Taller de concordancia en la evaluación de imágenes capilaroscópicas / Reliability of nailfold videocapillaroscopy workshop

Introducción: la capilaroscopia es un método no invasivo que permite observar la microvasculatura en el área periungueal. Los resultados informados pueden ser altamente variables entre distintos observadores. A lo largo del tiempo surgieron métodos cuantitativos y semicuantitativos para mejorar la reproducibilidad. Objetivos: conocer el nivel de acuerdo intra e interobservador al informar los diferentes patrones capilaroscópicos en individuos con diferente nivel de entrenamiento. Materiales y métodos: estudio de corte transversal. Participaron médicos reumatólogos especialistas y en formación que habían realizado previamente un curso virtual de capacitación en capilaroscopia. Recibieron 40 imágenes capilaroscópicas proyectadas en una presentación de PowerPoint y debían responder a través de un cuestionario digital. Se evaluó la concordancia de respuestas intra e interobservador. Resultados: se encontró un alto nivel de concordancia global con un kappa 0,66 IC 95% (0,63-0,70) p<0,0000. También en otros grupos como reumatólogos en formación: kappa 0,65 IC 95% (0,60-0,71) p=0,0000, y médicos reumatólogos: kappa 0,67 IC 95% (0,62-0,72) p=0,0000. Conclusiones: el nivel de concordancia encontrado fue globalmente alto, independientemente del nivel de entrenamiento de los profesionales, y de ser o no reumatólogo. La concordancia fue superior cuando se comparó a quienes tenían más de 4 años de experiencia en la realización de videocapilaroscopia.

Introduction: videoapillaroscopy is a non-invasive method that allows the observation of the microvasculature in the periungual area. Reported results can be highly variable between different observers. Over time, quantitative and semi-quantitative methods emerged to improve reproducibility. Objetives: to know the level of intra and interobserver agreement when reporting the different capillaroscopic patterns in individuals with different levels of training. Materials and methods: cross section study. Specialist rheumatologists and those in training who had previously completed a virtual capillaroscopy training course participated. They received 40 capillaroscopic images projected in a PowerPoint presentation and had to issue their response through a digital questionnaire. Concordance of intra and interobserver responses was evaluated. Results: a high level of global agreement was found with a kappa 0.66 CI 95% (0.63-0.70) p<0.0000, also in other groups such as rheumatologists in training: kappa 0.65 CI 95% (0.60-0.71) p=0.0000, physicians rheumatologists: kappa 0.67 95% CI (0.62-0.72) p=0.0000. Conclusions: the level of agreement found was globally high, regardless of the level of training of the professionals, and whether or not they were a rheumatologist. Concordance was higher when compared to those who had more than 4 years of experience performing videocapillaroscopy.

Work disability in Argentinian patients with systemic lupus erythematosus is prevalent and it is due to ethnic, socioeconomic and disease-related factors.

OBJECTIVE: To study the prevalence and the associated factors of work disability (WD) in systemic lupus erythematosus (SLE) patients. METHODS: A sample of 419 SLE patients from an observational cross-sectional multicenter study was included. Sociodemographic features, disease characteristics, comorbidities, quality of life, unhealthy behaviors, and work-related factors were measured in a standardized interview. Work disability was defined by patient self-report of not being able to work because of SLE. To identify variables associated with work disability, two different multivariate regression models using a stepwise backward method were performed. RESULTS: Prevalence of WD due to SLE was 24.3%. Eighty-nine percent were female and 51% were Caucasians. Mean disease duration was 8.9 ± 7.2 years, and median System Lupus International Collaborating Clinics/American College of Rheumatology damage index SLICC-SDI was 1.5 (range 0-17). In stepwise multivariate logistic regression, living below the poverty line (odds ratio [OR] = 4.65), less than 12 years of education (OR = 2.84), Mestizo ethnicity (OR = 1.94) and SLICC-SDI (OR = 1.25) were predictors of WD. A second model was performed including patient-derived measures; in this model sedentary lifestyle (OR = 2.69) and lower emotional health domain score of the Lupus Quality of Life (LupusQoL) questionnaire (OR = 1.03) were found to be associated to WD and a higher score in LupusQoL physical health domain (OR = 0.93) was protective. CONCLUSION: The prevalence of WD in Argentinian SLE patients was 24.3%. WD was associated with ethnic (Mestizo), socioeconomic (poverty) and disease-related factors. Patient-related outcomes such us sedentary lifestyle and poor emotional quality of life were also associated with WD.

