Trabecular and cortical bone involvement in rheumatoid arthritis by DXA and DXA-based 3D modelling.

Rheumatoid arthritis (RA) patients had a higher risk of developing low bone mineral density (BMD) or osteoporosis. RA patients on classic disease-modifying antirheumatic drug (c-DMARD) therapy showed significantly lower BMD than controls, while no significant differences in most parameters were found between RA patients receiving biological disease-modifying antirheumatic drugs (b-DMARDs) and controls. The 3D analysis allowed us to find changes in the trabecular and cortical compartments. INTRODUCTION: To evaluate cortical and trabecular bone involvement of the hip in RA patients by dual-energy X-ray absorptiometry (DXA) and 3D analysis. The secondary end-point was to evaluate bone involvement in patients treated with classic (c-DMARD) or biological (b-DMARD) disease-modifying antirheumatic drug therapies and the effect of the duration of the disease and corticosteroid therapy on 3D parameters. METHODS: A cross-sectional study of 105 RA patients and 100 subjects as a control group (CG) matched by age, sex, and BMI was carried out. BMD was measured by DXA of the bilateral femoral neck (FN) and total hip (TH). The 3D analyses including trabecular and cortical BMD were performed on hip scans with the 3D-Shaper software. RESULTS: FN and TH BMD and trabecular and cortical vBMD were significantly lower in RA patients. The c-DMARD (n = 75) group showed significantly lower trabecular and cortical vBMD than the CG. Despite the lower values, the b-DMARD group (n = 30) showed no significant differences in most parameters compared with the CG. The trabecular and cortical 3D parameters were significantly lower in the group with an RA disease duration of 1 to 5 years than in the CG, and the trabecular vBMD was significantly lower in the group with a duration of corticosteroid therapy of 1 to 5 years than in the CG, while no significant differences were found by standard DXA in the same period. CONCLUSIONS: RA patients had a higher risk of developing low BMD or osteoporosis than controls. RA patients receiving c-DMARD therapy showed significantly lower BMD than controls, while no significant differences in most parameters were found between RA patients receiving b-DMARDs and controls. 3D-DXA allowed us to find changes in trabecular and cortical bone compartments in RA patients.

Fulminant thrombotic thrombocytopenic purpura in systemic lupus erythematosus.

We describe two cases of fulminant thrombotic thrombocytopenic purpura (TTP) in unusual association in systemic lupus erythematosus (SLE) patients. In our two SLE patients the exceptionally rapid fatal course of TTP made any therapeutic intervention impossible.

Chronic cutaneous lupus erythematosus and subsequent infection with HIV1.

Since the beginning of the pandemia caused by the Human Immunodeficiency Virus several reports have described cases of infection by HIV1 in patients bearing rheumatic diseases. The infection by HIV 1 in patients with Systemic Lupus Erythematosus (SLE) and Chronic Cutaneous Lupus Erythematosus (CCLE), however, seems to be elusive. As far as we know, only 3 cases of HIV infection associated with SLE have been published. Furthermore, we have not been able to find out any report concerning HIV infection in patients bearing CCLE. The aim of the present article is to present a case of a female patient with CCLE that subsequently developed an infection with human immunodeficiency virus.

[HIV infection in a patient with chronic cutaneous lupus]. / Infeccion por HIV en una paciente con Lupus Cutáneo Crónico.

We present a case of chronic cutaneous lupus erythematosus (CCLE) in a patient who subsequently became infected with human immunodeficiency virus, HIV-1. The symptoms attributed to CCLE had persisted for years, and curiously had disappeared by the time the patient probably became infected with HIV-1. Even if there is lack of evidence to consider HIV-1 infection as direct causative agent in the clinical remission of CCLE, this response is in accordance with previous reports from other authors, regarding the attenuating role of HIV on the clinical course of the systemic lupus erythematosus. Even if the number of reported cases is very low it is of the upmost importance to establish whether this hypothesis is correct or not, since both diseases present great difficulties regarding diagnosis, due to the important overlapping between symptoms and serological tests.

[Systemic lupus erythematosus and AIDS. Difficulties in the differential diagnosis]. / Lupus eritematoso sistémico y SIDA. Dificultades en el diagnóstico diferencial.

