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1.
Brasília; CONITEC; out. 2020.
No convencional en Portugués | BRISA/RedTESA | ID: biblio-1141599

RESUMEN

INTRODUÇÃO: A artrite reativa (ARe) pertence ao grupo das espondiloartrites e é convencionalmente definida como uma artrite que surge após uma infecção extra-articular, geralmente geniturinária ou gastrointestinal. É uma doença relativamente rara que acomete tipicamente adultos jovens. O tratamento da ARe possui diferentes abordagens, e inclui o tratamento da infecção desencadeante e das manifestações musculoesqueléticas. O uso de anti-inflamatórios não esteroidais (AINE) constitui a abordagem inicial do tratamento da doença articular sintomática. De acordo com o Protocolo Clínico e Diretrizes Terapêuticas (PCDT) da Artrite Reativa de 2015, o único AINE disponibilizado para a doença no Sistema Único de Saúde (SUS) é o ibuprofeno. O naproxeno é um AINE não seletivo que possui tradição de uso e histórico de incorporações no SUS para condições musculoesqueléticas (espondilite anquilosante, artrite psoriásica, artrite reumatoide, osteoartrite de joelho e quadril), além de representar uma alternativa mais segura em relação aos eventos cardiovasculares quando comparado a outros AINE. PERGUNTA: O naproxeno é uma opção segura e eficaz para o tratamento da ARe? EVIDÊNCIAS CIENTÍFICAS: Foram realizadas buscas nas bases de dados Medline (via Pubmed) e Embase. Uma revisão sistemática (RS) de avaliação de AINE em espondiloartrites foi elegível. A RS incluiu cinco ensaios clínicos randomizados (ECR) de avaliação do naproxeno, sendo três em comparação a outros AINE (aceclofenaco, butacote, piroxicam) e dois em comparação a outros AINE (celecoxibe, etoricoxibe) e placebo. Os estudos que incluíram a comparação com placebo avaliaram desfechos de eficácia e segurança em pacientes com espondilite anquilosante. Os estudos evidenciaram benefício do naproxeno na melhora da dor, avaliação global do paciente, escore BASDAI e escore BASFI, sem aumento significativo dos eventos adversos, com exceção de um estudo que evidenciou maior taxa de eventos adversos (EA) gastrointestinais. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: a estimativa de custo global anual no cenário base foi de aproximadamente 27 mil reais, com impacto cumulativo em 5 anos de cerca de 138 mil reais. Na análise de sensibilidade, foram observados valores de 42 mil reais no cenário mais otimista, e acima de 516 mil reais no cenário mais pessimista, para o período de 5 anos. A variável de maior impacto nos resultados foi o custo unitário do medicamento. Análise comparativa com ibuprofeno evidencia custo incremental entre R$ 16,38 a R$ 28,35 por paciente tratado com naproxeno. CONSIDERAÇÕES: Não foram identificados estudos de avaliação do naproxeno em ARe e nenhum estudo comparou naproxeno com ibuprofeno, AINE já disponibilizado no SUS. A evidência disponível avalia a eficácia e a segurança do naproxeno em comparação a placebo, em pacientes com espondilite anquilosante, espondiloartrite que acomete preferencialmente a coluna vertebral. Os estudos evidenciam benefício do medicamento, sem comprometimento significativo da segurança. Apesar da escassez de evidências do uso de naproxeno em ARe, seu uso baseia-se na experiência clínica e na evidência de benefício em outras condições musculoesqueléticas, particularmente em outras formas de espondiloatrite. O medicamento possui tradição de uso e histórico de incorporações no SUS para condições semelhantes. RECOMENDAÇÃO PRELIMINAR: Diante do exposto, a Conitec, em sua 88ª reunião ordinária, realizada no dia 08 de julho de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar favorável à incorporação do naproxeno como opção terapêutica da ARe no Sistema Único de Saúde. CONSULTA PÚBLICA: A Consulta Pública nº 43/2020 foi realizada entre os dias 20/08/2020 a 08/09/2020. Foram recebidas 89 contribuições no total, das quais 5 (5,6%) foram pelo formulário para contribuições técnico-científicas e 84 (94,4%) pelo formulário para contribuições sobre experiência ou opinião de pacientes, familiares, amigos ou cuidadores de pacientes, profissionais de saúde ou pessoas interessadas no tema. Das 5 contribuições de cunho técnico-científico, uma era relacionada a outro tema de consulta pública, sendo consideradas na análise somente quatro contribuições. Em relação à recomendação preliminar da Conitec, que foi favorável à ampliação do uso do naproxeno, dois participantes submeteram a contribuição com opinião favorável a recomendação preliminar da comissão. As outras duas contribuições discordaram da recomendação preliminar da Conitec. Foram recebidas 84 contribuições de experiência e opinião, no entanto 37 contribuições possuíam comentários relacionadas a outro tema de consulta pública, não sendo consideradas na análise. Em relação à recomendação preliminar da Conitec, 18 participantes (38%) submeteram a contribuição com opinião favorável a recomendação preliminar da comissão, uma contribuição não concordou e não discordou da recomendação e 28 participantes (59%) discordaram da recomendação preliminar da Conitec. Houve onze relatos sobre a recomendação preliminar, no entanto, nove deles relatavam discordância com relação a não incorporação de uma tecnologia, não sendo o caso da tecnologia avaliada neste relatório. RECOMENDAÇÃO FINAL: Os membros do Plenário presentes na 91ª Reunião Ordinária da Conitec, no dia 07 de outubro de 2020, deliberaram, por unanimidade, recomendar a ampliação de uso do naproxeno para o tratamento de pacientes com Artrite Reativa. Na apreciação da CP, os membros do Plenário entenderam que a maioria das contribuições relatavam discordância em relação a não incorporação de uma tecnologia, não sendo o caso da tecnologia avaliada neste relatório, sendo assim mantiveram a recomendação preliminar. Foi assinado o Registro de Deliberação nº 558/2020. DECISÃO: Ampliar o uso do naproxeno para o tratamento de pacientes com artrite reativa, no âmbito do Sistema Único de Saúde - SUS, conforme Portaria n° 48, publicada no Diário Oficial da União n° 217, seção 1, página 144, em 13 de novembro de 2020.


