Artritis reumatoide y enfermedad tiroidea autoinmunitaria / Rheumatoid arthritis and autoimmune thyroid disease

Resumen: ANTECEDENTES: Las enfermedades autoinmunitarias sistémicas, como la artritis reumatoide, pueden coexistir con enfermedades autoinmunitarias órgano-específicas. OBJETIVO: Describir una serie de casos de artritis reumatoide y enfermedad tiroidea autoinmunitaria (tiroiditis de Hashimoto, enfermedad de Graves). MATERIAL Y MÉTODO: Estudio retrospectivo en el que de enero a diciembre de 2017 se incluyeron pacientes con artritis reumatoide y enfermedad tiroidea autoinmunitaria. La artritis reumatoide se evaluó de acuerdo con los criterios diagnósticos de 2010 (ACR/EULAR). RESULTADOS: Se identificaron 26 pacientes con artritis reumatoide y enfermedad tiroidea autoinmunitaria. En 14 casos la manifestación inicial fue artritis reumatoide y en 12 la manifestación inicial fue enfermedad de Graves. Todos los pacientes (mujeres, mediana de edad: 46 años) acudieron con un cuadro clínico de poliartritis simétrica de las manos, los carpos y las rodillas. En total, la serología fue positiva para factor reumatoide (21), anticuerpo contra péptidos cíclicos citrulinados (11), anti-peroxidasa (21) y TSH elevada (15). En 5 casos, la enfermedad de Graves precedió a la artritis reumatoide. En cuatro casos se encontró anormalidad palpable de la glándula tiroidea. El tratamiento consistió en hormonas tiroideas sintéticas, yodo radioactivo, cirugía de tiroides y fármacos modificadores de artritis reumatoide. CONCLUSIÓN: En esta serie de casos, la causa más común de hipotiroidismo fue tiroiditis de Hashimoto que precedió o siguió el diagnóstico de artritis reumatoide.

Abstract: BACKGROUND: Systemic autoimmune diseases including rheumatoid arthritis can coexist with organ-specific autoimmune diseases. OBJECTIVE: To report a case series of rheumatoid arthritis patients who developed autoimmune thyroid disease (Hashimoto's thyroiditis, Graves' disease). MATERIAL AND METHOD: A retrospective study was done from January to December 2017 including patients with rheumatoid arthritis and autoimmune thyroid disease. Rheumatoid arthritis was assessed according to the diagnostic criteria of 2010 (ACR/ EULAR). RESULTS: There were identified 26 cases with rheumatoid arthritis and an autoimmune thyroid disease. In 14 cases rheumatoid arthritis was the initial manifestation and in 12 the initial manifestation was hypothyroidism or Graves' disease (GD). All the patients (females, median age: 46) had symmetrical polyarthritis of hands, wrists and knees. In total, serology was positive for rheumatoid factor (21), anti-cyclic citrullinated peptide antibody (11), anti-thyroid peroxidase antibody (21) and elevated levels of TSH in 15 cases. In 5 cases, hyperthyroidism was the initial feature. Palpable abnormality of the thyroid gland was present in 5 cases. The treatment consisted on synthetic thyroid hormones, radioactive iodine therapy, thyroid surgery and disease modifying drugs. CONCLUSION: In this case series, the most common cause of hypothyroidism was Hashimoto's thyroiditis preceding or following rheumatoid arthritis.

