Cardiovascular and disease-related features associated with extra-articular manifestations in axial spondyloarthritis. A multicenter study of 888 patients.

OBJECTIVES: To determine the potential impact of extra-articular manifestations (EAMs) on disease characteristics and cardiovascular (CV) risk in patients with axial spondylarthritis (axSpA). METHODS: This is a cross-sectional study from the AtheSpAin cohort, a Spanish multicenter cohort to study atherosclerosis in axSpA. Data on the history of CV events, subclinical carotid atherosclerosis, and disease-related features, including EAMs, were collected. RESULTS: 888 axSpA patients were recruited. Concomitant acute anterior uveitis (AAU), psoriasis (PSO), and inflammatory bowel disease (IBD) were present in 177 (19.9%), 96 (10.8%), and 57 (6.4%) patients, respectively. When compared with axSpA patients without EAMs, a significant increase in past CV events was observed in patients with PSO (9% versus 4%, p = 0.048) and in those with at least one EAM (7% versus 4%, p = 0.032) or with more than one EAM (11% versus 4%, p = 0.022). The frequency of carotid plaques and the values of cIMT were higher in patients with EAMs than in those without EAMs, although only the univariable analysis for carotid plaques in patients with PSO (39% versus 30%, p = 0.038) and for cIMT in patients with AAU (665 ± 156 µm versus 637 ± 139 µm, p = 0.042) and those with at least one EAM (661 ± 155 µm versus 637 ± 139 µm, p = 0.024) showed significant results. In addition, patients with PSO or IBD were found to have specific disease-related features, such as higher ESR at diagnosis, and more frequent use of glucocorticoids and TNF inhibitors than those without EAMs. Also, PSO patients had more commonly peripheral involvement and those with AAU more severe radiographic damage than those without EAMs. The frequency of HLA B27 was higher in patients with AAU and lower in those with PSO or IBD compared to those without EAMs. CONCLUSION: Patients with axSpA and EAMs, in addition to displaying their own disease-related features, are likely to have an increased CV risk that appears proportional to the number of EAMs and could be related to proatherogenic factors other than traditional CV risk factors, such as the inflammatory load and the use of glucocorticoids.

Intravenous methylprednisolone induces rapid improvement in non-infectious uveitis: a multicentre study of 112 patients.

OBJECTIVES: Rapid control of intraocular inflammation in non-infectious uveitis (NIU) is mandatory to avoid irreversible structural and functional damage. In this study, we assessed the efficacy and safety of intravenous methylprednisolone (IVMP) pulses in the treatment of NIU. METHODS: A retrospective case series of 112 patients who received IVMP for the treatment of NIU, either isolated or associated with different underlying diseases, was studied. Intraocular inflammation (anterior chamber cells and vitritis) was the primary outcome measure. Secondary outcome measures were macular thickness and best corrected visual acuity (BCVA). Patients were assessed at baseline visit, and at days 2-5, 7, 15 and 30 after initiation of IVMP pulse therapy. RESULTS: A total of 112 patients (mean age 42±14.5 yrs) were assessed. An underlying immune-mediated disease was diagnosed in 73 patients. Inflammatory ocular patterns were panuveitis (n=68), posterior uveitis (n=30), anterior uveitis (AU) (n=12), and intermediate uveitis (n=2). Additionally, patients presented cystoid macular oedema (CME) (n=50), retinal vasculitis (n=37), and exudative retinal detachment (n=31). Therapies used before IVMP included intraocular glucocorticoids (n=4), high-dose oral systemic glucocorticoids (n=77), and conventional (n=107) or biologic (n=40) immunosuppressive drugs. IVMP dose ranged from 80 to 1,000 mg/day for 3-5 consecutive days. Improvement was observed in AU, vitritis, BCVA, CME, and retinal vasculitis. At first month evaluation, total remission was achieved in 19 patients. Side effects of IVMP were respiratory infections (n=3), uncontrolled hyperglycaemia (n=1), herpes zoster (n=1), and oral candidiasis (n=1). CONCLUSIONS: IVMP pulse therapy was effective and safe, and achieved rapid control of NIU.