Asunto(s)
Humanos , Naproxeno/uso terapéutico , Artritis Reactiva/tratamiento farmacológico , Evaluación de la Tecnología Biomédica , Sistema Único de Salud , Brasil , Análisis Costo-Beneficio/economía
2.
RMD Open ; 6(2)2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32763956

RESUMEN

Reactive arthritis (ReA) is typically preceded by sexually transmitted disease or gastrointestinal infection. An association has also been reported with bacterial and viral respiratory infections. Herein, we report the first case of ReA after the he severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This male patient is in his 50s who was admitted with COVID-19 pneumonia. On the second day of admission, SARS-CoV-2 PCR was positive from nasopharyngeal swab specimen. Despite starting standard dose of favipiravir, his respiratory condition deteriorated during hospitalisation. On the fourth hospital day, he developed acute respiratory distress syndrome and was intubated. On day 11, he was successfully extubated, subsequently completing a 14-day course of favipiravir. On day 21, 1 day after starting physical therapy, he developed acute bilateral arthritis in his ankles, with mild enthesitis in his right Achilles tendon, without rash, conjunctivitis, or preceding diarrhoea or urethritis. Arthrocentesis of his left ankle revealed mild inflammatory fluid without monosodium urate or calcium pyrophosphate crystals. Culture of synovial fluid was negative. Plain X-rays of his ankles and feet showed no erosive changes or enthesophytes. Tests for syphilis, HIV, anti-streptolysin O (ASO), Mycoplasma, Chlamydia pneumoniae, antinuclear antibody, rheumatoid factor, anticyclic citrullinated peptide antibody and Human Leukocyte Antigen-B27 (HLA-B27) were negative. Gonococcal and Chlamydia trachomatis urine PCR were also negative. He was diagnosed with ReA. Nonsteroidal Anti-Inflammatory Drug (NSAID)s and intra-articular corticosteroid injection resulted in moderate improvement.