Artropatía relacionada con hepatitis C / Hepatitis C-related arthropathy

Resumen: OBJETIVO: Reportar una serie de casos de artropatía relacionada con hepatitis C. MATERIAL Y MÉTODO: Estudio retrospectivo en el que de enero de 2015 a diciembre de 2017 se incluyeron pacientes con infección crónica por VHC y artropatía referidos a la consulta de reumatología. Se examinaron de manera retrospectiva factores de riesgo, factor reumatoide (FR), anticuerpo contra péptido cíclico citrulinado (anti-PCC), anticuerpos contra VHC, genotipo viral y enzimas. También se determinó la subclase de artropatía, existencia de erosiones y tratamiento. Se excluyeron los pacientes infectados con VHB. RESULTADOS: Se incluyeron 31 pacientes. Los factores de riesgo de infección por VHC se identificaron solamente en 28 casos, que incluyen transfusión sanguínea antes de 1992 (n = 12) o abuso de drogas intravenosas (n = 16). En seis casos coexistieron artritis reumatoide y VHC; todos fueron seropositivos a factor reumatoide y anti-PCC y tres casos mostraron erosiones. Nueve casos tuvieron poliartritis simétrica u oligoartritis no erosiva que semejaba artritis reumatoide y 16 casos tuvieron artralgias simples. En total, el factor reumatoide fue positivo en 77% y las enzimas estuvieron altas en seis casos. La combinación de sulfasalazina, cloroquina y prednisona a dosis bajas y antiinflamatorios fue comúnmente indicada. CONCLUSIÓN: Los pacientes con infección por VHC pueden padecer artralgias-artritis. El tipo de artropatía debe diferenciarse por la hepatotoxicidad de los fármacos modificadores de enfermedad. El anti-PCC es útil para distinguir artropatía relacionada con hepatitis C de artritis reumatoide.

Abstract: OBJECTIVE: To report a case series of HCV-related arthropathy. MATERIAL AND METHOD: A retrospective study was done from January 2015 to December 2017 with patients with chronic HCV infection and arthropathy referred to our rheumatology clinic. All the patients were retrospectively reviewed. Risk factors for HCV infection including blood transfusion or intravenous drug abuse, rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP), anti-HCV (ELISA), viral genotype, and enzymes levels were examined. The clinical presentation of joint involvement, erosions, and type of treatment were also studied. Patients seropositive to HBV were excluded. RESULTS: There were included 31 patients. Risk factors were identified in only 28 cases, including blood transfusion (12) before 1992 and intravenous drug abuse (16). Rheumatoid arthritis coexisting with hepatitis C was found in 6 cases; all of these had anti-CCP, RF and erosions in 3. Nine patients gave a history of mild, symmetric poliar- thritis or oligoarthritis no-erosive resembling classic rheumatoid arthritis. Sixteen patients presented polyarthralgias. In total, RF was present in 77% out of 31 patients. Elevated enzymes were seen in 6 cases. Sulphasalazine, chloroquine, low dose prednisone and NSAIDs were commonly prescribed. CONCLUSION: The patients with HCV infection can present arthralgias/arthritis. The type of arthropathy must be differentiated due to the hepatotoxicity of disease modifying drugs. Anti-PCC antibody is useful for distinguishing HCV-related arthropathy from rheumatoid arthritis.

Artritis reumatoide, autoanticuerpos y enzimas PADs / Rheumatoid arthritis, autoantibodies, and PAD enzymes

Resumen: La artritis reumatoide es una enfermedad inflamatoria sistémica que se caracteriza por sinovitis crónica y producción de autoanticuerpos. Los factores de riesgo incluyen genes HLA-DRῘβ1 con epítope compartido, periodontitis y tabaquismo. Al menos cinco diferentes sistemas de anticuerpos contra autoantígenos están implicados en la patogénesis de la enfermedad: 1) el factor reumatoide; 2) los anticuerpos a péptidos/proteínas citrulinadas (ACPAs); 3) los anticuerpos a proteínas carbamiladas (anti-Pcar); 4) los anticuerpos contra enzimas peptidilarginina desaminasas (anti-PAD2/4) y 5) los anticuerpos contra fibrinógeno citrulinado. La existencia de ACPA ha dividido a los sujetos con artritis reumatoide en dos subclases: artritis reumatoide positiva a ACPA y negativa a ACPA. Solamente los pacientes con artritis reumatoide positiva a ACPA están estrechamente relacionados con alelos HLA-DRβ1 con epítope compartido y son reconocidos por antígenos específicos de células T y células B.

