ABSTRACT
AIM: The soluble scavenger receptor differentiation antigen 163 (sCD163), a monocyte/macrophage activation marker, is related to cardiovascular mortality in the general population. This study aimed to evaluate their relationship between serum levels of sCD163 with cardiovascular risk indicators in rheumatoid arthritis (RA). METHODS: A cross-sectional study was performed on 80 women diagnosed with RA. The cardiovascular risks were determined using the lipid profile, metabolic syndrome, and QRISK3 calculator. For the assessment of RA activity, we evaluated the DAS28 with erythrocyte sedimentation rate (DAS28-ESR). The serum levels of sCD163 were determined by the ELISA method. Logistic regression models and receiver operating characteristics (ROC) curve were used to assess the association and predictive value of sCD163 with cardiovascular risk in RA patients. RESULTS: Levels of sCD163 were significantly higher in RA patients with high sensitivity protein C-reactive to HDL-c ratio (CHR)≥0.121 (p=0.003), total cholesterol/HDL-c ratio>7% (p=0.004), LDL-c/HDL-c ratio>3% (p=0.035), atherogenic index of plasma>0.21 (p=0.004), cardiometabolic index (CMI)≥1.70 (p=0.005), and high DAS28-ESR (p=0.004). In multivariate analysis, levels of sCD163≥1107.3ng/mL were associated with CHR≥0.121 (OR=3.43, p=0.020), CMI≥1.70 (OR=4.25, p=0.005), total cholesterol/HDL-c ratio>7% (OR=6.63, p=0.044), as well as with DAS28-ESR>3.2 (OR=8.10, p=0.008). Moreover, levels of sCD163 predicted CHR≥0.121 (AUC=0.701), cholesterol total/HDL ratio>7% (AUC=0.764), and DAS28-ESR>3.2 (AUC=0.720). CONCLUSION: Serum levels of sCD163 could be considered a surrogate of cardiovascular risk and clinical activity in RA.
ABSTRACT
Rheumatoid Arthritis (RA) is a multifactorial autoimmune disease. Currently, several genes play an important role in the development of the disease. The objective was to evaluate the association of the STAT4 rs7574865 and rs897200 gene variants with RA susceptibility, DAS28, RF, and anti-CCP in Western and Southern Mexico populations. Genotyping was performed on 476 samples (cases = 240; controls = 236) using the Taqman® system and qPCR probes. Disease activity was assessed using DAS28 and HAQ DI. CRP, ESR, RF, and anti-CCP were determined for clinical assessment. Our study showed there is a statistically significant association with susceptibility to RA for the rs7574865 variant in the Western population for the GT and TT genotypes. The same genotypes also showed a moderate-to-high activity according to DAS28 and positive anti-CCP compared to the control group. This association was not found in the Southern population. This work confirms the association of the rs7574865 variant with RA, as well as a moderate-to-high activity and positive anti-CCP in the Western population but not in the Southern population. No association of the rs897200 variant was found in any of the studied populations.
Subject(s)
Anti-Citrullinated Protein Antibodies , Arthritis, Rheumatoid , Humans , Mexico , Genetic Predisposition to Disease , Polymorphism, Single Nucleotide/genetics , Arthritis, Rheumatoid/genetics , STAT4 Transcription Factor/geneticsABSTRACT
Se evaluó la relevancia clínica de analizar conjuntamente dos nuevos autoanticuerpos (anti-vimentina citrulinada mutada: anti-MCV y anti-peptidil arginina desaminasa 4: anti-PAD4) en conjunto con los utilizados clásicamente en el diagnóstico (factor reumatoideo: FR y anticuerpos contra péptidos citrulinados cíclicos de la anti-CCP) en la artritis reumatoidea (AR). Los autoanticuerpos se determinaron mediante ensayos inmunoenzimáticos en suero de 370 pacientes con AR y 200 controles. Se observó que los anticuerpos anti-MCV presentaron la mayor especificidad de todos los analizados (100%), mientras que los anticuerpos anti-PAD4 presentaron la menor sensibilidad (24%) y especificidad (95%). El 4% de los individuos seronegativos a FR y anti-CCP fue seropositivo a anti-MCV o PAD4. Los pacientes triples seropositivos (FR, anti-CCP y anti-MCV) presentaron mayor inflamación sistémica/articular y actividad clínica que los que expresaron otras combinaciones de autoanticuerpos (p<0,001). Por otra parte, los pacientes sólo positivos a FR cursaron con menor inflamación y actividad clínica (p<0,001). En conclusión, la inclusión de los anticuerpos anti-MCV al panel utilizado para el diagnóstico de la AR (FR y anti-CCP) podría mejorar el diagnóstico oportuno de los individuos, principalmente en aquellos pacientes seronegativos a FR y anti-CCP. Por otra parte, existen perfiles de autoanticuerpos asociados a la actividad clínica de los pacientes.
