Práctica clínica en la arteritis de células gigantes a partir de una encuesta a especialistas / Clinical practice in giant cell arteritis based on a survey of specialists

Antecedentes: El propósito de este estudio fue conocer la práctica clínica de especialistas que atienden a pacientes con arteritis de células gigantes, para comprobar si siguen las recomendaciones para el diagnóstico y tratamiento de esta enfermedad e identificar áreas de mejora. Métodos: Encuesta transversal de prácticas clínicas realizada en 2019. Ciento sesenta y siete médicos (64% reumatólogos, 27% especialistas en medicina interna, 9% otros especialistas) que asistieron a un curso de actualización del tratamiento de la arteritis de células gigantes completó la encuesta. Comparamos la práctica clínica recogida en el estudio con las últimas recomendaciones aprobadas por la Liga Europea Contra el Reumatismo (EULAR). Resultados: Los médicos encuestados atendían a una mediana de 10 pacientes (rango intercuartílico 6-30) con arteritis de células gigantes en su práctica clínica. Como método de diagnóstico, los encuestados utilizaron biopsia de arteria temporal (84%), ecografía de arteria temporal (61%) u otras técnicas de imagen (37%). Como terapia de primera línea, los encuestados utilizaron glucocorticoides en dosis altas (al menos 40mg de prednisona o equivalente por día) (84%), glucocorticoides con metotrexato (7%) y glucocorticoides con tocilizumab (5%). Los fármacos más utilizados para la recaída fueron el metotrexato (37%) y tocilizumab (58%). Conclusión: Los resultados de esta encuesta indican que los médicos especialistas encuestados siguen las recomendaciones recientes de EULAR sobre diagnóstico y tratamiento de la arteritis de células gigantes (AU)

Background: The purpose of this study was to learn about the clinical practice of specialists who care for patients with giant cell arteritis, to verify whether they follow the diagnosis and treatment recommendations for this disease, and to identify areas for improvement. Methods: A cross-sectional survey on clinical practice in 2019. The survey was completed by 167 physicians (64% rheumatologists, 27% internal medicine specialists, and 9% other specialists) who attended a course on updating giant cell arteritis treatment. We compared the clinical practice collected in the study with the latest recommendations approved by the European League Against Rheumatism (EULAR). Results: The physicians surveyed cared for a median of 10 patients (interquartile range 6-30) with giant cell arteritis during their practice. As a diagnostic method, respondents used temporal artery biopsy (84%), temporal artery ultrasound (61%) or other imaging techniques (37%). As first-line therapy, respondents used high-dose glucocorticoids (at least 40mg of prednisone, or equivalent, per day) (84%), glucocorticoids with methotrexate (7%) and glucocorticoids with tocilizumab (5%). The most frequent drugs used for relapse were methotrexate (37%) and tocilizumab (58%). Conclusion: Our results indicate that the medical specialists surveyed follow the recent EULAR recommendations for giant cell arteritis diagnosis and therapy (AU)

Clinical practice in giant cell arteritis based on a survey of specialists.

BACKGROUND: The purpose of this study was to learn about the clinical practice of specialists who care for patients with giant cell arteritis, to verify whether they follow the diagnosis and treatment recommendations for this disease, and to identify areas for improvement. METHODS: A cross-sectional survey on clinical practice in 2019. The survey was completed by 167 physicians (64% rheumatologists, 27% internal medicine specialists, and 9% other specialists) who attended a course on updating giant cell arteritis treatment. We compared the clinical practice collected in the study with the latest recommendations approved by the European League Against Rheumatism (EULAR). RESULTS: The physicians surveyed cared for a median of 10 patients (interquartile range 6-30) with giant cell arteritis during their practice. As a diagnostic method, respondents used temporal artery biopsy (84%), temporal artery ultrasound (61%) or other imaging techniques (37%). As first-line therapy, respondents used high-dose glucocorticoids (at least 40 mg of prednisone, or equivalent, per day) (84%), glucocorticoids with methotrexate (7%) and glucocorticoids with tocilizumab (5%). The most frequent drugs used for relapse were methotrexate (37%) and tocilizumab (58%). CONCLUSION: Our results indicate that the medical specialists surveyed follow the recent EULAR recommendations for giant cell arteritis diagnosis and therapy.