Abstract: Rheumatoid arthritis is a systemic, inflammatory disease characterized by chronic synovitis and presence of autoantibodies. Risk factors include HLA-DRβ1 genes, periodontal disease and smoking. At least 5 different autoantibodies to autoantigens are implicated in the pathogenesis of this disorder: 1) rheumatoid factor; 2) autoantibodies directed against citrullinated peptides/proteins (ACPA); 3) anti-carbamilated protein antibody (anti-carP); 4) anti-peptidylarginine deiminase antibody (anti-PAD2/4), and 5) anti-citrullinated fibrinogen antibody. Patients with rheumatoid arthritis have been divided into two disease subsets: ACPA-positive rheumatoid arthritis and ACPA- negative rheumatoid arthritis. ACPA-positive rheumatoid arthritis is associated with HLA-DRβ1 shared epitope alleles and is recognized by antigen-specific T cells and B cells.

Artritis reumatoide en una paciente con acromegalia / Rheumatoid arthritis in a female patient with acromegaly

Resumen: Se comunica el caso de una paciente de 46 años de edad con antecedente de artritis de articulaciones metacarpofalángicas, interfalángicas proximales, carpos y codos de seis meses de duración. Tres años antes sufría cefalea y se le detectó diabetes mellitus. El examen físico mostró artritis de articulaciones de manos, carpos y codos. En vista de cambios sugerentes de acromegalia en la cara y las extremidades se solicitaron más estudios. Debido a las concentraciones elevadas de hormona del crecimiento e IGF-1, la imagen de resonancia magnética del cráneo, existencia de poliartritis, actividad de enfermedad de 28 articulaciones (DAS28) de 7.3, factor reumatoide e hiperglucemia, se establecieron los diagnósticos de tumor de hipófisis con acromegalia, artritis reumatoide activa y diabetes mellitus. A la paciente se le practicó cirugía trans-esfenoidal del tumor de hipófisis, que resultó en normalización de las concentraciones de hormona del crecimiento, IGF-1, glucosa y cefalea. Su artritis entró en remisión con metotrexato oral.

Abstract: This paper reports the case of a 46-year-old woman with a 6-month history of duration of arthritis of metacarpophalangeal, proximal interphalangeal, carpal and elbow joints of 6 months duration. Three years before she reported headache and diabetes mellitus. Due to changes suggestive of acromegaly on the face and extremities more studies were requested. In view of the elevated levels of GH, IGF-1, positive rheumatoid factor, arthritis, hyperglycemia, and the presence of a pituitary adenoma, the patient was diagnosed with acromegaly, rheumatoid arthritis and diabetes mellitus. The patient underwent trans-sphenoidal resection, which resulted in normalization of hyperglycemia, headache, eradication of the tumor mass, GH and IGF-1 levels and remission of her rheumatoid arthritis with oral methotrexate.

[Segmental portal hypertension with splenic vein thrombosis caused by pancreatitis]. / Hipertensión portal segmentaria por trombosis de la vena esplénica causada por pancreatitis.

BACKGROUND: Splenic vein thrombosis is a complication of pancreatic carcinoma, pancreatitis or pancreatic pseudocyst. It may lead to segmental portal hypertension and bleeding from gastric varices. CLINICAL CASE: A 31 year-old man was diagnosed with pancreatitis of two weeks of evolution and was referred to our hospital in 2013. He had a history of alcohol consumption. Physical examination showed no stigmata of liver cirrhosis. Laboratory analyses revealed hemoglobin 9.5 g/dL, and leukocytes and platelets were normal. Liver function tests were normal as well. Abdominal CT showed a pseudocyst, which was drained by percutaneous puncture. By pseudocyst recurrence, drainage and necrosectomy by retroperitoneal laparascopy were performed. The patient presented hyperglycemia during his treatment in hospital. He was discharged, but he returned to emergency room because of gastrointestinal bleeding without hemodynamic instability. Gastroscopy showed bleeding gastric varices. The colonoscopy showed normal results. Liver biopsy was also normal. Abdominal CT angiography revealed blockage of the splenic vein. Patient underwent splenectomy and was discharged. CONCLUSION: This case is rare due to the high frequency of portal hypertension and cirrhosis. The isolated gastric varices with normal liver function are a sign of splenic thrombosis. The definitive treatment is splenectomy.