In this paper it was evaluated the clinical relevance of analyzing together two new autoantibodies (anti-mutated citrullinated vimentin: anti-MCV and anti-peptidyl arginine deiminase type 4: anti-PAD4) and those used classically in the diagnosis (rheumatoid factor: RF and antibodies against cyclic citrullinated peptide: anti-CCP) of rheumatoid arthritis (RA). The autoantibodies were examined by immunoenzymatic assays in sera of 370 patients with RA and 200 controls. It was observed that anti-MCV antibodies have the highest level of specificity of all the analyzed (100%), while the anti-PAD4 antibodies have the lowest sensitivity (24%) and specificity (95%). Four percent of the individuals that were seronegative for RF and anti-CCP were seropositive for anti-MCV or PAD4. Triple seropositive patients (RF, anti-CCP, and anti-MCV) have greater systemic/ joint inflammation and clinical activity than those with other combinations of autoantibodies (p<0.001). Patients who are only positive for FR had less inflammation and clinical activity (p<0.001). In conclusion, the inclusion of anti-MCV antibodies into the panel used for the diagnosis of RA (RF and anti-CCP) could improve the early diagnosis of individuals, mainly in patients that were seronegative for RF and anti-CCP. On the other hand, there are profiles of autoantibodies associated with the clinical activity of RA patients.
O objetivo deste estudo foi avaliar a relevância clínica de analisar dois novos autoanticorpos (anti-vimentina citrulinada mutada: anti-MCV e anti-peptidilarginina deiminase 4: anti-PAD4) e os convencionalmente utilizados no diagnóstico (fator reumatóide: FR e anticorpos contra peptídeos citrulinados cíclicos: anti-CCP) da artrite reumatóide (AR). Os autoanticorpos foram avaliados através de ensaios imunoenzimáticos em soro de 370 doentes com AR e 200 controles. Foi observado que os anticorpos anti-MCV apresentaram o maior grau de especificidade de todos os analisados (100%), enquanto que os anticorpos anti-PAD4 apresentaram a menor sensibilidade (24%) e especificidade (95%). Quatro por cento dos indivíduos soronegativos para FR e anti-CCP foram soropositivos para anti-MCV ou PAD4. Os doentes tríplice soropositivos (FR, anti-CCP e anti-MCV) apresentam maior inflamação sistêmica/articular e atividade clínica do que aqueles com outras combinações de autoanticorpos (p<0.001). Os doentes apenas positivos para FR apresentaram menor inflamação e atividade clínica (p<0.001). Em conclusão, a inclusão dos anticorpos anti-MCV para o painel utilizado para o diagnóstico de AR (FR e anti-CCP) poderia melhorar o diagnóstico oportuno dos indivíduos, principalmente daqueles que são soronegativos para FR e anti-CCP. Por outro lado, existem perfis de autoanticorpos associados à atividade clínica de doentes.