Asunto(s)
Articulación del Tobillo/diagnóstico por imagen , Artritis Reactiva/diagnóstico , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , /terapia , Corticoesteroides/uso terapéutico , Amidas/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Antivirales/uso terapéutico , Artritis Reactiva/tratamiento farmacológico , Artritis Reactiva/etiología , Artrocentesis , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Pirazinas/uso terapéutico , Respiración Artificial , /complicaciones
3.
Keio J Med ; 68(4): 96, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31875623

RESUMEN

A series of our studies on IL-6 have revealed that it has a pleiotropic activity in various tissues and cells and its deregulated expression is responsible for several chronic inflammations and hemopoietic malignancies.Humanized antibody against 80kd IL-6R (Tocilizumab) has shown significant therapeutic effect in RA, JIA, Castleman's diseases and several other autoimmune inflammatory diseases, such as, giant cell arteritis, reactive arthritis, polymyalgia rheumatica and adult still's disease. Cytokine storm induced by CAR-T cell therapy has been shown to be controlled by Tocilizumab.Therapeutic effect of Tocilizumab confirmed that over and constitutive-production of IL-6 is responsible for the pathogenesis of autoimmune diseases.Then, the question to be asked is how is IL-6 production regulated. We identified a novel molecule called Arid5a which binds with the 3'-UTR of IL-6 mRNA and protects its degradation by competing with Regnase-1. Interestingly, this molecule is present in nuclei and inflammatory stimulation induced translocation of Arid5a from nuclei into cytoplasm and it competes with Regnase-1 for the protection of mRNA of IL-6.Our study indicates that Arid5a is one of the key molecules for inflammation as well as the development of septic shock.The results also suggest the therapeutic potential of anti-agonistic agents for Arid5a in the prevention of various inflammatory diseases and septic shock.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Proteínas de Unión al ADN/genética , Factores Inmunológicos/uso terapéutico , Interleucina-6/genética , Receptores de Interleucina-6/genética , Regiones no Traducidas 3' , Anticuerpos Monoclonales Humanizados/biosíntesis , Artritis Reactiva/tratamiento farmacológico , Artritis Reactiva/genética , Artritis Reactiva/inmunología , Artritis Reactiva/patología , Artritis Reumatoide/genética , Artritis Reumatoide/inmunología , Artritis Reumatoide/patología , Enfermedad de Castleman/tratamiento farmacológico , Enfermedad de Castleman/genética , Enfermedad de Castleman/inmunología , Enfermedad de Castleman/patología , Proteínas de Unión al ADN/inmunología , Regulación de la Expresión Génica , Arteritis de Células Gigantes/tratamiento farmacológico , Arteritis de Células Gigantes/genética , Arteritis de Células Gigantes/inmunología , Arteritis de Células Gigantes/patología , Humanos , Factores Inmunológicos/biosíntesis , Interleucina-6/inmunología , Polimialgia Reumática/tratamiento farmacológico , Polimialgia Reumática/genética , Polimialgia Reumática/inmunología , Polimialgia Reumática/patología , Unión Proteica , Proteolisis , Receptores de Interleucina-6/antagonistas & inhibidores , Receptores de Interleucina-6/inmunología , Ribonucleasas/genética , Ribonucleasas/inmunología , Transducción de Señal
4.
Curr Rheumatol Rep ; 21(11): 63, 2019 11 19.
Artículo en Inglés | MEDLINE | ID: mdl-31741118

RESUMEN

PURPOSE OF REVIEW: Recent studies regarding the frequency of Chlamydia-induced reactive arthritis (ReA) are reviewed, with a focus on the question of whether the entity is in fact disappearing or whether it is simply being underdiagnosed/underreported. Epidemiological reports indicate diversity in the frequency of Chlamydia-associated ReA in various parts of the world, with evidence of declining incidence in some regions. RECENT FINDINGS: The hypothesis that early effective treatment with antibiotics prevents the manifestation of Chlamydia-associated ReA requires further investigation. For clinicians, it is important to remember that ReA secondary to Lymphogranuloma venereum (LGV) serovars L1-L3 of C. trachomatis is probably underestimated due to a limited awareness of this condition, the re-emergence in Western countries of LGV overall, and the present increasingly rare classical inguinal presentation.