Melioidosis importada desde Colombia a España / Melioidosis imported from Colombia to Spain

No disponible

Avances en el diagnóstico de las vasculitis de vasos de gran calibre: identificación de biomarcadores y estudios de imagen / Advances in the diagnosis of large vessel vasculitis: identification of biomarkers and imaging studies

Dependiendo de la región geográfica y del grupo de edad afectado, las vasculitis de vaso grande (VVG) constituyen uno de los tipos de vasculitis sistémicas más frecuentes. Mientras que la arteritis de células gigantes (ACG) ocurre de forma exclusiva en individuos de edad avanzada y es más frecuente en países con ascendencia europea, la arteritis de Takayasu (AT) afecta fundamentalmente a mujeres jóvenes de países orientales. El diagnóstico de estas enfermedades se ha basado, además de los criterios clínicos, en los hallazgos histológicos característicos en la biopsia de arteria temporal (BAT) en el caso de la ACG, y en los resultados de la angiografía en la AT. Durante los últimos años, ningún nuevo biomarcador ha conseguido desplazar a los reactantes de fase aguda tradicionales (VSG y PCR) en el diagnóstico y monitorización de las VVG. Únicamente la interleucina-6 circulante se ha mostrado como más sensible que los marcadores de actividad clásicos, pero su uso está limitado por la falta de disponibilidad de su determinación de forma rutinaria. Por otra parte, las técnicas de imagen juegan un papel creciente en el diagnóstico y seguimiento de las VVG. La utilización en los últimos años de técnicas no invasivas, como la resonancia magnética, la ecografía Doppler, la tomografía por emisión de positrones y la tomografía computarizada han ayudado a mejorar el conocimiento de estas patologías, aunque se discute tanto su sensibilidad y especificidad diagnóstica frente a la BAT y la angiografía, como su valor para el seguimiento de los pacientes afectados por este tipo de VVG (AU)

Depending on the geographic area and the affected age group, large vessel vasculitis (LVV) are one of the most frequent types of systemic vasculitidies. Whereas giant cell arteritis (GCA) occurs exclusively in elderly individuals and is more frequent in countries with European ancestry, Takayasuıs arteritis (TA) mainly affects young women from eastern countries. The diagnosis of these disorders has been based on the characteristic clinical picture, together with the typical histopathological features in the temporal artery of patients with GCA, and the angiography results in TA patients. During the last few years, no new biomarkers have substituted the traditional ones (ESR and CRP) in the diagnosis and monitoring of disease activity in LVV. Only the levels of circulating IL-6 have demonstrated a higher sensitivity compared with the classic acute phase reactants, but its utility is limited due to its lack of inclusion as a routine technique. On the other hand, imaging techniques play a relevant role in the diagnosis and follow-up of patients with LVV. The use of new non-invasive techniques such as MRI, Doppler ultrasound, PET scan or CT has helped to improve the understanding of these disorders, although the sensitivity and specificity of these new imaging techniques compared with the classic temporal artery biopsy or angiography for diagnosis and follow-up remains to be established (AU)

[Advances in the diagnosis of large vessel vasculitis: identification of biomarkers and imaging studies]. / Avances en el diagnóstico de las vasculitis de vasos de gran calibre: identificación de biomarcadores y estudios de imagen.

Depending on the geographic area and the affected age group, large vessel vasculitis (LVV) are one of the most frequent types of systemic vasculitidies. Whereas giant cell arteritis (GCA) occurs exclusively in elderly individuals and is more frequent in countries with European ancestry, Takayasús arteritis (TA) mainly affects young women from eastern countries. The diagnosis of these disorders has been based on the characteristic clinical picture, together with the typical histopathological features in the temporal artery of patients with GCA, and the angiography results in TA patients. During the last few years, no new biomarkers have substituted the traditional ones (ESR and CRP) in the diagnosis and monitoring of disease activity in LVV. Only the levels of circulating IL-6 have demonstrated a higher sensitivity compared with the classic acute phase reactants, but its utility is limited due to its lack of inclusion as a routine technique. On the other hand, imaging techniques play a relevant role in the diagnosis and follow-up of patients with LVV. The use of new non-invasive techniques such as MRI, Doppler ultrasound, PET scan or CT has helped to improve the understanding of these disorders, although the sensitivity and specificity of these new imaging techniques compared with the classic temporal artery biopsy or angiography for diagnosis and follow-up remains to be established.