Introducción: la obstrucción aislada de la vena esplénica es una complicación de carcinoma pancreático, pancreatitis o pseudoquiste del páncreas. La trombosis de la vena esplénica puede conducir a hipertensión portal segmentaria y sangrado de várices gástricas. Caso clínico: un hombre de 31 años de edad fue referido a nuestro hospital en 2013 con el diagnóstico de pancreatitis de dos semanas de evolución. Tenía el antecedente de consumo de alcohol. El examen físico no mostró estigmas de cirrosis hepática. El laboratorio reveló hemoglobina de 9.5 g/dL con leucocitos y plaquetas normales. Las pruebas de función hepática fueron normales. La TAC abdominal mostró un pseudoquiste, el cual fue drenado por punción percutánea. Por recurrencia del pseudoquiste, se efectuó drenaje y necrosectomía por laparoscopia retroperitoneal. El paciente presentó hiperglucemia durante su estancia. Después de haber egresado, acudió a urgencias por sangrado gastrointestinal superior sin inestabilidad hemodinámica. La gastroscopia mostró várices gástricas sangrantes. La colonoscopia mostró resultados normales. La biopsia de hígado también resultó normal. La angio-TAC abdominal mostró obstrucción de la vena esplénica. Se sometió a esplenectomía y fue egresado. Conclusión: este caso es raro en nuestro medio debido a la alta frecuencia de hipertensión portal por cirrosis. Las várices gástricas aisladas con función hepática normal son un signo de trombosis de la vena esplénica. El tratamiento definitivo es la esplenectomía.

[The first clinical description of granulomatosis with polyangiitis (known before as Wegener's granulomatosis)]. / La primera descripción clínica de la granulomatosis con poliangeítis (antes granulomatosis de Wegener).

Before 1950, cases of necrotizing vasculitis were commonly published in journals of pathology. Most of these cases were designated as polyarteritis nodosa. In 1952, the pathologist Pearl Zeek critically reviewed and summarized the literature dealing with polyarteritis nodosa and first grouped the different types of necrotizing vasculitis. But she omitted some types of not well-characterized vasculitis, among them granulomatosis with polyangiitis (Wegener's granulomatosis).

Antes de 1950, los casos de vasculitis necrosantes comúnmente se publicaban en revistas de patología. La mayoría de los casos se designaban poliarteritis nodosa. En 1952, la patóloga Pearl Zeek revisó críticamente la literatura sobre poliarteritis nodosa y por primera vez agrupó los diferentes tipos de vasculitis necrosantes. Sin embargo, omitió algunos tipos de vasculitis, hasta entonces no bien caracterizadas, entre las cuales estaba la granulomatosis con poliangeítis (antes granulomatosis de Wegener).

[Bouveret's syndrome: A rare presentation of gallstone ileus]. / Síndrome de Bouveret: una rara variante de íleo biliar.

BACKGROUND: Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a gallstone which passes into the duodenal bulb through a cholecystoduodenal fistula. CLINICAL CASE: We reported the case of a 46-year-old woman who presented intermittent epigastric pain, nausea, vomiting, and weight loss of 2-months duration. The patient admitted alcohol and methamphetamine abuse. She had not fever, dehydration or jaundice. Amylase, electrolytes, enzymes, and creatinine level were within normal limits. Seven months previously she was seen in the emergency department for acute cholecystitis. In that occasion, an abdominal ultrasound was reported with cholelithiasis without dilatation of the intra/extra-hepatic bile duct. Abdominal plain radiographs showed no relevant findings. A laparoscopic surgery was performed. During the procedure a sub-hepatic plastron with firm adhesions was found. The gallbladder was found attached to the duodenal bulb and an impacted calculus in the duodenum. The procedure was converted to surgery. Surgeon decided to perform a Bilroth 1 as the best choice. Seven days later, she was discharged. CONCLUSIONS: The clinical manifestations of the Bouveret's syndrome are nonspecific. Preoperative diagnosis is a challenge for clinicians because of the rarity of this condition. Treatment must be individualized.