Asunto(s)
Antibacterianos/uso terapéutico , Artritis Reactiva/epidemiología , Infecciones por Chlamydia/epidemiología , Artritis Reactiva/tratamiento farmacológico , Chlamydia , Infecciones por Chlamydia/tratamiento farmacológico , Humanos , Incidencia , Prevalencia
5.
Medicine (Baltimore) ; 98(40): e17233, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31577714

RESUMEN

RATIONALE: The pathology of gouty arthritis and reactive arthritis (ReA) partially overlaps, and both diseases are characterized by the production of inflammatory cytokines associated with the activation of monocytes and macrophages. However, the precise cytokine profile of cases with a coexistence of both diseases is unknown, and there are few reports on the course of treatment in patients with both gouty arthritis and ReA. PATIENT CONCERNS: A 39-year-old man with a recurrent episode of gouty arthritis presented prednisolone-resistant polyarthritis with high level of C-reactive protein (CRP). He had the features of gouty arthritis such as active synovitis of the first manifestation of metatarsophalangeal (MTP) joints and the presence of monosodium urate (MSU) crystals from synovial fluid. But he also had the features of ReA such as the presence of tenosynovitis in the upper limb, the positivity of human leukocyte antigen (HLA)-B27, a history of sexual contact and positive findings of anti-Chlamydia trachomatis-specific IgA and IgG serum antibodies. DIAGNOSES: He was diagnosed with HLA-B27 associated Chlamydia-induced ReA accompanied by gout flares. INTERVENTIONS: He was treated with 180 mg/day of loxoprofen, 1 mg/day of colchicine, and 10 mg/day of prednisolone for gout flares. However, his polyarthritis worsened with an increased level of CRP (23.16 mg/dL). Accordingly, we added 500 mg/day of salazosulfapyridine followed by adalimumab (ADA) 40 mg once every 2 weeks. OUTCOMES: After starting ADA, the patient's symptoms and laboratory findings showed rapid improvement and he achieved clinical remission 1 month after initiation of ADA treatment. As of this writing, the patient's clinical remission has been maintained for >1 year. LESSONS: This case suggests that with exacerbation of arthritis during gouty arthritis, coexistence with other pathologies such as peripheral spondyloarthritis should be considered, and early intensive treatment including tumor necrosis factor inhibitors may be necessary.


Asunto(s)
Artritis Reactiva/etiología , Infecciones por Chlamydia/complicaciones , Gota/complicaciones , Adulto , Artritis Reactiva/tratamiento farmacológico , Proteína C-Reactiva/análisis , Infecciones por Chlamydia/tratamiento farmacológico , Chlamydia trachomatis , Citocinas/metabolismo , Gota/tratamiento farmacológico , Humanos , Mediadores de Inflamación/metabolismo , Masculino , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores
6.
JAAPA ; 32(7): 25-28, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31169570

RESUMEN

Reactive arthritis, also known as Reiter syndrome, is a spondyloarthropathy that typically follows a urogenital or gastrointestinal infection, and is characterized by conjunctivitis, urethritis, and arthritis. The frequency of reactive arthritis in the United States is estimated at 3.5 to 5 patients per 100,000. Physician assistants (PAs) can manage the condition; therefore, they should be familiar with the disease's signs and symptoms, diagnostic criteria, and treatment regimens. Without proper management, reactive arthritis can progress to a chronic destructive arthritis. Prompt recognition of the condition is key to early intervention and a better patient outcome with fewer complications.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Reactiva/diagnóstico , Artritis Reactiva/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Artritis Reactiva/etiología , Artritis Reactiva/fisiopatología , Conjuntivitis/fisiopatología , Gastroenteritis/complicaciones , Humanos , Inyecciones Intraarticulares , Infecciones del Sistema Genital/complicaciones , Infecciones del Sistema Respiratorio/complicaciones , Uretritis/fisiopatología , Infecciones Urinarias/complicaciones
8.
Clin Exp Rheumatol ; 37(6): 1065-1076, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31140399