Subject(s)
Humans , Arthritis, Rheumatoid , Arthritis, Rheumatoid/complications , Autoantibodies , Autoimmune Diseases , Data Interpretation, StatisticalABSTRACT
Antecedentes. El embarazo en mujeres con enfermedades reumáticas autoinmunes se asocia a diversas complicaciones maternofetales. El desarrollo de guías de práctica clínica con la mejor evidencia científica disponible puede ayudar a homogeneizar la atención en estas pacientes. Objetivos. Proporcionar recomendaciones respecto al control prenatal, el tratamiento y el seguimiento más efectivo de la mujer embarazada con lupus eritematoso (LES), artritis reumatoide (AR) y síndrome por anticuerpos antifosfolípidos (SAF). Metodología. Para la elaboración de las recomendaciones se conformaron grupos nominales de expertos y se realizaron consensos formales, búsqueda sistematizada de la información, elaboración de preguntas clínicas, elaboración y calificación de las recomendaciones, fase de validación interna por pares y validación externa del documento final teniendo en cuenta los criterios de calidad del instrumento AGREE II. Resultados. Los grupos de trabajo contestaron las 37 preguntas relacionadas con la atención maternofetal en LES, AR y SAF, así como de fármacos antirreumáticos durante el embarazo y la lactancia. Las recomendaciones fueron discutidas e integradas en un manuscrito final y se elaboraron los algoritmos correspondientes. En esta primera parte se presentan las recomendaciones para mujeres embarazadas con LES. Conclusiones. La guía mexicana de práctica clínica para la atención del embarazo en mujeres con LES proporciona recomendaciones e integra la mejor evidencia disponible para el tratamiento y el seguimiento de estas pacientes (AU)
Background. Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. Objectives. To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphospholipid antibody syndrome (APS). Methodology. Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and grading of recommendations, internal validation by peers, and external validation of the final document. The quality criteria of the AGREE II instrument were followed. Results. The various panels answered the 37 questions related to maternal and fetal care in SLE, RA, and APS, as well as to the use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. We present the recommendations for pregnant women with SLE in this first part. Conclusions. We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with SLE integrate the best available evidence for the treatment and follow-up of patients with these conditions (AU)
Subject(s)
Adult , Female , Humans , Pregnancy , Rheumatic Diseases/complications , Rheumatic Diseases/diagnosis , Societies, Medical/organization & administration , Societies, Medical/standards , Societies, Medical , Rheumatology/organization & administration , Rheumatology/standards , Rheumatic Diseases/epidemiology , Rheumatic Diseases/prevention & control , Mexico/epidemiology , Prenatal Care/standards , Prenatal Diagnosis , Antiphospholipid Syndrome/complicationsABSTRACT
Antecedentes. El embarazo en mujeres con enfermedades reumáticas autoinmunes se asocia a diversas complicaciones materno-fetales. El desarrollo de guías de práctica clínica con la mejor evidencia científica disponible puede ayudar a homogeneizar la atención en estas pacientes. Objetivos. Proporcionar recomendaciones respecto al control prenatal, el tratamiento y el seguimiento más efectivo de la mujer embarazada con lupus eritematoso sistémico, artritis reumatoide (AR) y síndrome por anticuerpos antifosfolípidos (SAF). Metodología. Para la elaboración de las recomendaciones se conformaron grupos nominales de expertos y se realizaron consensos formales, búsqueda sistematizada de la información, elaboración de preguntas clínicas, elaboración y calificación de las recomendaciones, fase de validación interna por pares y validación externa del documento final teniendo en cuenta los criterios de calidad del instrumento AGREE II. Resultados. Los grupos de trabajo contestaron las 37 preguntas relacionadas con la atención materno-fetal en lupus eritematoso sistémico, AR y SAF, así como de fármacos antirreumáticos durante el embarazo y lactancia. Las recomendaciones fueron discutidas e integradas en un manuscrito final y se elaboraron los algoritmos correspondientes. En esta segunda parte se presentan las recomendaciones para mujeres embarazas con AR, SAF y el uso de fármacos antirreumáticos durante el embarazo y lactancia. Conclusiones. La guía mexicana de práctica clínica para la atención del embarazo en mujeres con AR y SAF integra la mejor evidencia disponible para el tratamiento y el seguimiento de estas pacientes (AU)
