Long-term follow-up of certolizumab pegol in uveitis due to immune-mediated inflammatory diseases: multicentre study of 80 patients.

OBJECTIVES: To evaluate effectiveness and safety of certolizumab pegol (CZP) in uveitis due to immune-mediated inflammatory diseases (IMID). METHODS: Multicentre study of CZP-treated patients with IMID uveitis refractory to conventional immunosuppressant. Effectiveness was assessed through the following ocular parameters: best-corrected visual acuity, anterior chamber cells, vitritis, macular thickness and retinal vasculitis. These variables were compared between the baseline, and first week, first, third, sixth months, first and second year. RESULTS: We studied 80 (33 men/47 women) patients (111 affected eyes) with a mean age of 41.6±11.7 years. The IMID included were: spondyloarthritis (n=43), Behçet's disease (n=10), psoriatic arthritis (n=8), Crohn's disease (n=4), sarcoidosis (n=2), juvenile idiopathic arthritis (n=1), reactive arthritis (n=1), rheumatoid arthritis (n=1), relapsing polychondritis (n=1), CONCLUSIONS: CZP seems to be effective and safe in uveitis related to different IMID, even in patients refractory to previous biological drugs.

Artritis de tobillo y acropaquias como forma de presentación de un caso de endocarditis por Listeria monocytogenes / Ankle arthritis and nail clubbing as a form of presentation of Listeria monocytogenes endocarditis

No disponible

Golimumab in refractory uveitis related to spondyloarthritis. Multicenter study of 15 patients.

OBJECTIVE: To assess the efficacy of golimumab (GLM) in refractory uveitis associated to spondyloarthritis (SpA). METHODS: Multicenter study of SpA-related uveitis refractory to at least 1 immunosuppressive drug. The main outcome variables were degree of anterior and posterior chamber inflammation, visual acuity, and macular thickness. RESULTS: A total of 15 patients (13 men/2 women; 18 affected eyes; mean age 39 ± 6 years) were evaluated. The underlying SpA subtypes were ankylosing spondylitis (n = 8), psoriatic arthritis (n = 6) and non-radiographic axial SpA (n = 1). The ocular involvement patterns were recurrent anterior uveitis in 8 patients and chronic anterior uveitis in 7. Before GLM they have received methotrexate (n = 13), sulfasalazine (n = 6), pulses of methylprednisolone (n = 4), azathioprine (n = 3), leflunomide (n = 2), and cyclosporine (n = 1). Overall, 10 of them had also been treated with TNF-α blockers; etanercept (n = 7), adalimumab (n = 7), infliximab (n = 6), and certolizumab (n = 1). GLM was given at the standard dose (50mg/sc/monthly) as monotherapy (n = 7) or in combination with conventional immunosuppressive drugs (n = 8), mainly methotrexate. Most patients had rapid and progressive improvement of intraocular inflammation parameters. The median number of cells in the anterior chamber at 2 years [0 (0-0)] was significantly reduced compared to baseline findings [1 (0-3); p = 0.04]. The mean best corrected visual acuity value also improved (0.84 ± 0.3 at 2 years versus 0.62 ± 0.3 at baseline; p = 0.03). Only minor side effects were observed after a mean follow-up of 23 ± 7 months. CONCLUSIONS: Our results indicate that GLM may be a useful therapeutic option in refractory SpA-related uveitis.

Efficacy of tocilizumab in conventional treatment-refractory adult-onset Still's disease: multicenter retrospective open-label study of thirty-four patients.

OBJECTIVE: Adult-onset Still's disease (AOSD) is frequently refractory to standard therapy. Tocilizumab (TCZ) has demonstrated efficacy in single cases and in small series of patients with AOSD. The aim of this multicenter study was to assess the efficacy of TCZ in patients with AOSD refractory to conventional treatment. METHODS: This was a retrospective open-label study of TCZ treatment in 34 patients with AOSD who had experienced an inadequate response to corticosteroids and at least 1 standard synthetic immunosuppressive drug and also, in many cases, biologic agents. RESULTS: The mean ± SD age of the patients (8 men and 26 women) was 38.7 ± 16.1 years. The median duration of AOSD before TCZ was initiated was 4.2 years (interquartile range [IQR] 1-9 years). The initial dosages of intravenous TCZ were 8 mg/kg every 4 weeks in 22 patients, 4 mg/kg every 4 weeks in 2 patients, and 8 mg/kg every 2 weeks in 10 patients. TCZ treatment resulted in rapid and maintained improvement in both clinical and laboratory parameters. After 1 year of TCZ therapy, the incidence of joint manifestations had decreased from 97.1% at baseline to 32.4%, the incidence of both cutaneous manifestations and fever had decreased from 58.8% to 5.9%, and the incidence of lymphadenopathy had decreased from 29.4% to 0%. A dramatic reduction in laboratory markers of inflammation, including the C-reactive protein level, the erythrocyte sedimentation rate, and the ferritin level, was achieved. The median dosage of prednisone was also reduced, from 13.8 mg/day (IQR 5-45) at the initiation of TCZ to 2.5 mg/day (IQR 0-30) at 12 months. After a median followup of 19 months (IQR 12-31 months), only 2 patients required permanent discontinuation of TCZ therapy because of severe infections. CONCLUSION: TCZ treatment was associated with rapid and maintained clinical and laboratory improvement in patients with AOSD refractory to standard treatment. However, joint manifestations seem to be more refractory to treatment compared with systemic manifestations.