RESUMEN

Reactive arthritis is a group of inflammatory joint diseases triggered by a previous infection, often associated with extra-articular features. The clinical course and consequently the treatment are complicated by the variability of the disease evolution in the single patient. In some patients, the disease assumes a chronic and destructing course, requiring the introduction of therapy. However, the role of antibiotic treatment of the triggering infection as well as the role of the currently available disease-modifying anti-rheumatic drugs is still unclear. The better understanding of the infectious agents-host interaction in reactive arthritis pathogenesis opens the possibility of new therapeutic strategies for the disease management. The purpose of this review is to illustrate the recent discoveries about the induction of joint inflammation by the infectious agents, the prognostic factors to better identify patients at risk of chronicity, the current available therapeutic strategies and lastly, the future possibilities of therapeutic approaches to reactive arthritis.


Asunto(s)
Antibacterianos , Antirreumáticos , Artritis Reactiva , Antibacterianos/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Reactiva/tratamiento farmacológico , Humanos
9.
Reumatismo ; 71(1): 46-50, 2019 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-30932444

RESUMEN

Poncet's disease is very important and yet a challenging diagnosis of importance in countries with high TB endemicity (e.g. India). In this case series, we present 5 patients with diagnosed as Poncet's disease and in our tertiary health care center over 12 months and examine the performance of the diagnostic criteria suggested by Sharma and Pinto. The majority (4/5) of the patients were subsequently diagnosed and responded to anti-tuberculous therapy. In the other patient, a diagnosis of atypical seropositive rheumatoid arthritis or Pseudo Poncet's disease was established on follow up.


Asunto(s)
Artritis Reactiva/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Adulto , Artritis Reactiva/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tuberculosis Pulmonar/tratamiento farmacológico
10.
PLoS Negl Trop Dis ; 12(8): e0006634, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-30074983

RESUMEN

Chikungunya virus (CHIKV) is a mosquito-transmitted RNA alphavirus causing major outbreaks of infectious chronic inflammatory rheumatisms (CIR). Recently, methotrexate (MTX), a disease modifying anti-rheumatic drug has been used successfully to treat patients suffering from rheumatoid-like arthritis post-CHIK but its immunomodulatory activity in the context of viral persistence has been a matter of concerns. We herein used a model of primary human synovial fibroblasts (HSF) and the synthetic molecule polyriboinosinic:polyribocytidylic acid (PIC) to mimic chronic infectious settings in the joints of CHIKV infected patients. The innate antiviral immune and inflammatory responses were investigated in response to MTX used at the therapeutic concentration of 1 µM. We found that MTX did not affect cellular viability as indicated by the LDH release assay. By quantitative RT-PCR, we observed that HSF responded robustly to PIC by increasing ISG15 and IFNß mRNA levels. Furthermore, PIC upregulated the mRNA expression of two of the major pattern recognition receptors, RIG-I and MDA5 involved in the innate immune detection of viral RNA. MTX did not impact the antiviral response of PIC on ISG15, IFNß, RIG-I and MDA5 mRNA expressions. MTX alone or combined with PIC did not affect the expression of proinflammatory CCL2 and CXCL8 chemokines. PIC strongly upregulated the mRNA and protein expression of osteoclastogenic factors (IL-6, GM-CSF but not RANKL). Critically, MTX treatment alone or combined with PIC did not affect the expression of all three tested osteoclastogenic cytokines. We found that MTX alone did not increase the capacity of CHIKV to infect and replicate in HSF. In conclusion, our study argues for a beneficial effect of MTX to treat CIR post-CHIKV given that it does not critically impact the antiviral, the proinflammatory and the bone tissue remodeling responses of synovial cells.


Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Reactiva/tratamiento farmacológico , Huesos/efectos de los fármacos , Fiebre Chikungunya/complicaciones , Metotrexato/uso terapéutico , Membrana Sinovial/efectos de los fármacos , Artritis Reactiva/etiología , Huesos/metabolismo , Células Cultivadas , Virus Chikungunya , Citocinas/metabolismo , Regulación de la Expresión Génica/efectos de los fármacos , Humanos , Líquido Sinovial/citología , Membrana Sinovial/inmunología
11.
BMJ Case Rep ; 20182018 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-29666092

