Autoimmune associations in a Mexican cohort with primary biliary cholangitis. / Asociaciones autoinmunes en una cohorte mexicana con colangitis biliar primaria.

INTRODUCTION: Several groups have reported associations of primary biliary cholangitis with other autoimmune entities, particularly Sjögren's syndrome and hypothyroidism. Its prevalence and characteristics in Mexican patients is unknown. AIM: To determine the frequency and characteristics of autoimmune diseases in a Mexican cohort of patients with primary biliary cholangitis. MATERIALS AND METHODS: The medical records of patients that presented with primary biliary cholangitis within the time frame of 2005 and 2012 were reviewed and assessed for other autoimmune diseases. RESULTS: Seventy-eight patients, 75 women and 3 men, were included. Their mean age was 55.8 years. Seventy-three cases had positive antimitochondrial antibodies (94.8%) and disease was confirmed in 5 through liver biopsy. Five patients (8%) had anti-smooth muscle antibodies and 55/78 (70.5%) had antinuclear antibodies by indirect immunofluorescence. Forty-nine patients (62.8%) were positive for an autoimmune disease other than primary biliary cholangitis. Among those, 20 patients had one associated disease, 14 had 2, and 15 patients had 3 concomitant diseases. They included: Sjögren's syndrome in 23/78 patients (29.5%), dysthyroidism in 21/78 cases (26.9%), Raynaud syndrome in 11/78 (14.1%), CREST syndrome in 9/78 patients (11.4%), rheumatoid arthritis in 6/78 patients (7.7%), vitiligo in 5/78 (6.4%), scleroderma in 4/78 patients (5.1%), and other diseases in 8 patients. In 12/78 patients (15.4%), there was a documented family background of autoimmune disease. CONCLUSIONS: The presence of autoimmune associations in our cohort was frequent, and similar in characteristics to the information reported by other groups. The clinical implications of those findings remain to be determined.

Eosinophilic enteritis in association with systemic lupus erythematosus.

Eosinophilic gastroenteritis (EGE) is an uncommon disease and has rarely been reported in association with connective tissue diseases as systemic lupus erythematosus. We report a 36-year-old woman who developed recurrent episodes of abdominal pain, nausea, vomiting and melena. Complete blood counts showed elevated eosinophil counts. Ultrasound and CT-scan images studies were significant for bowel wall thickening and ascites. The patient underwent an exploratory laparotomy with a mesenteric biopsy and appendectomy that showed eosinophil infiltration in the muscularis propria, establishing the diagnosis of EGE. The patient developed pleural effusions, with laboratory studies showing haemolytic anaemia, thrombocytopenia, positive antinuclear antibody and anticardiolipin antibodies. The patient was treated with high-dose systemic corticosteroid therapy, with successful resolution of symptoms. Three months later, she developed a new episode of abdominal pain defined as intestinal pseudo-obstruction that was resolved without complications.

Drug-drug interactions of non-steroidal anti-inflammatory drugs with other drugs in patients with rheumatic diseases

Objetivo: Determinar la prevalencia e identificar las interacciones (INTMED) entre antiinflamatorios no esteroideos (AINE) y otros fármacos en una base de datos de prescripción a enfermos reumáticos. Material y métodos: Se trata de un estudio transversal de una base de datos de prescripción de 35.000 beneficiarios de un sistema de atención médica de prepago para trabajadores bancarios y sus familiares. El análisis abarca un año (de enero a diciembre de 1998). La lista y la clasificación de las AINE-INTMED en 3 niveles (1: mínimo; 2: moderado, y 3: alto riesgo para la salud/peligro de muerte) se hicieron de acuerdo con DRUGDEX® y búsquedas en MEDLINE y EMBASE. Resultados: Se analizaron 3.207 prescripciones de AINE (1,7 ± 1,6 por paciente) a 1.855 pacientes reumáticos (el 76,7% adultos, el 20,2% geriátricos y el 3,0% pediátricos; reumatismo extraarticular: 52%; osteoartrosis: 19%; artritis reumatoide: 10%). Se encontraron 648 (20,20%) AINE-INTMED, de las que 594 (91,66%) correspondieron al nivel 1, 46 (7,09%) al nivel 2 y 8 (1,23%) al nivel 3. Además, encontramos 96 (2,99%) prescripciones con duplicación de AINE. No encontramos AINE-INTMED con anticoagulantes, anticonvulsionantes o hipoglucemiantes orales. Conclusiones: La prevalencia de AINE-INTMED en prescripciones a 1.855 pacientes reumáticos en un año fue del 20,20%. La mayoría (91,66%) fue del nivel 1 y raramente del 3 (1,23%). El 2,99% de ellas tuvieron duplicaciones de AINE. Nuestros resultados proporcionan información de la prevalencia de INTMED que potencialmente podrían producir daños al individuo y datos que podrían influir en el desarrollo de estudios de la importancia clínica de las AINE-INMED(AU)