[Giant Cell Arteritis. Recommendations in Primary Care]. / Arteritis de las células gigantes. Recomendaciones en Atención Primaria.

Giant cell arteritis is a systemic vasculitis with significant intra and extracranial involvement that, with early diagnosis and treatment in primary care, can improve its prognosis as it is a medical emergency. Our working group on vascular diseases of the Spanish Society of Primary Care Physicians (SEMERGEN) proposes a series of recommendations based on current scientific evidence for a multidisciplinary approach and follow-up in primary care.

Insulin resistance in non-diabetes patients with spondyloarthritis.

Objectives: Insulin resistance (IR) constitutes a major underlying abnormality driving cardiovascular disease in the general population and has been linked to inflammatory diseases. In this study, we aimed to determine the prevalence of IR in patients with spondyloarthritis (SpA) and whether IR can be explained by disease-related features in such cases. Method: The study included 577 subjects: 306 patients diagnosed with SpA according to Assessment of SpondyloArthritis international Society criteria and 271 controls. Insulin and C-peptide serum levels, IR and ß-cell function (%B) indices by homoeostatic model assessment (HOMA2), and lipid profiles were assessed in patients and controls. A multivariable regression analysis was performed to evaluate the differences in IR indices between patients and controls and to determine how IR is associated with disease-related characteristics in SpA patients. Results: HOMA2-%B and HOMA2-IR scores, both calculated with insulin or C-peptide, had significantly higher values in SpA patients compared to controls in multivariable analysis adjusted for age, gender, traditional IR-related factors, and glucocorticoid intake. Disease activity, functional status, and metrological SpA indices were positively related to IR, but only in univariable analysis. Disease duration and positivity for human leucocyte antigen-B27 were independently associated with a higher HOMA2-%B after multivariable analysis. Conclusion: Patients with SpA have an increased IR compared to controls. SpA disease-related data are independently associated with ß-cell dysfunction.

Recommendations for the treatment of anti-melanoma differentiation-associated gene 5-positive dermatomyositis-associated rapidly progressive interstitial lung disease.

OBJECTIVES: The study aimed to develop evidence-based recommendations for the treatment of rapidly progressive interstitial lung disease (RPILD) associated with the anti-Melanoma Differentiation-Associated Gene 5-positive dermatomyositis (DM) syndrome. METHODS: The task force comprised an expert panel of specialists in rheumatology, intensive care medicine, pulmonology, immunology, and internal medicine. The study was carried out in two phases: identifying key areas in the management of DM-RPILD syndrome and developing a set of recommendations based on a review of the available scientific evidence. Four specific questions focused on different treatment options were identified. Relevant publications in English, Spanish or French up to April 2018 were searched systematically for each topic using PubMed (MEDLINE), EMBASE, and Cochrane Library (Wiley Online). The experts used evidence obtained from these studies to develop recommendations. RESULTS: A total of 134 studies met eligibility criteria and formed the evidentiary basis for the recommendations regarding immunosuppressive therapy and complementary treatments. Overall, there was general agreement on the initial use of combined immunosuppressive therapy. Combination of high-dose glucocorticoids and calcineurin antagonists with or without cyclophosphamide is the first choice. In the case of calcineurin antagonist contraindication or treatment failure, switching or adding other immunosuppressants may be individualized. Plasmapheresis, polymyxin B hemoperfusion and/or intravenous immunoglobulins may be used as rescue options. ECMO should be considered in life-threatening situations while waiting for a clinical response or as a bridge to lung transplant. CONCLUSIONS: Thirteen recommendations regarding the treatment of the anti-MDA5 positive DM-RPILD were developed using research-based evidence and expert opinion.

Insulin resistance in hidradenitis suppurativa: a case-control study.

