<0.05). The mean RAQoL was higher in patients with more disease activity and comorbidities (p<0.05). Likewise, patients with functional disability had a mean RAQoL score of 15.6 versus 4.1 in patients without disability (p<0.05). There were positive correlations between RAQoL and ESR, CRP, painful-joint count, swollen-joint count, VAS of pain, and physician assessment (p<0.05). CONCLUSION: QoL is severely affected in patients with RA. Depression, fatigue, morning stiffness, pain, high disease activity, and disability have a negative effect on QoL in RA. Likewise, patients with more comorbidities and extraarticular manifestations show worse QoL.

Pan-American League of Associations for Rheumatology (PANLAR) capillaroscopy study group consensus for the format and content of the report in capillaroscopy in rheumatology.

OBJECTIVE: The aim of this work was to produce a consensus-based report for capillaroscopy in rheumatology to be used in daily clinical practice. METHODS: A written Delphi questionnaire regarding capillaroscopy report was developed from a literature review and expert consensus. The Delphi questionnaire was sent to an international panel including 25 rheumatologists experts in capillaroscopy, asking them to rate their level of agreement or disagreement with each statement. The exercise consisted of three online rounds and a face-to-face (live meeting) that took place in the PANLAR 2018 congress held in Buenos Aires, Argentina. RESULTS: The participants to the first, second, third, and face-to-face round were 22, 21, 21, and 16 rheumatologists, respectively. Fifty-five items were discussed in the first round, 58 in the second, 22 in the third, and 9 in the face-to-face meeting. At the end of the exercise, 46 recommendations for the capillaroscopy report in rheumatology reached a consensus. CONCLUSION: This is the first consensus-based report in capillaroscopy. It will be useful in daily clinical practice and to address the effort of the standardization in the technique. KEY POINTS: • The current lack of consensus for the capillaroscopy report makes difficult the interpretation of findings as well as follow-up of rheumatic diseases. • This study produced the first international consensus for the format and content of the naifold capillaroscopy report in rheumatology. • The report is an integral part of the capillaroscopy examination and its use in a homogeneous form can help in the correct interpretation of findings in daily practice.

Use of denosumab in osteogenesis imperfecta: A case report / Uso de denosumab en osteogénesis imperfecta: informe de un caso

ABSTRACT Osteogenesis imperfecta (01) is an inherited disorder of phenotypically heterogeneous affec tions of the connective tissue. Until now, no definitive treatment for OI has been found. Certain drugs used in osteoporosis are used in these patients such as intravenous bisphosphonates in order to improve bone density. However, in recent years the use of denosumab, an anti-resorptive monoclonal antibody has shown positive results in bone mineral loss. There are no studies that directly compare the use of bisphosphonates and denosumab in OI. The following article presents a case of a 9-year-old patient with diagnosis of OI and a past medical history of epilepsy and cerebral palsy that was treated with bisphosphonates and denosumab.

RESUMEN La osteogénesis imperfecta (OI) es un trastorno hereditario del tejido conectivo fenotípicamente heterogéneo. Hasta ahora no se ha encontrado ningún tratamiento definitivo para la OI. Se aplican ciertos fármacos utilizados en la osteoporosis en estos pacientes como los bisfosfonatos intravenosos para mejorar la densidad ósea. Sin embargo, en los últimos arios el uso de denosumab, un anticuerpo monoclonal anti-resorción ha demostrado resultados positivos en la pérdida mineral ósea. No hay estudios que comparen directamente el uso de bisfosfonatos y denosumab en la OI. El artículo presenta un caso de OI infantil en una paciente de 9 años con antecedentes de epilepsia y parálisis cerebral, que fue tratada con bisfosfonatos y denosumab.

