From A Formal Training Program In Musculoskeletal Ultrasound (MSUS) To A High Reproducibility for MSUS Ultrasound In Rheumatoid Arthritis.

OBJECTIVE: To assess the intra- and inter-observer reliability of Ultrasound (US) in scoring B-mode, Doppler synovitis and combined B-mode and Doppler synovitis scores in different peripheral joints of Rheumatoid Arthritis (RA) patients. METHODS: Four rheumatologists with a formal training in Musculoskeletal US (MSKUS) particularly focus on definitions and scoring synovitis on B-mode and Doppler mode participated in a patient- based reliability exercise on 16 active RA patients. The four rheumatologists independently and consecutively performed a B-mode and Power Doppler (PD) US assessment of 7 joints of each patient in two rounds in a blinded fashion. Each joint was semi quantitatively scored from 0 to 3 for B-mode Synovitis (BS), Doppler Synovitis (DS), and combined B-mode/Doppler synovitis (CS). Intraobserver reliability was assessed by Cohen's κ. Interobserver reliability was assessed by unweight Light's κ. RESULTS: The mean prevalence of synovitis on B-mode was 83% of joints; scores ranging from grade 1 in 18% of joints, to grade 3 in 33%. In 55% of joints synovial PD signal was detected and the distribution of scores range from 14% of joints for grade 3, to 26% for grade 2. After a total of 448 joints scanned with 896 adquired images our intraobserver and interobserver reliability was good to excellent for most of the joints. CONCLUSION: Formal, structured and continuous training in musculoskeletal ultrasound would bring a good to excellent reproducibility in rheumatological hands with a high reliability in real time acquisition BS, DS and CS modalities for scoring synovitis in patients with active rheumatoid arthritis.

Calcinosis tumoral secundaria a enfermedad renal crónica / Tumoral calcinosis secondary to chronic kidney disease

Objetivo: evaluar la literatura disponible hasta hoy, respecto a la calcinosis tumoral en enfermedad renal crónica, centrándose en herramientas diagnósticas y manejo terapéutico disponible. Metodos: usando los siguientes descriptores "Calcinosis", "Kidney Failure, Chronic", "Therapeutics", "Diagnosis", "Epidemiology"; se buscaron artículos en la base de datos Pubmed. Se incluyeron artículos de ensayo clínico, metaanálisis, revisiones sistemáticas y casos clínicos que estuvieran en inglés, francés, portugués y español, que fueran en población adulta. Se excluyeron artículos publicados antes de 1990, excepto aquellos que fuesen vitales para la definición de calcinosis tumoral. Se excluyeron artículos que incluyeran "Calciphylaxis" y que no aportaran al objetivo de la revisión. Resultados: un total de 91 artículos fueron incluidos, la mayoría fueron casos clínicos. Según lo encontrado el sitio de calcinosis tumoral más común fue en miembros superiores, seguido de piel y cadera. Una de las recomendaciones más importantes de diagnóstico fue las imágenes radiográficas y la química sanguínea, y de tratamiento es el uso de quelantes de fósforo combinado con dieta baja en calcio y fósforo. Conclusión: se incluyó gran cantidad de información. Faltan más estudios en Latinoamérica respecto a esta condición y se necesitan mejores grados y calidad de evidencia para hacer algún tipo de recomendación o guía de manejo. (Acta Med Colomb 2012; 37: 74-79).

Objective: to assess the available literature to date regarding tumoral calcinosis in chronic renal disease, focusing on diagnostic tools and therapeutic management available. Methods: using the descriptors "Calcinosis", "Kidney Failure, Chronic", "Therapeutics", "Diagnosis", "Epidemiology", we sought articles in the pubmed database. We included clinical trial articles, meta-analyzes, systematic reviews and clinical cases that were in English, French, Portuguese and Spanish, all in adults. We excluded articles published before 1990 except those that were vital to the definition of tumoral calcinosis. Articles that included "Calciphylaxis" and that did not contribute to the objective of the review, were excluded. Results: a total of 91 articles were included; most were case reports. We found that the most common site of tumor calcinosis was in the upper limbs, followed by skin and hip. One of the key diagnostic recommendations was radiographic images and blood chemistry, and the recommendation regarding treatment is the use of phosphorus binders combined with diet low in calcium and phosphorus. Conclusion: we included a lot of information. Further studies on this condition are needed in Latin America, as well as better grades and quality of evidence to make any recommendation or management guide. (Acta Med Colomb 2012; 37: 74-79).

[Polymorphisms of IL-10 gene promoter and rheumatoid arthritis in a Colombian population]. / Polimorfismos de la región promotora del gen de la IL-10 y artritis reumatoide en una población colombiana.

INTRODUCTION: Rheumatoid arthritis is an inflammatory disease driven by TH1 CD4+ cells. Interleukin-10 is present in higher concentrations in serum and synovial fluid from patients with rheumatoid arthritis and has a marked anti-inflammatory activity. Furthermore, it is capable of stimulating B cells and increasing autoantibody production. Interleukin-10 synthesis is under genetic control. OBJECTIVE: Three polymorphisms of the promoter region were analyzed for interleukin-10 genes -1082, -819 and -592. Subjects were patients with rheumatoid arthritis compared with a control population for these genes. MATERIAL AND METHODS: One hundred two patients with rheumatoid arthritis and 102 matched healthy controls were studied. The following data were taken from the rheumatoid arthritis patients: age of disease onset, presence and titers of rheumatoid factor, and history of replacement joint surgery. Genotypes were obtained by polymerase chain reaction and sequence-specific primer method. The three polymorphisms are in strong linkage-disequilibrium and form three haplotypes -1082A/-819C/-592C, -1082A/-819T/-592A y -1082G/-819C/-592C. RESULTS: No association was detected between Interleukin-10 alleles, haplotypes/genotypes and rheumatoid arthritis. No significant differences occurred between interleukin-10 polymorphisms and age of disease onset, presence and titer of rheumatoid factor and history of major joint replacement. CONCLUSIONS: Interleukin-10 is an important regulator of the immune response and likely plays a role in the pathogenesis of rheumatoid arthritis. The current results suggested that Interleukin-10 promoter polymorphisms were not important for development or severity of rheumatoid arthritis.