RESUMEN

A 33-year-old man presented with new-onset, asymmetric, migratory oligoarthritis in the setting of several weeks of nausea and vomiting, diarrhoea, fevers and dysuria. He was initially treated in the inpatient setting with broad-spectrum antibiotics due to concern for an evolving sepsis presentation. Arthrocentesis of a large right knee effusion revealed inflammatory synovial fluid without findings suggestive of septic arthritis. Human leucocyte antigen B27 was positive and, taken together with the antecedent history of gastroenteritis, dysuria and inflammatory oligoarthritis, the clinical diagnosis was most consistent with reactive arthritis. Antibiotics were discontinued. His treatment course proved refractory to non-steroidal anti-inflammatory drugs and intra-articular and systemic glucocorticoid therapy with concurrent use of sulfasalazine and ultimately necessitated treatment with a tumour necrosis factor alpha inhibitor.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Reactiva/diagnóstico , Enfermedades Gastrointestinales/microbiología , Articulación de la Rodilla/patología , Sepsis/diagnóstico , Líquido Sinovial/microbiología , Adulto , Artritis Reactiva/tratamiento farmacológico , Artritis Reactiva/fisiopatología , Diarrea , Disuria , Fiebre , Enfermedades Gastrointestinales/complicaciones , Glucocorticoides/uso terapéutico , Humanos , Articulación de la Rodilla/microbiología , Masculino , Enfermedades Raras , Sepsis/tratamiento farmacológico , Sepsis/fisiopatología , Sulfasalazina/uso terapéutico , Resultado del Tratamiento , Vómitos
12.
J Infect Chemother ; 24(7): 531-537, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29606414

RESUMEN

Reactive arthritis after Group A streptococcal infection (poststreptococcal reactive arthritis: PSRA) that does not meet the Jones criteria for acute rheumatic fever (ARF) has been reported as a new entity for over a decade. In Japan there are few reports of PSRA. We encountered four children with arthritis accompanied with Group A streptococcal infection in our department. We investigated our cases and the recent Japanese literature. Japanese cases of PSRA are frequently accompanied with uveitis and erythema nodosum, and tonsillectomy resolved their symptoms in some cases. There were overlap cases between ARF, juvenile idiopathic arthritis, and PSRA.


Asunto(s)
Artritis Juvenil/diagnóstico por imagen , Artritis Reactiva/diagnóstico por imagen , Artritis Reactiva/microbiología , Infecciones Estreptocócicas/complicaciones , Adolescente , Antibacterianos/uso terapéutico , Artritis Juvenil/microbiología , Artritis Reactiva/tratamiento farmacológico , Biomarcadores/sangre , Niño , Preescolar , Quimioterapia Combinada , Eritema Nudoso , Femenino , Humanos , Japón , Masculino , Fiebre Reumática/diagnóstico por imagen , Fiebre Reumática/microbiología , Infecciones Estreptocócicas/tratamiento farmacológico , Tonsilectomía , Uveítis
13.
Rev Med Suisse ; 14(597): 534-537, 2018 Mar 07.
Artículo en Francés | MEDLINE | ID: mdl-29512951

RESUMEN

Reactive arthritis is usually regarded as a form of spondylarthritis. Patients generally present with an acute asymmetrical oligoarthritis following an episode of diarrhea or urethritis. The most frequent involved pathogens are Salmonella, Shigella, Campylobacter and Chlamydia trachomatis. Additional causative pathogens have been described. Non-steroidal anti-inflammatory drugs are the first line treatment for reactive arthritis, associated with physiotherapy. Occasionally, a short course of glucocorticoids or an intra-articular injection is needed. Chlamydia induced reactive arthritis should be treated with antibiotics. Some patients experience chronic persistent arthritis. These patients could benefit from a treatment with DMARDs such as sulfasalazine. In refractory cases, TNF-inhibitors are sometimes used.


