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2.
Reumatismo ; 64(2): 113-21, 2012 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-22690388

RESUMEN

The traditional management of psoriatic arthritis (PsA) includes NSAIDs, corticosteroids and DMARDs. Advancement in the knowledge of the immunopathogenesis of PsA has been associated with the development of biologic agents which have revolutionized the management of the disease. Among biologics drugs, there are the 4 currently available anti-TNFα blocking agents (etanercept, infliximab, adalimumab and golimumab) which are more effective than traditional DMARDs on symptoms/signs of inflammation, quality of life, function, and in inhibiting the progression of the structural joint damage. Despite of the high cost, TNF inhibitors are cost-effective on both the musculoskeletal and skin manifestations of psoriatic disease.


Asunto(s)
Artritis Psoriásica/tratamiento farmacológico , Factores Biológicos/uso terapéutico , Adalimumab , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Artritis Psoriásica/economía , Artritis Psoriásica/terapia , Factores Biológicos/economía , Ensayos Clínicos como Asunto , Etanercept , Humanos , Inmunoglobulina G/uso terapéutico , Infliximab , Interleucinas/antagonistas & inhibidores , Depleción Linfocítica , Guías de Práctica Clínica como Asunto , Ligando RANK/antagonistas & inhibidores , Receptor Activador del Factor Nuclear kappa-B/antagonistas & inhibidores , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores
3.
Clin Exp Rheumatol ; 27(4 Suppl 55): S50-5, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19822046

RESUMEN

Enthesitis is a distinctive pathological feature of spondyloarthritis and may involve synovial joints, fibrocartilaginous joints, syndesmoses and extra-articular entheses. Extra-articular pain may often be present in rheumatoid arthritis patients. This review focuses on peripheral enthesitis which is a clinical hallmark of spondylarthritis, by comparing the same findings in rheumatoid arthritis.


Asunto(s)
Artritis Reumatoide/patología , Cápsula Articular/patología , Espondilitis Anquilosante/patología , Artritis Reumatoide/complicaciones , Artrografía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Espondilitis Anquilosante/complicaciones , Ultrasonografía Doppler
4.
Rheumatol Int ; 29(6): 711-2, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19002688

RESUMEN

In this article we describe a gouty caucasian male patient who had high levels of serum uric acid since 1970s. Serious adverse reactions to allopurinol discouraged its administration. We prescribed cyproterone acetate (CA) because of severe prostatic hypertrophy, associated with a suspect small cancer. The administration of this drug obtained persistent normalization of serum uric acid levels. Our observation, that needs to be confirmed in other cases, could suggest a possible new treatment for gout in male patients with prostatic disorders.


Asunto(s)
Antagonistas de Andrógenos/administración & dosificación , Acetato de Ciproterona/administración & dosificación , Gota/tratamiento farmacológico , Enfermedades de la Próstata/complicaciones , Ácido Úrico/sangre , Anciano de 80 o más Años , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Estudios de Seguimiento , Humanos , Masculino , Factores de Tiempo , Resultado del Tratamiento
5.
Clin Exp Rheumatol ; 26(3 Suppl 49): S131-4, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18799070

RESUMEN

Patients with ankylosing spondylitis (AS) may develop cardiovascular manifestations ranging from asymptomatic forms to life threatening conditions. The most important cardiovascular manifestation of AS is aortitis, which frequently involves the aortic root and the ascending aorta leading to valvular insufficiency. The extension of the subaortic fibrotic process into the interventricular septum may cause conduction abnormalities that represent the second common cardiovascular manifestations occurring in AS patients. More rarely, an involvement of coronary arteries and of thoracic and abdominal aorta could be present. Rheumatologists managing AS patients should carefully consider, both in late and in early phases of the disease, the occurrence of an aortic involvement in order to promptly administer adequate treatment.


Asunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Aortitis/etiología , Espondilitis Anquilosante/complicaciones , Aorta/patología , Insuficiencia de la Válvula Aórtica/patología , Ecocardiografía Transesofágica , Humanos
6.
Clin Exp Rheumatol ; 26(1 Suppl 48): S39-47, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18570753

RESUMEN

Chronic hepatitis C virus (HCV) infection is a worldwide public health problem with a global prevalence of 2-3%. It is believed that about 170 million people are currently infected (about 3% of the world's population), and a further 3-4 million are infected each year. HCV is the main reason for liver transplantation in the developed world, and the main cause of liver-related morbidity and mortality in a number of countries, including Italy. It is not only a frequent cause of chronic liver diseases such as hepatitis, cirrhosis and hepatocellular carcinoma, but is also involved in the pathogenesis of various autoimmune and rheumatic disorders (arthritis, vasculitis, sicca syndrome, porphyria cutanea tarda, lichen planus, nephropathies, thyroid diseases, and lung fibrosis), as well as in the development of B-cell lymphoproliferative diseases. Furthermore, patients suffering from C hepatitis tend to produce rheumatoid factor, cryoglobulins and a large series of autoantibodies (ANA, anti-SSA/SSB, SAM, ATG, aCL). The use of glucocorticoids or immuno-suppressant agents in HCV infected individuals, which are needed to treat autoimmune and rheumatic disorders, leads to a risk of worsening the clinical outcome of HCV. Under these conditions, the viral infection often needs to be treated with antiviral agents, mainly pegylated interferon combined with ribavirin. However, cyclosporine A seems to be safe and effective in patients with autoimmune disease (AD) and concomitant chronic HCV infection as is documented by the reduction in viremia and transaminases, particularly in patients with high baseline levels. Finally, HCV is the main trigger of mixed cryoglobulinemia. An attempt at viral eradication is therefore indicated in most patients, and is particularly effective in the case of mild or moderate manifestations. In severe cases, rituximab is an apparently safe and effective alternative to conventional immunosuppression and, specifically, it controls B-cell proliferation.


Asunto(s)
Antivirales/uso terapéutico , Enfermedades Autoinmunes/virología , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/inmunología , Artritis/inmunología , Artritis/virología , Enfermedades Autoinmunes/inmunología , Crioglobulinemia/inmunología , Crioglobulinemia/virología , Hepatitis C Crónica/complicaciones , Humanos
7.
Clin Rheumatol ; 27(1): 101-3, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17943229

RESUMEN

We evaluated the prevalence of hepatitis C virus (HCV) infection in Italian patients suffering from fibromyalgia (FM), in comparison with patients affected by non-HCV related rheumatic degenerative disorders. Consecutive patients with FM and a statistically comparable group of patients suffering from peripheral osteoarthritis (OA) or sciatica due to L4-L5 or L5-S1 herniated disc were tested for HCV infection with a third-generation microparticle enzyme immunoassay (MEIA). In the positive cases, a third-generation recombinant immunoblot assay (RIBA) confirmatory test and serum HCV-RNA test were performed. Fisher's exact test was performed to compare the prevalence of HCV infection (MEIA- and RIBA-positive results) obtained in the two enrolled groups. Enrolled were 152 subjects suffering from FM and 152 patients with peripheral OA or sciatica. Anti-HCV antibodies were found in 7/152 (4.6%) patients suffering from FM and in 5/152 (3.3%) of control subjects. No statistically significant differences in HCV prevalence were detected between cases and controls. Our present report does not confirm previous data indicating an increased prevalence of HCV in FM patients and does not seem to support a significant pathogenetic role of HCV under this condition.


Asunto(s)
Instituciones de Atención Ambulatoria , Fibromialgia/epidemiología , Hepacivirus/aislamiento & purificación , Hepatitis C/epidemiología , Pacientes Ambulatorios , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Fibromialgia/diagnóstico , Fibromialgia/virología , Hepacivirus/inmunología , Hepatitis C/diagnóstico , Hepatitis C/virología , Humanos , Immunoblotting , Técnicas para Inmunoenzimas , Desplazamiento del Disco Intervertebral/epidemiología , Desplazamiento del Disco Intervertebral/virología , Italia/epidemiología , Masculino , Persona de Mediana Edad , Osteoartritis/epidemiología , Osteoartritis/virología , Prevalencia , Estudios Prospectivos , Ciática/epidemiología , Ciática/virología
9.
Rheumatology (Oxford) ; 46(11): 1709-11, 2007 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17938137

RESUMEN

OBJECTIVES: To describe a case-series of patients who presented with the typical postural abnormalities of long-standing advanced ankylosing spondylitis (AS) but were instead found to suffer from diffuse idiopathic skeletal hyperostosis (DISH). METHODS: We enrolled consecutive patients who showed postural abnormalities, which at first suggested to us the diagnosis of long-standing advanced AS, although the diagnostic process led us to the correct diagnosis of DISH. Each patient had a complete physical examination and radiographs of the spine and pelvis, and was investigated for HLA-B27 locus typing. RESULTS: From 15 June 1998 to 15 June 2006, 15 patients with DISH were seen who presented with the typical postural abnormalities of long-standing advanced AS. All patients were males with a median age of 69 yrs (range 51-91). All lacked HLA-B27 and denied personal or family history of spondyloarthritis. All measurements assessing cervical, thoracic and lumbar spinal movement were abnormal. CONCLUSIONS: Patients suffering from DISH can occasionally have severe limitations of spinal mobility, along with postural abnormalities that resemble long-standing advanced AS. Thus, the differential diagnosis between DISH and advanced AS is not limited to the radiological findings and can also extend to the clinical findings in the two diseases, as is highlighted by our report.