Introducción: el síndrome de Bouveret se caracteriza por una obstrucción de la salida gástrica, causado por un cálculo en el bulbo duodenal, después de pasar a través de una fístula colecistoduodenal. Caso clínico: reportamos el caso clínico de una mujer de 46 años de edad, quien se presentó con dolor epigástrico intermitente, nausea, vómito y pérdida de peso de 2 meses de duración. No tenía fiebre, deshidratación o ictericia. La paciente admitió uso de alcohol y abuso de metanfetamina. La amilasa, enzimas, electrolitos y creatinina estuvieron dentro de los límites normales. Siete meses antes había ingresado a Urgencias por colecistitis aguda. El ultrasonido fue reportado como colelitiasis sin dilatación de la vía biliar intra/extrahepática. Las radiografías simples de abdomen no mostraron hallazgos relevantes. Recibió tratamiento conservador y fue egresada. Se programó para cirugía laparoscópica. Durante el procedimiento se encontró un plastrón subhepático con adherencias firmes, por lo que se efectuó cirugía abierta. La vesícula se encontró adherida al bulbo duodenal y un cálculo impactado en el duodeno. Se removió el calculo por enterotomía. Habia leve distension gastrica. Debido a la inflamacion regional, el cirujano decidio efectuar Bilroth 1; no hubo complicaciones. Conclusiones: las manifestaciones clínicas del síndrome de Bouveret son inespecíficas. El diagnóstico preoperatorio es un desafío para el clínico por la rareza del padecimiento. El tratamiento debe individualizarse.

[B lymphocyte stimulator (BLyS/BAFF) level in sera of patients with lupus]. / Nivel de estimulador de linfocitos B (BLyS/BAFF) en el suero de pacientes con lupus.

BACKGROUND: B lymphocyte stimulator (BLyS/BAFF) is an endogenous protein that plays an important role in the differentiation and maduration of B lymphocytes. Enhanced levels of BLyS have been reported in lupus and other rheumatic diseases. METHODS: Serum samples from 92 lupus patients (94% females, median age 35.5 years) and 106 controls (50 healthy donors, 38 with rheumatoid arthritis, 18 with scleroderma) were analyzed for BLyS. The cutoff of BLyS ˃1.98 ng/ml corresponds to the 95th percentile from the healthy donors. Antibodies against native DNA and disease activity also were evaluated in lupus patients. During follow up, BLyS levels in 32 patients showed heterogeneity. RESULTS: The median level of BLyS in 92 lupus patients was 1.9 ng/mL (range 0.4-5.3), compared to 1.30, 1.35, and 1.35 ng/mL in healthy donors, rheumatoid arthritis, and scleroderma, respectively. Thirty-nine (42%) out of 92 patients had elevated levels of BLyS (median 2.8 ng/mL). A moderate correlation between titers of anti-DNA antibody (r=0.34) and Mex-SLEDAI (r=0.45) was found. The monitoring of 32 patients showed persistently high levels, or normal or intermittent variations of BLyS. CONCLUSION: The BLyS level is increased in some lupus patients. There was a moderate correlation with titers of anti-DNA antibody and disease activity. The monitoring of 32 patients showed heterogeneous levels of BLyS.

Introducción: el estimulador de linfocitos B (BLyS/BAFF) es una proteína endógena fundamental en la diferenciación y la maduración de linfocitos B. En el lupus se han encontrado niveles altos de BLyS. Métodos: se analizaron muestras séricas de 92 pacientes con lupus (94 % mujeres, con una mediana de edad de 35.5) y 106 controles (50 donadores de sangre, 38 pacientes con artritis reumatoide y 18 pacientes con esclerodermia). El punto de corte de BLyS ˃ 1.98 ng/mL corresponde al percentil 95 de los 50 donadores de sangre. También se evaluaron anticuerpos contra ADN nativo y actividad de enfermedad. Durante el seguimiento, los niveles de BLyS en 32 pacientes mostraron heterogeneidad. Resultados: la mediana de BLyS en 92 pacientes con lupus fue de 1.9 ng/mL (rango 0.4-5.3), comparada con 1.30, 1.35, y 1.35 ng/mL en donadores de sangre, pacientes con artritis reumatoide y pacientes con esclerodermia, respectivamente. Treinta y nueve pacientes con lupus tuvieron niveles elevados de BLyS (mediana 2.8 ng/mL), comparados con el grupo control. Hubo una moderada correlación entre títulos de anti-ADN (r = 0.34) y actividad de enfermedad (0.45). El seguimiento de 32 pacientes mostró un nivel de BLyS persistentemente elevado, normal o con variaciones intermitentes. Conclusión: el nivel de BLyS resultó elevado en algunos pacientes con lupus. Hubo una moderada correlación con títulos de anti-ADN y actividad de enfermedad. El seguimiento de 32 pacientes mostró fluctuaciones en los niveles de BLyS.