Revisión sistemática de la literatura sobre la osteonecrosis maxilar con el uso de bisfosfonatos en pacientes con osteoporosis / Systematic literature review of bisphosphonates and osteonecrosis of the jaw in patients with osteoporosis

Objetivo. Evaluar sistemáticamente la literatura en relación con la aparición de osteonecrosis de mandíbula (ONM) con el uso de bisfosfonatos (BF) en el tratamiento de la osteoporosis (OP). Métodos. Se realizó una búsqueda sistemática de la literatura en Pubmed, EMBASE y la Cochrane Central Register of Controlled Trials hasta julio de 2010 incluyendo términos relativos a OP, ONM, y BF (mesh y texto libre). Se seleccionaron metaanálisis, revisiones sistemáticas y ensayos clínicos (EC), en inglés o español, que incluían pacientes>18 años de ambos sexos con OP en tratamiento con BF (por vías intravenosa y oral). Además, los estudios debían evaluar la aparición de ONM durante el tratamiento con BF. Se excluyeron los estudios que incluían pacientes con cáncer u otra enfermedad distinta de la OP, estudios en animales y ciencia básica. La selección de los artículos, tanto por título y abstract como la revisión en detalle, la realizaron 2 revisores de forma independiente. Se utilizó la escala de Oxford modificada (versión del 2001) para evaluar la calidad de los estudios incluidos. Resultados. Se identificaron 1.422 artículos, de los que se incluyeron 18 (8 revisiones sistemáticas, 8 EC y 2 metaanálisis). La mayoría de los estudios son de buena calidad y estudiaron el uso de BF en mujeres de mediana edad con OP. La frecuencia de ONM fue baja. Conclusiones. No hemos encontrado evidencia suficiente para afirmar que los BF por vía oral ni intravenosa utilizados exclusivamente para el tratamiento de la OP confieran un riesgo significativo de ONM al paciente (nivel de evidencia 2a, grado de recomendación B)(AU)

Objective: To systematically assess the literature related to the occurrence of osteonecrosis of the jaw (ONJ) using bisphosphonates (BP) in the treatment of osteoporosis (OP). Methods: We conducted a systematic literature search in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials up to July 2010, including terms relating to OP, ONJ, and BP (MeSH and free text). We selected meta-analysis, systematic reviews and clinical trials (CT), English or Spanish, including patients > 18 years of both sexes with OP treated with BF (intravenous and oral). Furthermore, studies should evaluate the occurrence of ONJ during treatment with BF. We excluded studies that included patients with cancer or diseases other than OP, animal studies and basic science. The selection of articles both by title and 2 independent reviewers conducted a detailed review of the abstracts. We used the modified Oxford Scale (version 2001) to assess the quality of the included studies. Results: We identified 1422 articles of which we included 18 (8 systematic reviews, 8 CT and 2 metaanalysis). Most studies were of good quality and examined the use of BF in middle-aged women with OP. Frequency of ONJ was low. Conclusions: We found insufficient evidence to affirm that intravenous or oral BF used exclusively for the treatment of OP lead to a significant risk of ONJ (evidence level 2a, grade B recommendation)(AU)

Systematic literature review of bisphosphonates and osteonecrosis of the jaw in patients with osteoporosis.

OBJECTIVE: To systematically assess the literature related to the occurrence of osteonecrosis of the jaw (ONJ) using bisphosphonates (BP) in the treatment of osteoporosis (OP). METHODS: We conducted a systematic literature search in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials up to July 2010, including terms relating to OP, ONJ, and BP (MeSH and free text). We selected meta-analysis, systematic reviews and clinical trials (CT), English or Spanish, including patients > 18 years of both sexes with OP treated with BF (intravenous and oral). Furthermore, studies should evaluate the occurrence of ONJ during treatment with BF. We excluded studies that included patients with cancer or diseases other than OP, animal studies and basic science. The selection of articles both by title and 2 independent reviewers conducted a detailed review of the abstracts. We used the modified Oxford Scale (version 2001) to assess the quality of the included studies. RESULTS: We identified 1422 articles of which we included 18 (8 systematic reviews, 8 CT and 2 meta-analysis). Most studies were of good quality and examined the use of BF in middle-aged women with OP. Frequency of ONJ was low. CONCLUSIONS: We found insufficient evidence to affirm that intravenous or oral BF used exclusively for the treatment of OP lead to a significant risk of ONJ (evidence level 2a, grade B recommendation).

Strongyloides stercolaris en un paciente con artritis reumatoide en tratamiento con etanercept / Strongyloides stercolaris in a patient with rheumatoid arthritis undergoing treatment with Etanercept

La terapia biológica para el tratamiento de enfermedades autoinmunitarias, como la artritis reumatoide, conlleva una serie de efectos secundarios y complicaciones cada vez más frecuentes y de gran complejidad tanto en el manejo como en la comorbilidad asociada. Presentamos el caso de un paciente con una de estas complicaciones asociada (AU)

Biologic therapy for the treatment of autoimmune diseases such as rheumatoid arthritis leads to a series of secondary effects and complications which are ever more frequent and increasingly complicate both the management as well as the associated comorbidity. We present the case of a patient who had one of theses associated complications (AU)

[Strongyloides stercolaris in a Patient With Rheumatoid Arthritis Undergoing Treatment With Etanercept]. / Strongyloides stercolaris en un paciente con artritis reumatoide en tratamiento con etanercept.

Biologic therapy for the treatment of autoimmune diseases such as rheumatoid arthritis leads to a series of secondary effects and complications which are ever more frequent and increasingly complicate both the management as well as the associated comorbidity. We present the case of a patient who had one of theses associated complications.