Effects of methotrexate on the expression of the translational isoforms of glucocorticoid receptors α and ß: correlation with methotrexate efficacy in rheumatoid arthritis patients.

OBJECTIVES: To test the effect of MTX on the expression of glucocorticoid receptor (GR) α and ß isoforms AB, C and D in peripheral blood mononuclear cells (PBMCs) in culture, from newly diagnosed RA patients and to evaluate whether the test results correlate with patients' subsequent response to MTX treatment. METHODS: Twenty patients with early active RA were enrolled. Patients who had previously received any DMARD or cytotoxic agent, or who had received CSs in the 6 months before enrolment were excluded. PBMCs from all patients were obtained and cultured in the presence and absence of MTX (10(-4), 10(-6) and 10(-8) M). The expression of GR isoforms was evaluated by western blot. After blood samples were taken, patients entered a 24-week study receiving MTX, diclofenac and prednisone (10 mg/day). At Week 24, the ACR core set of disease activity measures was calculated and a correlation between the MTX effect on patients' PBMC GR expression in vitro and the ACR response was evaluated. RESULTS: MTX 10(-6) M in the culture medium induced the expression of the PBMC isoform AB of GRα (P = 0.009). Other GR isoforms were unaffected. The magnitude of the induced expression correlated with the ACR response to treatment at Week 24 of therapy (r = 0.92, P = 0.00003). CONCLUSION: MTX in vitro induces greater expression of GRαAB isoform in PBMC from RA patients who later respond to MTX treatment than in non-responding patients. This may have clinical applications for predicting MTX efficacy in RA patients.

Pan-American League of Associations for Rheumatology (PANLAR) recommendations and guidelines for musculoskeletal ultrasound training in the Americas for rheumatologists.

OBJECTIVE: To develop guidelines for Musculoskeletal Ultrasound (MSKUS) training for rheumatologists in the Americas. METHODS: A total of 25 Rheumatologists from 19 countries of the American Continent participated in a consensus-based interactive process (Delphi method) using 2 consecutive electronic questionnaires. The first questionnaire included the following: the relevance of organizing courses to teach MSKUS to Rheumatologists, the determination of the most effective educational course models, the trainee levels, the educational objectives, the requirements for passing the course(s), the course venues, the number of course participants per instructor, and the percentage of time spent in hands-on sessions. The second questionnaire consisted of questions that did not achieve consensus (>65%) in the first questionnaire, topics, and pathologies to be covered at each course MSKUS level. RESULTS: General consensus was obtained for MSKUS courses to be divided into 3 educational levels: basic, intermediate, and advanced. These courses should be taught using a theoretical-didactic and hands-on model. In addition, the group established the minimum requirements for attending and passing each MSKUS course level, the ideal number of course participants per instructor (4 participants/instructor), and the specific topics and musculoskeletal pathologies to be covered. In the same manner, the group concluded that 60% to 70% of course time should be focused on hands-on sessions. CONCLUSION: A multinational group of MSKUS sonographers using a consensus-based questionnaire (Delphi method) established the first recommendations and guidelines for MSKUS course training in the Americas. Pan-American League of Associations for Rheumatology urges that these guidelines and recommendations be adopted in the future by both national and regional institutions in the American continent involved in the training of Rheumatologists for the performance of MSKUS.

El ultrasonido en el estudio del síndrome de codo doloroso: [revisión] / Ultrasound in the study of elbow pain syndrome: [review]

La ultrasonografía es una herramienta útil para la evaluación de las anormalidades del codo, especialmente aquellas relacionadas con artropatías inflamatorias, mecánicas y degenerativas, al deporte, con actividades repetitivas o con entesitis. Es una herramienta dinámica que permite evaluar tanto estructuras extraarticulares como los ligamentos, tendones, músculos, bursas, entesis, nervios y vasos, así como las estructuras intraarticulares como los recesos articulares, cartílagos y superficies óseas articuladas. El objetivo de esta revision es brindar una actualizacion del uso de este método de imagen en las patologías más frecuentes que afectan el codo.

Ultrasonography is a useful tool for evaluation of abnormalities of the elbow, especially those related to inflammatory arthritis, mechanical and degenerative diseases, sports with repetitive activities or enthesitis. It is a dynamic tool that provides an evaluation of extra-articular structures such as ligaments, tendons, muscles, bursas, enthesis, nerves and vessels, as well as intra-articular structures such as joint recess, cartilage and bone surfaces articulated. The aim of this review is to provide an update on the use of this method of image in the most common diseases that affect the elbow.

La ultrasonografía y su rol actual en la artrosis / Ultrasonography and its current role in osteoarthritis

La artrosis es un proceso crónico caracterizado por alteraciones degenerativas propias del cartílago articular y modificaciones de tipo proliferativo del tejido óseo adyacente. La producción de equipos ultrasonográficos con transductores de alta frecuencia (>15 MHz) y elevada capacidad de resolución ha constituido un paso fundamental para la consolidación progresiva de este método de imágenes en el campo de estudio de la artrosis, permitiendo una detallada visualización de las distintas estructuras anatómicas (cartílago articular, membrana sinovial y tejido óseo) involucradas en las diferentes etapas del proceso artrósico, Este potencial ofrece relevantes aplicaciones prácticas en esta patología, considerando que generalmente las expresiones clínico-radiológicas de la artrosis tienden a manifestarse con notable retraso respecto a las expresiones iniciales de condropatía. La presente revisión tiene como objetivo principal demostrar la utilidad de la US en el estudio de pacientes con artrosis mediante la ilustración de los hallazgos ecográficos más representativos de dicha entidad.

Osteoarthritis is a chronic process characterized by degenerative alterations of articular cartilage and several changes of both bone profile and synovial membrane. Leading-edge ultrasound equipments with high frequency probes (>15 MHz) and high resolution allow for quick and accurate assessment of even minimal pathological changes in patients with osteoarthritis (articular cartilage, synovial membrane and bone tissue). This fact is fundamental for the early diagnostic of this condition considering that, in general, the clinico-radiological expression of osteoarthritis usually manifest some time prior to the initial expressions of chondropathy. The principal aim of this study is to demonstrate the utility of US in the study of patients with osteoarthritis by means of visualizing the most representative echographic findings.

Atención médica en colangitis aguda / Medical care in acute cholangitis

Es un estudio descriptivo de 57 pacientes con diagnósticode colangitis aguda, operados en el Hospital Salvador entre enero de 1987 y junio de 1989. Se establecen un grupo de colangitis y otro de colangitis complicada,estudiándose las variables de atención médica y los factores asociados a una mayor morbimortalidad y su costo económico. Este se midió según días-camas ocupados, uso de ecografía y de antibióticos en el pre y postoperatorio. Se encontró que la colangitis es más grave por demora en el diagnóstico. Ello lleva a operaciones más largas y más complejas, aumento de días-cama y uso de antibióticos de alto costo por más tiempo, además de mayor morbilidad y mortalidad postoperatorias. Llamó la atención el menor empleo de ecografía en las colangitis complicadas. Se concluye que los factores estudiados repercuten, además del sufrimiento de los pacientes y sus familiares, en un mayor costo de la atención médica. Este costo va, según los valores establecidos por el Servicio, desde $29.355 (103 dólares) con colangitis simple hasta $50.717 (179 dólares) en colangitis complicada, por paciente y sin considerar el gasto en ecografía, exámenes de laboratorio y operación. Estos valores se duplicarían aproximadamente si se incluye el acto quirúrgico. La ecografía tiene poco impacto dado el bajo valor establecido