Lupus eritematoso sistémico asociado a una infección por citomegalovirus en una adolescente / Systemic lupus erythematosus associated with a cytomegalovirus infection in an adolescent girl

Se presenta el caso de una paciente de 16 años de edad sin enfermedades previas, a quien se le diagnosticó lupus eritematoso sistémico (LES) con daño renal al mes de detectarse una infección por citomegalovirus (CMV). Tanto la nefritis como la enfermedad sistémica evolucionaron favorablemente con tratamiento combinado de metilprednisona y mofetil micofenolato. No se administraron fármacos antivirales y no hubo reactivación de la virosis durante el tratamiento. El objetivo de esta comunicación es describir a una adolescente, quien desarrolló LES inmediatamente después de una infección por CMV.

Artritis séptica por Bacteroides fragilis en paciente con linfoma no hodgkiniano y enfermedad mixta del tejido conectivo / Septic arthritis due to Bacteroides fragilis in a patient with non-Hodgkin lymphoma and mixed connective tissue disease

Presentamos una paciente de 53 años de edad con enfermedad mixta del tejido conectivo que desarrolló un linfoma no hodgkiniano de alto grado de malignidad y 2 años más tarde, un cuadro de absceso inguinal izquierdo, luego tenosinovitis supurada de tobillo izquierdo y, finalmente, artritis séptica del hombro derecho y tenosinovitis supurada del tercer dedo de la mano derecha. Se logró aislar Bacteroides fragilis en líquido sinovial del hombro, en hemocultivos y en punta de catéter central intravenoso. El foco infeccioso primario se presume que haya sido intraabdominal, y el catéter central en permanencia, el factor de mantenimiento de la infección crónica. Utilizamos un tratamiento empírico secuencial de ampicilina/sulbactam y clindamicina intravenosos y más tarde metronidazol por vía oral hasta la cura definitiva de la infección. La artritis séptica por Bacteroides fragilis es una entidad rara que ocurre principalmente en pacientes inmunodeficientes, tal como refleja este caso (AU)

We present a 53 year old woman with pre-existing mixed collagen tissue disease who developped highly-malignant non-Hodgkin lymphoma and 2 years later had left groin abscess, then septic tenosynovitis of the left ankle, septic artrhritis of the right shoulder and purulent tenosynovitis of the right hand. Bacteroides fragilis was identified in synovial fluid drawn from the right shoulder, in blood cultures and in culture of a central venous catheter tip. The primary infection site is presumed to have been the abdominal cavity, and the presence of an indwelling central venous catheter the reason for recurrence of infection. We treated her empyrically with intravenous ampicillin/sulbactam and clindamycine then oral metronidazol until definite resolution of the infection. Septic artrhritis due to Bacteroides fragilis is a rare entity mainly occurring in immunocompromised patients, as shown in this case (AU)

[Septic arthritis due to Bacteroides fragilis in a patient with non-Hodgkin lymphoma and mixed connective tissue disease]. / Artritis séptica por Bacteroides fragilis en paciente con linfoma no hodgkiniano y enfermedad mixta del tejido conectivo.

We present a 53 year old woman with pre-existing mixed collagen tissue disease who developped highly-malignant non-Hodgkin lymphoma and 2 years later had left groin abscess, then septic tenosynovitis of the left ankle, septic artrhritis of the right shoulder and purulent tenosynovitis of the right hand. Bacteroides fragilis was identified in synovial fluid drawn from the right shoulder, in blood cultures and in culture of a central venous catheter tip. The primary infection site is presumed to have been the abdominal cavity, and the presence of an indwelling central venous catheter the reason for recurrence of infection. We treated her empyrically with intravenous ampicillin/sulbactam and clindamycine then oral metronidazol until definite resolution of the infection. Septic artrhritis due to Bacteroides fragilis is a rare entity mainly occurring in immunocompromised patients, as shown in this case.

Absceso en extremidad inferior por haemophylus influenzae en una paciente portadora de artritis reumatoide y mieloma múltiple / Abcess of lower limb due to haemophilus influenzae in a patient with rheumatoid arthritis and concomitant multiple myeloma

Reportamos el caso de una mujer de 63 años de edad con artritis reumatoide de 15 años de evolución y mieloma múltiple de reciente descubrimiento, en la que se desarrolló un proceso de supuración recidivante en la pierna izquierda después de un proceso neumónico. El cultivo del material del absceso fue positivo para Haemophylus influenzae, y el mismo germen fue identificado en los hemocultivos, por lo que se consideró que el foco primario fue pulmonar y la diseminación hematógena. Sería el primer caso reportado de absceso en extremidad inferior por H. influenzae en la bibliografía internacional en pacientes con estas características. (AU)