Desmielinización del sistema nervioso central asociado a encefalomielitis diseminada aguda: Reporte de un caso / Demyelination of central nervous system associated with acute disseminated encephalomyelitis: Case report

Resumen Las enfermedades desmielinizantes inflamatorias comprenden una serie de desórdenes de origen autoinmune que afectan la mielina a nivel del sistema nervioso central (SNC) y periférico. Pueden ser monofásicas, multifásicas, progresivas, monofocales o multifocales, y su diagnóstico suele ser de exclusión. Se presenta el caso de una paciente de 15 años que debuta con cefalea, ataxia, hemiparesia, oftalmoparesia y alteración de la conciencia. En la resonancia magnética nuclear se observaron lesiones compatibles con enfermedad desmielinizante. Se realizó diagnóstico de encefalomielitis diseminada aguda. La paciente respondió favorablemente al tratamiento con corticoides.

Abstract Inflammatory demyelinating diseases comprise a series of autoimmune disorders affecting myelin at the level of the central nervous system (CNS) and peripheral nervous system. They can be monophasic, multiphasic, progressive, monofocal or multifocal, and their diagnosis is usually of exclusion. We report the case of a 15-year-old female patient with headache, ataxia, hemiparesis, ophthalmoplegia and altered consciousness. Magnetic resonance imaging showed lesions compatible with demyelinating disease. Acute disseminated encephalomyelitis was diagnosed. The patient responded to treatment with corticosteroids.

Prevalence of vitamin D levels in patients with autoimmune diseases in Ecuador: A retrospective study / Prevalencia de vitamina D en pacientes con enfermedades autoinmunes en Ecuador: estudio restrospectivo

ABSTRACT Introduction: Vitamin D is a hormone that maintains a fundamental role in the phosphocalcic metabolism. In recent years, studies have shown an association between vitamin D deficiency and different rheumatic diseases. Purpose: To evaluate vitamin D levels in patients at a rheumatology center during a period of 2015-2016. Methods: A retrospective study of patients who attended a rheumatology center, who had an initial study of 25(OH)D serum. Vitamin D levels were classified as: normal: 30-40 ng/mL, deficiency: 30-20 ng/mL, insufficiency: 20-10 ng/mL and severe insufficiency: <10 ng/mL. Results: 279 patients with a mean age of 58 years [8-93], 86% women [58.4 years] and 14% men [59.8 years] were included. The mean value of vitamin D was 29.09 ng/mL. A total of 41.2% (115) of the patients had values >30 ng/mL, and 58.8% (164) below this range. The most frequent primary diagnoses found were: osteoarthrosis, rheumatoid arthritis, fibromyalgia and osteoporosis; from which low levels of vitamin D ≤30 ng/mL were identified in 53.8%, 69.7%, 76.5% and 42.9%, respectively. Conclusion: There is a high incidence of hypovitaminosis D in Ecuadorian patients who came to a rheumatology center.

RESUMEN Introducción: La vitamina D es una hormona que mantiene un papel fundamental en el metabolismo fosfocálcico. En los últimos arios, los estudios han demostrado una asociación entre la deficiencia de vitamina D y diferentes enfermedades reumáticas. Objetivo: Evaluar los niveles de vitamina D en pacientes en un centro de reumatologia durante el periodo de 2015-2016. Métodos: Estudio retrospectivo de pacientes que acudieron a un centro de reumatología, que realizaron un estudio inicial de suero 25 (OH) D. Los niveles de vitamina D se clasificaron como normal: 30-40 ng/mL, deficiencia: 30-20 ng/mL, insuficiencia: 20-10 ng/mL e insuficiencia severa: <10 ng/mL. Resultados: Se incluyeron 279 pacientes con una edad media de 58 años (8-93), 86% mujeres (58,4 años) y 14% hombres (59,8 años). El valor medio de la vitamina D fue de 29,09 ng/mL. Un total de 41,2% (115) de los pacientes tenía valores> 30ng/ml y 58,8% (164) por debajo de este rango. Los diagnósticos primarios más frecuentes encontrados fueron: osteoartrosis, artritis reumatoide, fibromialgia y osteoporosis; de los cuales se identificaron niveles bajos de vitamina D ≤ 30 ng/mL en 53,8; 69,7; 76,5 y 42,9%, respectivamente. Conclusión: Existe una alta incidencia de hipovitaminosis D en pacientes ecuatorianos que acudieron a un centro de reumatología.