Asunto(s)
Artritis Reactiva , Infecciones por Chlamydia , Artritis Reactiva/diagnóstico , Artritis Reactiva/tratamiento farmacológico , Artritis Reactiva/microbiología , Infecciones por Chlamydia/complicaciones , Chlamydia trachomatis , Humanos
14.
Joint Bone Spine ; 85(2): 201-205, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-28238883

RESUMEN

OBJECTIVE: Reactive arthritis (ReA) is a sterile arthritis following an extra-articular infection, usually of the gastrointestinal or genitourinary tract. The aim of this study was to assess the incidence and the clinical and therapeutic characteristics of ReA and to compare them with those of a historical cohort. We hypothesised that improved hygiene together with prevention and treatment of sexually transmitted infections may have decreased the incidence of ReA. METHODS: All patients with ReA diagnosed in the University Hospital Centres of Lyon Sud and Besançon from January 2002 to December 2012 were included in the study retrospectively and were compared with ReA patients diagnosed from January 1986 to December 1996 in the same two hospitals. Medical records were reviewed, clinical features, treatments and outcomes were analysed and diagnoses were compared with international diagnostic criteria. RESULTS: Twenty-seven patients were included between 2002 and 2012 compared with 31 between 1986 and 1996. The overall incidence of ReA in patients hospitalised in the rheumatology department did not change, although the current evolution is more severe with development of chronic disease in the form of more frequent spondyloarthritis. While the incidence of Chlamydiae trachomatis has decreased, new microbes are now found to be involved. CONCLUSIONS: ReA still exists and its incidence has been stable over the last 30 years. However, ReA currently more often progress to spondyloarthritis. Our study also highlights the need for diagnostic criteria that accurately detect ReA.


Asunto(s)
Antibacterianos/uso terapéutico , Artritis Reactiva/tratamiento farmacológico , Artritis Reactiva/microbiología , Adulto , Distribución por Edad , Artritis Reactiva/epidemiología , Artritis Reactiva/fisiopatología , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Femenino , Francia , Hospitalización/estadística & datos numéricos , Hospitales Universitarios , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Resultado del Tratamiento , Adulto Joven
18.
BMC Res Notes ; 10(1): 416, 2017 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-28821265

RESUMEN

BACKGROUND: Poncet's disease is a rare syndrome characterized by articular impairment in a form of rare tuberculid. One of the theories of its cause involves an autoimmune response induced by the intravesical administration of the Calmette-Guerin Bacillus or the treatment of bladder carcinoma. Furthermore, there may be an appearance of oligoarticular or polyarticular arthritis, beginning 1-3 months after the start of therapy. Few physicians know the disease and the literature related to that syndrome is scarce and restricted to case reports, which contributes to its under diagnosis. CASE PRESENTATION: Female patient, 64 years old, Caucasian, in whom was noticed firstly dark urine, without haematuria or dysuria. Later felt also colic pain in the hypogastric region. Microscopically, the conclusive diagnosis was a high grade non-invasive papillary urothelial carcinoma. Thereupon, the treatment of the tumour began with transurethral resection technique and intravesical instillation of Calmette-Guérin Bacillus as adjuvant treatment. Eight months after the beginning of treatment, the lingering presence of the carcinoma was identified. Nevertheless, arthritis was identified through radiographs, after an increase in the clavicle capitation, right knee and left ankle in bone scintigraphy. Coinciding with the joint manifestations, the patient developed fever and purulent urethral discharge (culture was negative). Therefore, trying to investigate the cause of the arthritis, Purified Protein Derivate was taken, with reactive results. An increase of acute phase reactants was found, with other tests resulting normal: blood chemistry, Complete Blood Count, immunology and serology. Human Leukocyte Antigen typing by polymerase chain reaction revealed the presence of A24/AX, B44, B27, BW4/BW4, DQ7 and DQ5. Consequently, Poncet's disease was the diagnostic conclusion. The treatment with intravesical Calmette-Guérin Bacillus was immediately discontinued. The patient received corticosteroids associated with etoricoxib and isoniazid for 4 months, achieving disappearance of the inflammatory joint signs in 3 months. After 6 months, no joint pain recurrence or other manifestations suggesting active disease had been seen. CONCLUSIONS: Therefore, such diagnosis should be considered when confronted with an osteoarticular clinical picture in patients treated with intravesical Calmette-Guérin Bacillus, especially patients with HLA-B27 (+) and B7 (+), as Poncet's disease is a reactive arthritis.