Background. Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. Objectives. To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus, rheumatoid arthritis (RA) and antiphospholipid syndrome (APS). Methodology. Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and staging of recommendations, internal validation by peers and external validation of the final document. The quality criteria of the AGREE II instrument were followed. Results. The panels answered 37 questions related to maternal and fetal care in lupus erythematosus, RA and APS, as well as for use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. In this second part, the recommendations for pregnant women with RA, APS and the use of antirheumatic drugs during pregnancy and lactation are presented. Conclusions. We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with RA and APS integrate the best available evidence for the treatment and follow-up of patients with these conditions (AU)
Subject(s)
Female , Humans , Male , Autoimmune Diseases/complications , Evidence-Based Practice/methods , Antibodies, Antiphospholipid/therapeutic use , Antirheumatic Agents/therapeutic use , Pregnancy Complications/epidemiology , Arthritis, Rheumatoid/epidemiology , Arthritis, Rheumatoid/prevention & control , Prenatal Diagnosis/methods , Follow-Up Studies , Antiphospholipid Syndrome/epidemiology , Antiphospholipid Syndrome/prevention & control , Postpartum Period , Breast Feeding/trendsABSTRACT
The elbow patients herein discussed feature common soft tissue conditions such as tennis elbow, golfers elbow and olecranon bursitis. Relevant anatomical structures for these conditions can easily be identified and demonstrated by cross examination by instructors and participants. Patients usually present rotator cuff tendinopathy, frozen shoulder, axillary neuropathy and suprascapular neuropathy. The structures involved in tendinopathy and frozen shoulder can be easily identified and demonstrated under normal conditions. The axillary and the suprascapular nerves have surface landmarks but cannot be palpated. In neuropathy however, physical findings in both neuropathies are pathognomonic and will be discussed (AU)
Se consideran ciertas patologías de los tejidos blandos del codo y del hombro. El codo de tenista, el codo de golfista y la bursitis olecraniana afectan estructuras anatómicas fácilmente identificables y demostrables en el examen cruzado de instructores y participantes. Los temas de hombro incluyen la tendinopatía del manguito rotador, el hombro congelado, la neuropatía del nervio axilar y la neuropatía del nervio supraescapular. En las tendinopatías y el hombro congelado la anatomía relevante es fácilmente identificable y demostrable. No así en las neuropatías que carecen de reparos anatómicos aunque son fácilmente demostrables por los déficits que causan en el examen de pacientes afectados. Este conjunto de estructuras se analiza desde un punto de vista anatómico general (AU)
Subject(s)
Humans , Elbow Joint/anatomy & histology , Musculoskeletal Diseases/diagnosis , Shoulder Joint/anatomy & histology , Upper Extremity/anatomy & histology , Adrenal Cortex Hormones/therapeutic use , Diagnosis, Differential , Injections, Intra-Articular , Musculoskeletal Diseases/drug therapy , Peripheral Nervous System Diseases/diagnosis , Physical Examination , Tennis Elbow/diagnosisABSTRACT
This paper emphasizes the anatomical substrate of several foot conditions that are seldom discussed in this context. These include the insertional and non-insertional Achilles tendinopathies, plantar fasciopathy, inferior and posterior heel spurs, foot compartment syndromes, intermetatarsal bursitis and Morton's neuroma. It is a rather superficial anatomical review of an organ that remains largely neglected by rheumatologists. It is our hope that the cases discussed and the cross examination by instructors and participants will stimulate study of the foot and the attention it deserves (AU)
Este artículo enfatiza las estructuras anatómicas que sirven de sustrato a entidades clínicas como la tendinopatía no insercional e insercional del tendón de Aquiles, la fasciopatía plantar, los espolones calcáneos, los síndromes compartamentales del pie, las bursitis intermetatarsianas y el neuroma de Morton. Es un recorrido superficial por una zona que alberga abismos, ya que no podemos designar de otra manera el desconocimiento que muchos reumatólogos tenemos acerca del pie. Es nuestro deseo que este resumen y las demostraciones cruzadas de los elementos anatómicos accesibles sirvan para estimular el estudio profundo del pie por nuestros colegas (AU)
Subject(s)
Humans , Ankle Joint/anatomy & histology , Foot/anatomy & histology , Musculoskeletal Diseases/diagnosis , Diagnosis, Differential , Physical ExaminationABSTRACT