Asunto(s)
Hiperostosis Esquelética Difusa Idiopática/diagnóstico , Curvaturas de la Columna Vertebral/etiología , Espondilitis Anquilosante/diagnóstico , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/fisiopatología , Diagnóstico Diferencial , Humanos , Hiperostosis Esquelética Difusa Idiopática/complicaciones , Hiperostosis Esquelética Difusa Idiopática/diagnóstico por imagen , Hiperostosis Esquelética Difusa Idiopática/fisiopatología , Vértebras Lumbares/fisiopatología , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular , Vértebras Torácicas/fisiopatología
10.
Scand J Rheumatol ; 34(2): 155-7, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16095015

RESUMEN

We describe a 28-year-old male patient in whom the development of idiopathic mixed cryoglobulinaemia (MC) with typical clinical manifestations such as polyarthralgia, weakness, purpura, and Raynaud's phenomenon was associated with a remarkable increase in serum triglycerides (TG). Prednisone administration was effective in classical cryoglobulinaemia symptoms and also in dyslipidaemia. Infective, autoimmune, and haematological disorders are often related to cryoglobulinaemia and it has been analysed that some of them also show an increase in TG.


Asunto(s)
Crioglobulinemia/complicaciones , Hepatitis C Crónica , Hipertrigliceridemia/complicaciones , Prednisona/uso terapéutico , Adulto , Artralgia/etiología , Crioglobulinemia/sangre , Crioglobulinemia/tratamiento farmacológico , Humanos , Hipertrigliceridemia/sangre , Hipertrigliceridemia/tratamiento farmacológico , Masculino , Debilidad Muscular/etiología , Púrpura/etiología , Enfermedad de Raynaud/etiología , Resultado del Tratamiento
11.
Clin Rheumatol ; 24(6): 632-3, 2005 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-15902525

RESUMEN

Hereditary angioedema (HAE) is an autosomal dominant disease that causes recurrent attacks of non-pitting edema of soft tissues, without pruritus. This disorder can also affect internal organs. The cause of HAE consists in quantitative or qualitative defective production of C1 inhibitor (C1-INH). Many autoimmune diseases such as systemic lupus erythematosus (SLE) (or SLE-like syndromes), Sjögren's syndrome, scleroderma, thyroiditis, glomerulonephritis, and inflammatory bowel disease have been described in patients suffering from HAE. A concomitance with pure arthritis was previously reported only in two adult patients. Here, we describe for the first time the association between HAE and a non-rheumatoid erosive oligoarthritis involving hips and wrists.


Asunto(s)
Angioedema/genética , Angioedema/patología , Artritis/patología , Angioedema/complicaciones , Antirreumáticos/uso terapéutico , Artritis/complicaciones , Artritis/tratamiento farmacológico , Artroplastia de Reemplazo de Cadera , Femenino , Articulación de la Cadera/patología , Articulación de la Cadera/fisiopatología , Articulación de la Cadera/cirugía , Humanos , Hidroxicloroquina/uso terapéutico , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Inducción de Remisión , Resultado del Tratamiento , Articulación de la Muñeca/patología , Articulación de la Muñeca/fisiopatología , Articulación de la Muñeca/cirugía
13.
Scand J Rheumatol ; 32(5): 309-11, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-14690146

RESUMEN

We describe a 47-year-old male patient suffering from X-linked (or Bruton's) agammaglobulinemia with severe psoriatic arthritis (PsA), which started in childhood. PsA has been previously described in T-cell defective disorders, such as HIV infection, but our observation demonstrates that this rheumatic disease can also occur in subjects with B-lymphocyte cell functional impairment. Chronic inflammatory (bacterial?) involvement of the bowel could represent a pathogenetic connection between X-linked agammaglobulinemia and PsA.