Asunto(s)
Adyuvantes Inmunológicos/efectos adversos , Artritis Reactiva/tratamiento farmacológico , Carcinoma Papilar/diagnóstico , Tuberculosis/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/diagnóstico , Adyuvantes Inmunológicos/administración & dosificación , Administración Intravesical , Corticoesteroides/uso terapéutico , Artritis Reactiva/inducido químicamente , Artritis Reactiva/diagnóstico , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía , Etoricoxib , Femenino , Humanos , Isoniazida/uso terapéutico , Persona de Mediana Edad , Mycobacterium bovis/química , Mycobacterium bovis/inmunología , Piridinas/uso terapéutico , Sulfonas/uso terapéutico , Resultado del Tratamiento , Tuberculosis/inducido químicamente , Tuberculosis/diagnóstico , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugía
19.
BMJ Case Rep ; 20172017 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-28687682

RESUMEN

A previously healthy 48-year-old man presented with a 1-week history of migrating polyarthropathy preceded by a viral illness, dysuria and bilateral red eyes. Ocular examination revealed anterior and interstitial stromal keratitis. He was systemically well but had raised erythrocyte sedimentation rate and C reactive protein and was positive for human leucocyte antigen B27 on extensive infective, rheumatological and autoimmune investigations. Although the exact triggering pathogen was not identified, clinical findings were consistent with reactive arthritis. Bilateral interstitial keratitis is a rare manifestation of reactive arthritis which, along with the anterior stromal keratitis, responded well to topical prednisolone sodium phosphate 0.5%. Systemic joint symptoms improved on oral sulfasalazine, non-steroid anti-inflammatory agent and low-dose prednisolone.


Asunto(s)
Artritis Reactiva/complicaciones , Queratitis/complicaciones , Queratitis/diagnóstico , Administración Tópica , Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Reactiva/tratamiento farmacológico , Artritis Reactiva/inmunología , Sustancia Propia/patología , Diagnóstico Diferencial , Glucocorticoides/uso terapéutico , Humanos , Queratitis/tratamiento farmacológico , Queratitis/patología , Masculino , Persona de Mediana Edad , Prednisolona/administración & dosificación , Prednisolona/análogos & derivados , Prednisolona/uso terapéutico , Enfermedades Raras , Sulfasalazina/administración & dosificación , Sulfasalazina/uso terapéutico , Resultado del Tratamiento
20.
BMC Res Notes ; 10(1): 203, 2017 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-28606166

RESUMEN

BACKGROUND: Poncet's disease is a rare reactive polyarthritis associated with active tuberculosis and no evidence of Mycobacterium tuberculosis in the affected joint. CASE PRESENTATION: We report a case of a 35 year old Human Immunodeficiency Virus positive Kenyan male of Kikuyu ethnicity from Kiambu County who presented to hospital with a 6 day history of bilateral knee pain and swelling, bilateral ankle pain with right ankle swelling. The patient reported 6 months history of cough and weight loss. Chest radiograph had features consistent with pulmonary tuberculosis and sputum smear was positive for acid fast bacilli. Analysis of fluid from knee effusion showed no evidence of tuberculosis. Resolution of joint swelling was seen after 3 weeks of tuberculosis chemotherapy suggesting that this was reactive arthritis following pulmonary tuberculosis in a patient infected with human immunodeficiency virus. CONCLUSION: This case represents a rare manifestation of tuberculosis presenting as a reactive arthritis. There are very few cases of Poncet's disease reported in literature and the diagnosis of Poncet's disease in Human Immunodeficiency Virus/tuberculosis coinfected patient is extremely uncommon. This case report has been presented to raise awareness of this unusual tuberculosis complication and review its diagnosis and treatment.


Asunto(s)
Artritis Reactiva/etiología , Infecciones por VIH/complicaciones , Tuberculosis Pulmonar/complicaciones , Adulto , Antibióticos Antituberculosos/uso terapéutico , Terapia Antirretroviral Altamente Activa , Artritis Reactiva/tratamiento farmacológico , Etambutol/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Humanos , Isoniazida/uso terapéutico , Masculino , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Tomografía Computarizada por Rayos X , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/tratamiento farmacológico
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