Objective: To determine the prevalence of and identify drug-drug interactions (DDI) between non-steroidal anti-inflammatory drugs (NSAID) and other drugs in a prescription database of patients with rheumatic diseases. Material and methods: This is a cross-sectional study of a drug prescription database saving information on 35,000 individuals who benefited from a pre-paid medical system serving bank employees and their relatives. The analysis included one year period (from January to December 1998). NSAID-DDI were listed and classified into 3 levels (1: minor; 2: moderate, and 3: high health risk or death risk) according to DRUGDEX® as well as MEDLINE and EMBASE search. Results: We analyzed 3,207 NSAID prescriptions (1.7 ± 1.6 per patient) to 1,855 rheumatic patients (adults: 76.7%; geriatric: 20.2%, and pediatric: 3.0%; soft tissue rheumatism: 52%; osteoarthritis: 19%, and rheumatoid arthritis: 10%). There were 648 (20.20%) NSAID-DDI prescriptions: 594 (91.66%) corresponded to level 1; 46 (7.09%) to level 2, and 8 (1.23%) to level 3. In addition, 96 (2.99%) prescriptions included NSAID duplications. Interestingly, we found no NSAID-DDI with anticoagulants, anticonvulsants, and oral hypoglycemiants were found. Conclusions: The prevalence of NSAID-DDI prescriptions to 1,855 rheumatic patients was 20.20% in one year. NSAID-DDI was mostly (91.66%) level 1, and rarely (1.23%) level 3. NSAID duplications were found in 2.99%. These results provides information on the frequency of prescriptions with DDI, which might potentially produce harmful effects and data, which may help in the development of studies searching for the clinical relevance of NSAID-DDI(AU)

Drug-drug interactions of non-steroidal anti-inflammatory drugs with other drugs in patients with rheumatic diseases.

OBJECTIVE: To determine the prevalence of and identify drug-drug interactions (DDI) between non-steroidal anti-inflammatory drugs (NSAID) and other drugs in a prescription database of patients with rheumatic iseases. MATERIAL AND METHODS: This is a cross-sectional study of a drug prescription database saving information on 35,000 individuals who benefited from a pre-paid medical system serving bank employees and their relatives. The analysis included one year period (from January to December 1998). NSAID-DDI were listed and classified into 3 levels (1: minor; 2: moderate, and 3: high health risk or death risk) according to DRUGDEX(r) as well as MEDLINE and EMBASE search. RESULTS: We analyzed 3,207 NSAID prescriptions (1.7±1.6 per patient) to 1,855 rheumatic patients (adults: 76.7%; geriatric: 20.2%, and pediatric: 3.0%; soft tissue rheumatism: 52%; osteoarthritis: 19%, and rheumatoid arthritis: 10%). There were 648 (20.20%) NSAID-DDI prescriptions: 594 (91.66%) corresponded to level 1; 46 (7.09%) to level 2, and 8 (1.23%) to level 3. In addition, 96 (2.99%) prescriptions included NSAID duplications. Interestingly, we found no NSAID-DDI with anticoagulants, anticonvulsants, and oral hypoglycemiants were found. CONCLUSIONS: The prevalence of NSAID-DDI prescriptions to 1,855 rheumatic patients was 20.20% in one year. NSAID-DDI was mostly (91.66%) level 1, and rarely (1.23%) level 3. NSAID duplications were found in 2.99%. These results provides information on the frequency of prescriptions with DDI, which might potentially produce harmful effects and data, which may help in the development of studies searching for the clinical relevance of NSAID-DDI.

Dermatomiositis asociado a adenocarcinoma de vesicula biliar: reporte de un caso / Dermatomyositis associated to gallbladder adenocarcinoma: a case report

La dermatomiositis asociada a neoplasias ha sido reportada en el 11.8 por ciento de los casos. Hasta el momento, solo se ha descrito en la literatura un caso de asociación entre dermatomiositis y adenocarcinoma de vesícula biliar. Presentamos el caso de una paciente de 53 años con debilidad muscular proximal de cinturas escapular y pélvica, manifestaciones cutáneas (Gottron y eritema en heliotropo), e incremento de enzimas musculares, en quién se hizo el diagnóstico de Dermatomiositis y se le prescribió el tratamiento adecuado sin embargo, a los 3 meses de evolución acudió con pérdida de peso, mala respuesta a esteroides y metotrexate, síndrome ictérico, hemorragia de tubo digestivo; se le realizó ultrasonido de hígado y vías biliares reportándose datos compatibles con coledocolitiasis y daño hepático difuso, se le realizó colecistectomía y el reporte histopatológico fue de adenocarcinoma de vesícula biliar. El objetivo de este reporte es la presentación del segundo caso en que asocia la dermatomiositis y el adenocarcinoma de vesícula biliar en la literatura médica internacional.