ChurchInAction: the role of religious interventions in times of COVID-19.

In a recently published letter to the editor of this journal, the authors have called for the need to establish psychological support structures that cater to people's mental health in this time of the coronavirus disease 2019 pandemic. To be more holistic, we extend this call to include people's spiritual well-being as well. We highlight the initiatives of the Philippines' religious sector. In particular, we report some of the interventions made by the Roman Catholic Church that have led to the social media hashtag, #ChurchInAction. These religious and spiritual interventions showcase the efforts of the Philippine Church and play an important role in providing assistance in time of public health crisis.

Differences associated with age at onset in early systemic sclerosis patients: a report from the EULAR Scleroderma Trials and Research Group (EUSTAR) database.

OBJECTIVE: The aim of this study was to analyse differences in clinical presentation in patients with early (< 3 years' duration) systemic sclerosis (SSc), comparing three age groups according to disease subsets. METHOD: Cross-sectional analysis of the prospective EULAR Scleroderma Trials and Research database (EUSTAR) was performed. Patients fulfilling preliminary American College of Rheumatology 1980 classification criteria for SSc, with < 3 years from the first non-Raynaud's SSc symptom at first entry, were selected. Patients with < 3 years from the first SSc symptom, including Raynaud's phenomenon, were also analysed. SSc-related variables, including antibodies, SSc subsets, and organ involvement, were examined. Age was categorized into ≤ 30, 31-59, and ≥ 60 years. We performed descriptive and bivariate analyses. RESULTS: The study included 1027 patients: 90% Caucasian, 80% women, and 40% with diffuse disease. In early stages of SSc, younger patients had significantly more anti-Scl-70 antibodies and diffuse disease. With increasing age, we observed more elevation of estimated pulmonary systolic pressure on echocardiography (5%, 13%, and 30%, respectively, in the three age groups), cardiac conduction blocks (6%, 6%, and 15%), and left ventricular diastolic dysfunction (4%, 12%, and 27%). The results were similar for 650 patients with < 3 years from first SSc symptom, including Raynaud's. CONCLUSION: In early stages of SSc, older patients showed data indicating more severe disease with greater cardiac involvement. The diffuse subset was more frequent in the younger subgroup. The identification of such differences may help in selecting appropriate management for individual patients in clinical practice.

Position statement for the management of comorbidities in psoriasis.

BACKGROUND: The association between psoriasis and some diseases has become relevant in recent years. Providing appropriate management of psoriasis from an early stage requires prompt diagnosis and treatment of concomitant diseases and to prevent any potential comorbidity. This approach should consider the adverse events of the drugs used to treat psoriasis potentially related to the onset of comorbidities. OBJECTIVE: To provide the dermatologist with an accurate and friendly tool for systematizing the diagnosis of psoriasis-associated comorbidities, which generally escapes the scope of the dermatology setting, and to facilitate decision-making about the referral and treatment of patients with comorbidities. METHODS: These position statement recommendations were developed by a working group composed of ten experts (four dermatologists, one cardiologist, one rheumatologist, one gastroenterologist, one nephrologist, one endocrinologist and one psychiatrist) and two health services researchers. The expert group selected the psoriasis comorbidities considered according to their relevance in the dermatology setting. The recommendations on diagnostic criteria are based on the current clinical practice guidelines for each of the comorbidities. The information regarding the repercussion of psoriasis medical treatments on associated comorbid diseases was obtained from the summary of product characteristics of each drug. RESULTS: Recommendations were developed to detect and refer the following psoriasis comorbidities: psoriatic arthritis, cardiovascular risk factors (diabetes, dyslipidaemia, obesity, hypertension and metabolic syndrome), non-alcoholic fatty liver disease, inflammatory bowel disease, kidney disease and psychological disorders (anxiety and depression). In addition, alcohol consumption and tobacco consumption were included. The tables and figures are precise, easy-to-use tools to systematize the diagnosis of comorbidities in patients with psoriasis and facilitate the decision-making process regarding referral and treatment of patients with an associated disease. CONCLUSION: The application of these position statement recommendations will facilitate the dermatologist practice, and benefit psoriasis patients' health and quality of life.

Replication of PTPRC as genetic biomarker of response to TNF inhibitors in patients with rheumatoid arthritis.

Genetic biomarkers could be useful for orienting treatment of patients with rheumatoid arthritis (RA), but none has been convincingly validated yet. Putative biomarkers include 14 single nucleotide polymorphisms that have shown association with response to TNF inhibitors (TNFi) in candidate gene studies and that we assayed here in 755 RA patients. Three of them, in the PTPRC, IL10 and CHUK genes, were significantly associated with response to TNFi. The most significant result was obtained with rs10919563 in PTPRC, which is a confirmed RA susceptibility locus. Its RA risk allele was associated with improved response (B=0.33, P=0.006). This is the second independent replication of this biomarker (P=9.08 × 10(-8) in the combined 3003 RA patients). In this way, PTPRC has become the most replicated genetic biomarker of response to TNFi. In addition, the positive but weaker replication of IL10 and CHUK should stimulate further validation studies.