Asunto(s)
Agammaglobulinemia/complicaciones , Agammaglobulinemia/genética , Artritis Psoriásica/complicaciones , Enfermedades Genéticas Ligadas al Cromosoma X/complicaciones , Enfermedades Genéticas Ligadas al Cromosoma X/genética , Adulto , Agammaglobulinemia/patología , Artritis Psoriásica/patología , Enfermedades Genéticas Ligadas al Cromosoma X/patología , Humanos , Masculino
18.
Reumatismo ; 54(2): 105-12, 2002.
Artículo en Italiano | MEDLINE | ID: mdl-12105678

RESUMEN

Reactive Arthritis (ReA) is an aseptic synovitis developing after a primary infection distant from the joint, mainly localized in the gastrointestinal (Enteroarthritis) or genitourinary tract (Uroarthritis). Because of either the asymmetric joint involvement, the possibility of involvement of the spine and enthesis, and the HLA-B27 association ReA is considered one of the spondylarthropathies. Recently, bacterial components or viable bacteria were found in joints during ReA. For this reason, the limits between ReA itself and infectious arthritis are now less definite. Generally accepted diagnostic and classification criteria are still lacking but the improvement in techniques for detection of bacteria increase the possibility to identify the triggering agents. Several studies have examined the role of antimicrobial drugs in ameliorating the natural course of ReA, with some positive results for Uroarthritis only. However, more conventional treatments based on NSAIDs, sulfasalazine and steroids are effective in many cases.


Asunto(s)
Artritis Reactiva/diagnóstico , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Reactiva/tratamiento farmacológico , Artritis Reactiva/etiología , Artritis Reactiva/microbiología , Bacterias/aislamiento & purificación , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Técnicas Bacteriológicas , Diagnóstico Diferencial , Enteritis/complicaciones , Femenino , Enfermedades Urogenitales Femeninas/complicaciones , Predisposición Genética a la Enfermedad , Antígeno HLA-B27/análisis , Humanos , Inmunosupresores/uso terapéutico , Masculino , Enfermedades Urogenitales Masculinas , Prohibitinas
19.
Scand J Rheumatol ; 31(2): 97-9, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12109655

RESUMEN

We describe the cases of two patients with clinical and radiological findings of the reflex sympathetic dystrophy syndrome (RSDS) in whom the history of a previous genito-urinary inflammation and high levels of ESR lead us to suspect a hidden reactive arthritis. However, instrumental examinations showed a characteristic picture of RSDS without evident signs of arthritis. In both patients we decided a treatment with quinolones because of detection of an ureaplasma urealyticum genito-urinary infection. This brought to complete remission of the joint symptoms in a few days. Our findings suggest that ureaplasma urealyticum can cause and sustain a RSDS picture, maybe with a reactive arthritis-like mechanism, and that an antibiogram-driven antimicrobial treatment can be rapidly effective against this disorder.


Asunto(s)
Distrofia Simpática Refleja/microbiología , Infecciones por Ureaplasma/complicaciones , Ureaplasma urealyticum , Adulto , Artritis Reactiva/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad
20.
Aging Clin Exp Res ; 14(1): 64-8, 2002 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-12027156

RESUMEN

The Impact Factor (IF) is one of the most reliable methods for evaluating the quality of scientific journals. To date, no one has studied the IF of geriatric journals over time. Our aims were 1) to evaluate the IF trend of geriatric journals in general, and with respect to internal medicine, which is the nearest discipline, and 2) to assess the proportion of papers on common geriatric topics published in geriatric journals, with respect to other general periodicals. The current literature was studied to define what IF is and describe its good points and deficiencies. We then analyzed the situation regarding geriatric journals. A bibliometric analysis addressed the kind of journal interested in important geriatric themes (syncope, falls, hip fractures, delirium). Geriatric journals have a low IF, but their importance has been growing over the years. Despite this, papers regarding geriatric themes are published mainly in non-specific journals, and the number of publications regarding syncope, falls, hip fractures, and delirium has not increased during the period in question. In conclusion, it is difficult to use the IF for comparisons between different disciplines, in particular when the one under consideration (geriatrics and gerontology) is spread over a wide range of medical fields. The increase in IF of geriatric journals over time is the most important result of our analysis; this finding will encourage geriatric scientists to submit their papers to geriatric periodicals and will increase the specificity of the gerontological discipline.


Asunto(s)
Bibliometría , Geriatría , Publicaciones Periódicas como Asunto/normas , Publicaciones Periódicas como Asunto/tendencias , Anciano , Humanos , Medicina Interna
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