Polimorfismos de la región promotora del gen de la IL-10 y artritis reumatoide en una población colombiana / Polymorphisms of IL-10 gene promoter and rheumatoid arthritis in a Colombian population

Introducción. La artritis reumatoide es una enfermedad inflamatoria con un predominio de la actividad de las células TH1 CD4+. La interleucina-10, presente en altas concentraciones en suero y líquido sinovial de pacientes con artritis reumatoide, tiene una marcada actividad antinflamatoria, al mismo tiempo que estimula las células B y la generación de autoanticuerpos. La producción de la interleucina-10 está bajo control genético. Objetivo. En este estudio analizamos los polimorfismos de la región promotora de la interleucina-10 -1082, -819 y -592 en pacientes con artritis reumatoide y en una población control, y su asociación con edad de inicio de la enfermedad, presencia y títulos de factor reumatoideo e historia de reemplazo articular. Materiales y métodos. Se estudiaron 102 pacientes con artritis reumatoide y 102 controles. La genotipificación se realizó por reacción en cadena de la polimerasa, iniciador específico de secuencia. Los tres polimorfismos están en marcado desequilibrio de unión y forman tres haplotipos –1082A/-819C/-592C, –1082A/-819T/-592A y –1082G/-819C/-592C. Resultados. No se encontró asociación de la artritis reumatoide con las diferentes variaciones alélicas, haplotípicas ni genotípicas del promotor de la interleucina-10. Tampoco se encontraron diferencias significativas con inicio de la enfermedad, presencia y títulos de factor reumatoideo e historia de reemplazo articular. Conclusiones. La interleucina-10 es uno de los principales reguladores de la respuesta inmune y por lo tanto podría jugar un papel importante en la patogénesis de la artritis reumatoide; sin embargo, nuestros resultados no dan evidencia de una asociación genética entre los polimorfismos estudiados y el desarrollo o gravedad de la artritis reumatoide.

Introduction. Rheumatoid arthritis is an inflammatory disease driven by TH1 CD4+ cells. Interleukin-10 is present in higher concentrations in serum and synovial fluid from patients with rheumatoid arthritis and has a marked anti-inflammatory activity. Furthermore, it is capable of stimulating B cells and increasing autoantibody production. Interleukin-10 synthesis is under genetic control. Objective. Three polymorphisms of the promoter region were analyzed for interleukin-10 genes -1082, -819 and -592. Subjects were patients with rheumatoid arthritis compared with a control population for these genes. Material and methods. One hundred two patients with rheumatoid arthritis and 102 matched healthy controls were studied. The following data were taken from the rheumatoid arthritis patients: age of disease onset, presence and titers of rheumatoid factor, and history of replacement joint surgery. Genotypes were obtained by polymerase chain reaction and sequence-specific primer method. The three polymorphisms are in strong linkage-disequilibrium and form three haplotypes –1082A/-819C/-592C, –1082A/-819T/-592A y –1082G/-819C/-592C. Results. No association was detected between Interleukin-10 alleles, haplotypes/genotypes and rheumatoid arthritis. No significant differences occurred between interleukin-10 polymorphisms and age of disease onset, presence and titer of rheumatoid factor and history of major joint replacement. Conclusions. Interleukin-10 is an important regulator of the immune response and likely plays a role in the pathogenesis of rheumatoid arthritis. The current results suggested that Interleukin- 10 promoter polymorphisms were not important for development or severity of rheumatoid arthritis.

Polymorphisms in the IL4 and IL4RA genes in Colombian patients with rheumatoid arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) is considered a Th1-driven disease. Interleukin 4 (IL-4) binds to its receptor, promoting Th2 differentiation and limiting Th1 responses, but its role in the pathogenesis of RA is conflicting. We analyzed 2 polymorphisms of the IL4 gene and 4 polymorphisms of the IL4RA gene in patients with RA and in a control population, as well as rheumatoid factor (RF) seropositivity, titers of RF, and history of replacement joint surgery among patients with RA. METHODS: The study population consisted of 102 patients with RA and 102 matched healthy controls. Genotyping of IL4 -590, IL4RA +148, +1124, +1218, and +1902 was determined by restriction fragment length polymorphism-polymerase chain reaction (PCR) and sequence-specific primer-PCR. IL4 variable number tandem repeat polymorphism was determined by direct amplification. RESULTS: The IL4 -590TT genotype was significantly more frequent in patients with RA than in controls (p = 0.018, OR 3.34, 95% CI 1.08-11.04). The IL4RA +148A allele was significantly associated with the presence of RF (p = 0.0019, OR 2.55, 95% CI 1.55-4.86) and a history of articular joint replacement (p = 0.024, OR 2.08, 95% CI 1.04-4.18). The IL4RA +1902G allele was more frequently seen in patients with RA and high RF titers (p = 0.00067, OR 4, 95% CI 1.64-9.93). CONCLUSION: Highly complex pathways lead to the development of RA and may not be similar in all patients. Our findings of higher frequency of IL4 and IL4RA genotypes and alleles with RA, presence of RF, RF titers, and history of articular joint replacement support the polygenic expression of RA and the likely role of IL-4 in influencing its initiation and development.