AIDS and systemic lupus erythematosus (SLE) share clinical and laboratory features that may difficult a differential diagnosis. We report five patients who presented diagnostic problems, two of them with SLE diagnosis and HIV-1 false-reactive screening tests, and the other three with AIDS diagnosis and clinical features fulfilling four or more ARA-clinical criteria for the diagnosis of SLE. It is recommended that tests for HIV-1 antibodies in patients with symptoms of SLE, be carried out by at least three different methods, with direct HIV-1 antigen detection as final confirmatory technique. On the other hand, as also proposed for Sjogren syndrome, the presence of HIV-1 or its antigens, established through cell-cultures or direct blood detection, should be considered as exclusion criteria for SLE diagnosis.

Lupus eritematoso sistémico y SIDA. Dificultades en el diagnóstico diferencial. / [Systemic lupus erythematosus and AIDS. Difficulties in the differential diagnosis]

AIDS and systemic lupus erythematosus (SLE) share clinical and laboratory features that may difficult a differential diagnosis. We report five patients who presented diagnostic problems, two of them with SLE diagnosis and HIV-1 false-reactive screening tests, and the other three with AIDS diagnosis and clinical features fulfilling four or more ARA-clinical criteria for the diagnosis of SLE. It is recommended that tests for HIV-1 antibodies in patients with symptoms of SLE, be carried out by at least three different methods, with direct HIV-1 antigen detection as final confirmatory technique. On the other hand, as also proposed for Sjogren syndrome, the presence of HIV-1 or its antigens, established through cell-cultures or direct blood detection, should be considered as exclusion criteria for SLE diagnosis.

Infeccion por HIV en una paciente con Lupus Cutáneo Crónico. / [HIV infection in a patient with chronic cutaneous lupus]

We present a case of chronic cutaneous lupus erythematosus (CCLE) in a patient who subsequently became infected with human immunodeficiency virus, HIV-1. The symptoms attributed to CCLE had persisted for years, and curiously had disappeared by the time the patient probably became infected with HIV-1. Even if there is lack of evidence to consider HIV-1 infection as direct causative agent in the clinical remission of CCLE, this response is in accordance with previous reports from other authors, regarding the attenuating role of HIV on the clinical course of the systemic lupus erythematosus. Even if the number of reported cases is very low it is of the upmost importance to establish whether this hypothesis is correct or not, since both diseases present great difficulties regarding diagnosis, due to the important overlapping between symptoms and serological tests.

Infeccion por HIV en una paciente con Lupus Cutáneo Crónico. / [HIV infection in a patient with chronic cutaneous lupus]

We present a case of chronic cutaneous lupus erythematosus (CCLE) in a patient who subsequently became infected with human immunodeficiency virus, HIV-1. The symptoms attributed to CCLE had persisted for years, and curiously had disappeared by the time the patient probably became infected with HIV-1. Even if there is lack of evidence to consider HIV-1 infection as direct causative agent in the clinical remission of CCLE, this response is in accordance with previous reports from other authors, regarding the attenuating role of HIV on the clinical course of the systemic lupus erythematosus. Even if the number of reported cases is very low it is of the upmost importance to establish whether this hypothesis is correct or not, since both diseases present great difficulties regarding diagnosis, due to the important overlapping between symptoms and serological tests.

Infeccion por HIV en una paciente con Lupus Cutáneo Crónico / HIV infection in a patient with chronic cutaneous lupus

We present a case of chronic cutaneous lupus erythematosus (CCLE) in a patient who subsequently became infected with human immunodeficiency virus, HIV-1. The symptoms attributed to CCLE had persisted for years, and curiously had disappeared by the time the patient probably became infected with HIV-1. Even if there is lack of evidence to consider HIV-1 infection as direct causative agent in the clinical remission of CCLE, this response is in accordance with previous reports from other authors, regarding the attenuating role of HIV on the clinical course of the systemic lupus erythematosus. Even if the number of reported cases is very low it is of the upmost importance to establish whether this hypothesis is correct or not, since both diseases present great difficulties regarding diagnosis, due to the important overlapping between symptoms and serological tests.