This article reviews the underlying anatomy of trigger finger and thumb (fibrous digital pulleys, sesamoid bones), flexor tenosynovitis, de Quervain's syndrome, Dupuytren's contracture, some hand deformities in rheumatoid arthritis, the carpal tunnel syndrome and the ulnar nerve compression at Guyon's canal. Some important syndromes and structures have not been included but such are the nature of these seminars. Rather than being complete, we aim at creating a system in which clinical cases are used to highlight the pertinent anatomy and, in the most important part of the seminar, these pertinent items are demonstrated by cross examination of participants and teachers. Self learning is critical for generating interest and expanding knowledge of clinical anatomy. Just look at your own hand in various positions, move it, feel it, feel also your forearms while you move the fingers, do this repeatedly and inquisitively and after a few tries you will have developed not only a taste, but also a lifelong interest in clinical anatomy (AU)
En este artículo revisa la anatomía subyacente en el dedo en gatillo y el pulgar en gatillo (poleas digitales fibrosas, huesos sesamoideos), tenosinovitis flexora, síndrome de De Quervain, contractura de Dupuytren, algunas deformidades de la mano en la artritis reumatoide, el síndrome del túnel carpiano y la compresión del nervio cubital en el canal de Guyon. Debido a la naturaleza de estos seminarios, no se han incluido algunos síndromes importantes y estructuras. Más que ser exhaustivos, nuestro objetivo es crear un sistema en el que los casos clínicos se utilizan para resaltar la anatomía pertinente y, en la parte más importante del seminario, estos elementos se muestran a partir de una examen cruzado entre participantes y profesores. El autoaprendizaje es fundamental para generar interés y ampliar el conocimiento de la anatomía clínica. Basta con mirarse las propias manos en distintas posturas, moverlas, sentirlas; sientan también el antebrazo mientras mueven los dedos, háganlo varias veces, con espiritu de indagación, y tras unos pocos intentos no solo habrán adquirido un gusto, sino un interés por la anatomía clínica (AU)
Subject(s)
Humans , Hand/anatomy & histology , Musculoskeletal Diseases/diagnosis , Diagnosis, Differential , Physical ExaminationABSTRACT
The contents of this review may appear odd. After a brief description of the coxofemoral joint, the entities discussed include ilioinguinal neuropathy within the context of the nerves that may be damaged during lower abdominal surgery, meralgia paresthetica, piriformis syndrome with the appropriate caveats, trochanteric syndrome, "ischial bursitis" and trochanteric syndrome caused by ischemia. These cases were chosen to stress our belief that rheumatologists are first and foremost internists. We further believe that being current in other pathologies such as peripheral neuropathies and certain vascular syndromes sooner or later benefits our patients (AU)
Este texto sobre pelvis y cadera pudiera causar sorpresa. Después de algunas consideraciones acerca de la articulación coxofemoral, se discuten, en sus aspectos anatómicos, la neuropatía ilioinguinal en el contexto de los nervios expuestos a daño iatrogénico, la meralgia parestésica, el síndrome del músculo piriforme con las reservas del caso, el síndrome trocantérico, la "bursitis isquiática", y un caso de pseudosíndrome trocantérico por oclusión arterial. Elegimos estos casos para enfatizar que antes de ser reumatólogos fuimos internistas y que no debemos perder una visión integral de nuestros pacientes. Estamos convencidos de que los reumatólogos, además de poseer conocimientos de medicina interna y del sistema musculoesquelético, deben estar informados acerca de otras patologías que entran en el diagnóstico diferencial del dolor regional (AU)
Subject(s)
Humans , Hip Joint/anatomy & histology , Musculoskeletal Diseases/diagnosis , Pelvic Bones/anatomy & histology , Peripheral Nervous System Diseases/diagnosis , Diagnosis, Differential , Physical ExaminationABSTRACT
The clinical anatomy of several pain syndromes of the knee is herein discussed. These include the iliotibial tract syndrome, the anserine syndrome, bursitis of the medial collateral ligament, Baker's cyst, popliteus tendon tenosynovitis and bursitis of the deep infrapatellar bursa. These syndromes are reviewed in terms of the structures involved and their role in knee physiology. All of the discussed structures can be identified in their normal state and more so when they are affected by disease. The wealth of information gained by cross examination of the medial, lateral, posterior and anterior aspects of the knee brings to life knowledge acquired at the dissection table, from anatomical drawings and from virtual images (AU)
En este artículo se revisa la anatomía clínica de varios síndromes dolorosos de la rodilla. Estos incluyen el síndrome de la bandeleta iliotibial, el síndrome de la pata de ganso, la bursitis del ligamento colateral medial, el quiste de Baker, la tenosinovitis poplítea y la bursitis infrapatelar profunda. El análisis anatómico de estos síndromes revela una multiplicidad de estructuras identificables en su estado normal y más aún en las tendinosis o cuando hay un derrame sinovial. El examen cruzado de las estructuras mediales, laterales, posteriores y anteriores de la rodilla provee aspectos dinámicos que complementan su estudio por disección, láminas anatómicas e imágenes virtuales (AU)