Genetic variation in the nuclear factor kappaB pathway in relation to susceptibility to rheumatoid arthritis.

OBJECTIVE: To examine genetic association between rheumatoid arthritis (RA) and known polymorphisms in core genes of the nuclear factor (NF)kappaB pathway, the major intracellular pathway in RA pathogenesis. METHODS: Discovery and replication sample sets of Spanish patients with RA and controls were studied. A total of 181 single nucleotide polymorphisms (SNPs) uniformly spaced along the genomic sequences of 17 core genes of the NFkappaB pathway (REL, RELA, RELB, NFKB1, NFKB2, NFKBIA, NFKBIB, NFKBIE, IKBKA, IKBKB, IKBKE, IKBKAP, KBRAS1, KBRAS2, MAP3K1, MAP3K14, TAX1BP1) were studied by mass spectrometry analysis complemented with 5'-nuclease fluorescence assays in the discovery set, 458 patients with RA and 657 controls. SNPs showing nominal significant differences were further investigated in the replication set of 1189 patients with RA and 1092 controls. RESULTS: No clear reproducible association was found, although 12 SNPs in IKBKB, IKBKE and REL genes showed significant association in the discovery set. Interestingly, two of the SNPs in the IKBKE gene, weakly associated in the discovery phase, showed a trend to significant association in the replication phase. Pooling both sample sets together, the association with these two SNPs was significant. CONCLUSION: We did not find any major effect among the explored members of the NFkappaB pathway in RA susceptibility. However, it is possible that variation in the IKBKE gene could have a small effect that requires replication in additional studies.

Bronquiolitis obliterante con neumonía organizada en un paciente con artritis reumatoide / Bronchiolitis obliterans with organizing pneumonia associated with rheumatoid arthritis

Presentamos un paciente con artritis reumatoide de larga evolución que ingresa por cuadro sugerente de infección respiratoria. Teniendo en cuenta su enfermedad de base y que en ese momento está en tratamiento con metotrexato, se plantea el diagnóstico diferencial entre afectación pulmonar asociada a artritis reumatoide o secundaria a toxicidad farmacológica. El paciente es diagnosticado finalmente de bronquiolitis obliterante con neumonía organizada en relación con artritis reumatoide, entidad poco frecuente de la que hemos encontrado escasas descripciones en la literatura revisada (AU)

Neuropatía periférica por vasculitis en paciente con artritis reumatoide / Peripheral neuropathy due to vasculitis in a patient with rheumatoid arthritis

La afección del sistema nervioso debida a vasculitis en la artritis reumatoide (AR) es una infrecuente manifestación extraarticular. Describimos a un paciente diagnosticado de AR, que presentó un cuadro insidioso de parestesias y debilidad en los miembros inferiores. El electromiograma puso de manifiesto un déficit sensitivomotor y la biopsia de nervio sural apoyó el diagnóstico de vasculitis necrosante. Se descartaron otras etiologías, como neoplasia, toxicidad farmacológica, déficit vitamínico y diabetes, entre otras. Revisamos las diferentes manifestaciones de las polineuropatías relacionadas con AR (AU)

Varón con dolor y pérdida de fuerza en miembros inferiores / Male with pain and loss of strenght at the lower limbs

La polineuropatía vasculítica en relación con artritis reumatoide es una causa infrecuente de pérdida de fuerza y dolor invalidante, cuyo diagnóstico de sospecha es de gran importancia para su correcto tratamiento y un buen pronóstico, y que puede ser motivo de consulta en una Unidad del Dolor. Describimos un varón de 70 años, diagnosticado de artritis reumatoide, con escasa afectación funcional, que ingresa y consulta por un cuadro de inicio insidioso y curso lentamente progresivo, sensitivo-motor, de tres meses de evolución, limitado a miembros inferiores, muy dolorosa e incapacitante, acompañado de atrofia muscular y síndrome constitucional sin afectación articular, que obligaron al encamamiento del paciente. Se descartaron otras causas sistémicas, medulares, radiculares y de nervio periférico que pudieran justificar el cuadro. Un estudio electrofisiológico y una biopsia de nervio sural confirmaron el diagnóstico de una polineuropatía vasculítica asociada a artritis reumatoide. Tratada primero con opiáceos débiles, gabapentina y amitriptilina, y posteriormente, con esta sospecha, con esteroides a altas dosis, se obtuvo una gran mejoría con recuperación de la marcha .Se reafirma la importancia de una Unidad del Dolor para el diagnóstico del paciente, la necesidad de un abordaje multidisciplinar en colaboración con otros especialistas, y, como el mejor tratamiento para el dolor, el etiológico o el fisiopatogénico, cuando es posible (AU)