[The golden age of rheumatoid arthritis treatment]. / La era dorada del tratamiento de la artritis reumatoide.

Today, we enjoy the golden age of rheumatology. In the 1970s, the paradigm for treating rheumatoid arthritis consisted in a pyramid. In the decade of the 1980s, and shortly after began a revolution in the understanding and treatment of rheumatic diseases. Methotrexate and tumor necrosis factor-blockers came on the scene.

Actualmente disfrutamos la edad dorada de la reumatología. En la década de 1970, el paradigma del tratamiento de la artritis reumatoide consistía en una pirámide. A partir de la década de 1980 surgió una revolución en el conocimiento y la terapia de las enfermedades reumáticas: el metotrexato y los bloqueadores del factor de necrosis tumoral aparecieron en la escena.

[B lymphocyte stimulator in systemic lupus erythematosus]. / Estimulador de linfocitos B en lupus eritematoso sistémico.

The B lymphocyte stimulator (BLyS) is an essential protein for the growth and survival of B cells. BLyS is expressed on monocytes, macrophages, and dendritic cells. BLyS binds to three receptors on B cells: BAFF-R, BCMA, and TACI. BLyS overexpression in mice leads to lupus-like syndrome, but not in all, whereas BLyS deficient mice results in a block of B cell development. High serum levels of BLyS can be detected in patients with lupus and rheumatoid arthritis. BLyS antagonists are an attractive target for treating autoimmune diseases.

[Possible association of gynecological cancer and rheumatoid arthritis]. / Posible asociación del cáncer ginecológico con artritis reumatoide.

BACKGROUND: The association between rheumatoid arthritis and cancer is controversial. Previous studies have shown a correlation between rheumatoid arthritis and the development of lymphoma. OBJECTIVE: Describe a case of rheumatoid arthritis and associated breast cancer plus the identification of the clinical features of a set of cases in which arthritis and cancer go along. MATERIAL AND METHOD: This is a retrospective clinical series study. A database of Hospital General ISSSTECALI of Mexicali, Mexico, containing information on patients suffering from both rheumatoid arthritis and cancer until 2012 was checked. The medical files confirmed the diagnoses. The data available included age, date of arthritis diagnosis, date of cancer diagnosis, related conditions, results of serological tests, type of cancer, treatments used and follow-up information. RESULTS: Fifteen cases of women suffering from both rheumatoid arthritis and cancer were identified on the database of the Hospital General ISSSTECALI in Mexicali. The case described here is the number four on that list. The average age was 54 years and the average time between arthritis and cancer diagnoses was four years. Ten patients were administered methotrexate. Nine patients (60%) suffered from breast cancer and six more from cervical cancer. Three patients suffered from cervical dysplasia. CONCLUSIONS: These cases emphasize the need of strict follow-up on patients suffering from inflammatory rheumatoid condition. If cancer follows chronic inflammation, immunosuppression, or it is pure coincidence, is still a matter of debate.

[HCV genotypes distribution in HCV infected adulthood patients]. / Genotipos del virus de la hepatitis C. Distribución en adultos.

