SER consensus statement on the use of biologic therapy for systemic lupus erythematosus.

OBJECTIVE: To provide a reference to rheumatologists and other physicians involved in the treatment of systemic lupus erythematosus (SLE) who are using, or about to use biologic therapies. METHODS: Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and degree of recommendation were classified according to a model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through a Delphi technique. RESULTS: We have produced recommendations on the use of belimumab, the only biological agent with approved indications for SLE, and other biological agents without an indication for SLE. The objective of treatment is to achieve a complete clinical response, taken as the absence of perceived or evident disease activity. Nuances regarding the use of biologic therapies in SLE were reviewed as well, such as the evaluation that should be performed prior to administration and the follow up of patients undergoing these therapies. CONCLUSIONS: We present the SER recommendations for the use of biological therapies in patients with SLE.

[Infection in Joint Prosthesis. When Should it Be Suspected?]. / Infección de prótesis articular. ¿Cuándo sospecharla?

Joint prosthesis constitute one of the major advances of medicine in the treatment of patients with osteoarticular disease. Infections of prosthetic material, though having a low frequency (1%-3% according to the series and type of prosthesis) constitute one of the larger complications of this surgery and a diagnostic challenge for the physician. The concept of prosthesis infection includes colonization due to germs in periprosthetic material that also leads to clinical manifestations. There are diverse classifications of the prosthetic infections, most of which are based in the form of clinical presentation which largely depends on the germ which is responsible for the infection. In this sense, late forms are generally caused by poorly virulent germs (plasma coagulase negative staphilococcus is the most frequent) and are the most difficult to diagnose. Diagnostic suspicion must be established in relation to the clinical manifestations and a series of accompanying clinical signs. In this sense, in the abscense of baseline inflammatory rheumatism, the persistent elevation of CRP (which normalizes 1-2 weeks after the surgery), or the presence of inflammatory joint fluid (with cell counts over 1700 cells/µL and especially with a predominance of PMN>68%) are signs that strenghten the diagnostic suspicion of bacterial infection. The definitive diagnosis is established by the isolation of the causal germ in culture and, in this sense, the biopsy of periprosthetic material and its study by the pathology department as well as its culture, allow for a trustworthy diagnosis in 80%-90% of cases.