La inhibición de la interleucina-6, una nueva opción terapéutica en la artritis reumatoide / Inhibition of interleukin 6, a new therapeutic option in rheumatoid arthritis

Tocilizumab (TCZ) es un anticuerpo monoclonal humanizado dirigido contra el receptor de la interleucina-6 (IL-6) desarrollado entre la farmacéutica japonesa Chugai y la suiza Roche. En Japón tiene ya indicación para la enfermedad de Castleman, artritis reumatoide (AR) y artritis idiopática juvenil. El desarrollo clínico fuera de Japón es muy extenso y ha demostrado eficacia en los escenarios posibles de la AR, AR precoz (parte del estudio AMBITION), AR establecida refractaria a metotrexato (OPTION) y a otros fármacos modificadores de enfermedad (TOWARD) y AR refractaria a anti-TNF-alfa (RADIATE), tanto con TCZ en monoterapia (estudio AMBITION) como asociado a fármacos de fondo. También se ha comprobado la eficacia radiológica (LITHE). En consecuencia el TCZ es probablemente el fármaco biológico con el desarrollo clínico más extenso habiéndose aprobado su comercialización por la agencia europea del medicamento con las siguientes indicaciones: TCZ en combinación con MTX está indicado para el tratamiento de la AR activa de moderada a grave en pacientes adultos que han presentado una respuesta inadecuada o fueron intolerantes a terapia previa con uno ó más FAMEs o antagonistas del TNF. En estos pacientes TCZ puede ser administrado en monoterapia, en caso de intolerancia a MTX, o cuando el tratamiento prolongado con MTX es inapropiado. En esta revisión nos centraremos especialmente en la eficacia clínica, radiológica, así como en el perfil de seguridad (AU)

Tocilizumab (TCZ) is a humanized monoclonal antibody which targets the receptor for IL-6, developed by the Japanese pharmaceutical company Chugai and the Swiss company Roche. In Japan it is already under use for Castleman's disease, rheumatoid arthritis (RA) and Juvenile Idiopathic Arthritis. The clinical development outside Japan is very extensive and has shown efficacy in possible RA scenarios; early RA (part of the AMBITION study), established, MTX-resistant RA (OPTION) and RA resistant to other DMARD (TOWARD), and anti-TNF-alpha resistant RA (RADIATE). Both monotherapy with TCZ (AMBITION) and associated to other background drugs. Radiological efficacy has also been proven (LITHE). So TCZ is probably the biologic therapy with the most extensive clinical development before marketing in the western hemisphere. In this review we will specifically deal with clinical and radiological efficacy, as wel as its safety profile (AU)

[Inhibition of interleukin 6, a new therapeutic option in rheumatoid arthritis]. / La inhibición de la interleucina-6, una nueva opción terapéutica en la artritis reumatoide.

Tocilizumab (TCZ) is a humanized monoclonal antibody which targets the receptor for IL-6, developed by the Japanese pharmaceutical company Chugai and the swiss company Roche. In Japan it is already under use for Castleman's disease, rheumatoid arthritis (RA) and Juvenile Idiopathic Arthritis. The clinical development outside Japan is very extensive and has shown efficacy in possible RA scenarios; early RA (part of the AMBITION study), established, MTX-resistant RA (OPTION) and RA resistant to other DMARD (TOWARD), and anti-TNF-α resistant RA (RADIATE). Both monotherapy with TCZ (AMBITION) and associated to other background drugs. Radiological efficacy has also been proven (LITHE). So TCZ is probably the biologic therapy with the most extensive clinical development before marketing in the western hemisphere. In this review we will specifically deal with clinical and radiological efficacy, as wel as its safety profile.