OBJECTIVE: to determine the distribution of HCV genotypes in a group of HCV infected patients in Mexicali, Mexico. METHODS: a retrospective study which included 66 HCV-infected patients was done. Anti-HCV antibodies were measured by ELISA and were confirmed by the detection of viral RNA in the serum. Subsequently, HCV RNA positive patients were genotyped. Viral loads were compared and risk factors also were investigated. RESULTS: 59 % were women. HCV genotypes found were 1, 2, 3, 4 and mixed. The most frequent subtypes were 1a y 1b (70 %), followed by 3a (12 %), 2b (11 %), mixed (6 %), and 4a (1.5 %). There was no statistically difference significant in medians of viral loads between males/females (p = 0.53). Ten patients had been intravenous drug users; 7 from them resulted with subtype 1a. The most frequent risk factor was blood transfusion (75 %). CONCLUSIONS: the distribution of HCV genotypes in our hospital was similar as those previously reported in other geographic regions of our country.

[Abnormal cervicovaginal cytology in women with rheumatoid arthritis]. / Citología cervical anormal en mujeres con artritis reumatoide.

BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of infections and cancer. A link between RA and abnormal cervicovaginal cytology has rarely been reported. OBJECTIVE: The aim of this study was to review cervicovaginal cytology results in women with RA and compare them with a control population. Sexual behavior also was investigated. MATERIAL AND METHOD: Cervicovaginal cytology results of 95 women with RA were compared to those of a control population of 1,719 women attending at the same hospital and followed until June 2009. Records of RA patients were reviewed to obtain clinical data, particularly sexual behavior. RESULTS: Of 95 RA patients, 13/95 had an abnormal cervicovaginal cytology result, compared with 120/1,719 controls. Twelve/13 had squamous intraepithelial lesions (SIL), compared with 27/120 controls. There was no significant difference in sexual partners between women with RA and controls. Women with RA without abnormal cervicovaginal cytology had less sexual partners than those with RA and abnormal cytology. Two women with RA and abnormal cervicovaginal cytology had a history of condylomata and herpes genital. Three/13 women with RA developed abnormal cervicovaginal cytology after 12 to 36 months initiating their illness. None from them had ever received immunosuppressants. CONCLUSIONS: Women with RA have an increased prevalence of abnormal cervical cytology, compared with a control population. It may be related to chronic inflammatory disease and sexual behavior.

[Squamous intraepithlelial lesions in women's lupus]. / Lesiones escamosas intraepiteliales en mujeres con lupus.

BACKGROUND: previous studies have suggested an association between systemic lupus erythematosus (SLE), abnormal cervical smears and squamous intraepithelial lesions (SIL), but the underlying cause of this association is not well defined. OBJECTIVE: To review Pap smear and biopsy results in SLE women compared with healthy controls and to identify traditional risk factors associated with abnormal smears. Retrospective cohort study. Sixty-two SLE patients and 1719 controls were included. Women with abnormal Pap smear results were referred to colposcopic biopsy histology. Information on traditional risk factors was obtained. Among SLE patients, activity score (Mex-SLEDAI) and immunosuppressive drugs exposure also were determined. RESULTS: Fourteen (22%) out of 62 patients had abnormal Pap smear results, compared with 120 (7%) out of 1719 controls. Thirteen (92%) out of 14 patients showed SIL by histological examination, compared with 27 (22%) out of 120 controls. Two SLE women had condylomata. There were no significant differences in the use of immunosuppressive agents among SLE patients with and without SIL. CONCLUSION: Abnormal Pap smears, SIL by biopsy and changes in the sexual behavioral were more common among SLE patients than in controls. The immunosuppressive drug exposure was not associated with abnormal Pap smears.

[Prevalance of antibodies against hepatitis C and B viruses in patients with systemic lupus erythematosus]. / Prevalencia de anticuerpos contra virus de hepatitis C y B en pacientes con lupus eritematoso sistémico.

UNLABELLED: Viruses might be one of the environmental agents that trigger systemic lupus erythematosus (SLE). OBJECTIVE: To determine the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) antibodies in patients with SLE. METHODS: We investigated 110 SLE patients (106 women and 4 men, mean age 35.1 years) who fulfilled the criteria for SLE of the American College of Rheumatology. Three hundred blood donors served as controls. Antibodies against HCV and HBV were tested by a third generation ELISA. Positive results for anti-HCV were further studied by a third generation recombinant immunoblot assay (RIBA 3.0) and polymerase chain reaction (PCR). A positive ELISA assay was considered when the result was positive on two consecutive determinations. RESULTS: Antibodies to HCV were present in 3 blood donors (1%), compared with 2 SLE patients (p = 0.4, Fisher's test). One SLE patient was RIBA positive and was lost for follow-up, and the another was confirmed by PCR. This patient had chronic hepatitis and a history of blood transfusion. No patient or control was HBV positive. CONCLUSIONS: The prevalence of antibodies against HCV and HBV was not higher than in blood donors and the relation between these viruses and SLE could not be established.

Influenza vaccination of patients with systemic lupus erythematosus.

OBJECTIVE: To determine the safety, the immunogenicity, and the increase of pre-existing autoantibodies in patients with systemic lupus erythematosus (SLE) following influenza vaccination. PATIENTS AND METHODS: Eighteen women with SLE received an inactivated influenza vaccine. Antibody titers were measured before and 4 weeks after vaccination using a standardized hemagglutination inhibition (HAI) assay. Disease activity and antinuclear autoantibodies were determined at study entry, at 4 weeks, and at 8 weeks after vaccination. RESULTS: After vaccination, the percentage of patients with anti-hemagglutinin antibody levels increased significantly but was lower than in healthy women. Mean antibody titer of patients increased significantly but also was lower than that of controls. Both the mean of disease activity and anti-ds DNA antibody decreased significantly. Adverse effects to the vaccine were mild. CONCLUSIONS: a) Influenza vaccination appears to be safe; b). Antibody response to influenza vaccination increases significantly for all 3 influenza antigens; c) Specific antibody response is not significantly affected by treatment, age, IgG levels, or disease activity.

Influenza vaccination of patients with systemic lupus erythematosus / Vacunación contra virus de la influenza en pacientes con lupus eritematoso sistémico

Objective. To determine the safety, the immunogenicity, and the increase of pre-existing autoantibodies in patients with systemic lupus erythematosus (SLE) following influenza vaccination. Patients and Methods. Eighteen women with SLE received an inactivated influenza vaccine. Antibody titers were measured before and 4 weeks after vaccination using a standardized hemagglutination inhibition (HAI) assay. Disease activity and antinuclear autoantibodies were determined at study entry, at 4 weeks, and at 8 weeks after vaccination. Results. After vaccination, the percentage of patients with anti-hemagglutinin antibody levels increased significantly but was lower than in healthy women. Mean antibody titer of patients increased significantly but also was lower than that of controls. Both the mean of disease activity and anti-ds DNA antibody decreased significantly. Adverse effects to the vaccine were mild. Conclusions. a) Influenza vaccination appears to be safe; b). Antibody response to influenza vaccination increases significantly for all 3 influenza antigens; c) Specific antibody response is not significantly affected by treatment, age, IgG levels, or disease activity.

Objetivo. Determinar la seguridad, la respuesta de anticuerpo y el aumento de autoanticuerpos preexistentes en pacientes con lupus después de la vacunación contra influenza. Métodos. Dieciocho mujeres con LES recibieron vacuna contra influenza inactivada. Se determinaron los títulos de anticuerpos antiinfluenza (prueba de inhibición de la hemaglutinación) antes y a las cuatro semanas después de la vacunación. Antes, a las cuatro y ocho semanas se midieron la actividad de la enfermedad y autoanticuerpos antinucleares. Resultados. Después de la vacunación, el porcentaje de pacientes con LES con títulos de anticuerpos antihemaglutinina aumentaron significativamente pero fueron bajos comparado con las mujeres sanas. La media de títulos de anticuerpos antiinfluenza aumentó significativamente a las cuatro semanas, pero fue más bajo que en los controles. La media de la actividad de la enfermedad y de anticuerpos antiDNA disminuyó significativamente. Los efectos colaterales fueron leves. Conclusiones. a) La vacuna contra influenza es segura; b) La respuesta de anticuerpos después de la vacunación aumenta significativamente; c) No hay correlación significativa entre la respuesta de anticuerpo con la edad, tratamiento, niveles de IgG o con la actividad de la enfermedad.