BACKGROUND: The association between chronic inflammatory diseases, such as rheumatoid arthritis and psoriasis, and insulin resistance (IR) has been well established. Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disease that affects the apocrine gland-bearing areas of the body. OBJECTIVE: We aimed to determine the prevalence of IR in patients with HS. METHODS: This cross-sectional, case-control study enrolled 137 subjects, 76 patients with HS and 61 age- and gender-matched controls. Demographic data, clinical examination of HS patients, anthropometric measures, cardiovascular risk factors and laboratory studies were recorded. The homeostasis model assessment of IR (HOMA-IR) was calculated in all participants by measuring fasting plasma glucose and insulin levels. RESULTS: The median (IQR) HOMA-IR value in HS patients was significantly higher [2.0 (1.0-3.6)] than in controls [1.5 (0.9-2.3)] (P = 0.01). The prevalence of IR was significantly higher in cases (43.4%) compared with controls (16.4%) (P = 0.001). In the linear regression multivariable analysis after adjusting for age, sex and body mass index (BMI), HS remained as a significant factor for a higher HOMA-IR [2.51 (0.18) vs 1.92(0.21); P = 0.04]. The HOMA-IR value and the prevalence of IR did not differ significantly among HS patients grouped by severity of the disease. CONCLUSION: Our results show an increased frequency of IR in HS. Thus, we suggest HS patients to be evaluated for IR and managed accordingly.

Tratamiento híbrido en isquemia mesentérica aguda / Hybrid treatment in acute mesenteric ischaemia

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Reparación endovascular de seudoaneurisma en aorta infrarrenal / Endovascular treatment of infrarenal aortic pseudoaneurysm

No disponible

Tratamiento endovascular del síndrome de vena cava superior / Endovascular treatment of superior vena cava syndrome

No disponible

Tratamiento endovascular de aneurismas micóticos en aorta torácica / Endovascular treatment of mycotic thoracic aortic

No disponible

Thyroid autoimmunity in patients with hidradenitis suppurativa: a case-control study.

The aetiopathogenesis of hidradenitis suppurativa (HS) is not fully understood; however, increasing evidence suggests that it may be an immune-mediated disorder. Autoimmune thyroid disease (AITD) has classically been considered as the 'paradigm' of autoimmunity, and it has been linked to a variety of skin disorders. To our knowledge, the prevalence of AITD has not been investigated in patients with HS. The aim of the present study was to assess and compare, for the first time, the prevalence of thyroid autoimmunity in 70 patients with HS and in 70 age- and sex-matched controls. In all participants, thyroid autoantibodies and thyroid function tests were analysed. No statistically significant difference was detected between patients with HS and controls, either for the prevalence of thyroid antibodies or for thyroid function parameters. This lack of an association between HS and thyroid autoimmunity suggests that conventional autoimmune mechanisms may not be implicated in the pathogenesis of HS.

Pulse wave velocity and augmentation index are not independently associated with carotid atherosclerosis in patients with rheumatoid arthritis.

Arterial stiffness can enhance cardiovascular risk by increasing atherogenesis or adverse hemodynamic effects. We examined whether the arterial stiffness markers of aortic pulse wave velocity (PWV) and the augmentation index (AIx) are independently associated with carotid artery intima-media thickness (IMT) and plaque in patients with rheumatoid arthritis (RA). PWV and AIx were determined by brachial oscillometry using the Mobil-O-Graph® system and carotid IMT and plaque by ultrasound in 194 consecutive RA patients without established cardiovascular disease, chronic kidney disease, and diabetes at disease onset. In crude analysis, PWV was associated with IMT (ß (95% CI) = 0.04 (0.03 to 0.05), p value < 0.0001) and plaque (OR (95% CI) = 1.69 (1.40 to 2.04), p value < 0.0001). Upon adjustment for the confounders of age, sex, mean blood pressure, body height, and cardiovascular risk factors comprising smoking, the atherogenic index, and diabetes, PWV was not related to IMT (ß (95% CI) = 0.01 (-0.02 to 0.04), p value = 0.5) or plaque (OR (95% CI) = 0.99 (0.96 to 1.01), p value = 0.3). AIx was not associated with IMT in crude (ß (95% CI) = -0.002 (-0.004 to 0.007), p value = 0.2) and adjusted analyses (ß (95% CI) = -0.002 (-0.004 to 0.000), p value = 0.06). AIx was also unrelated to carotid plaque in crude (OR (95% CI) = 1.04 (0.60 to 1.82), p value = 0.9) and adjusted analyses (OR (95% CI) = 0.97 (0.94 to 1.01), p value = 0.1). PWV and AIx are not independently associated with subclinical carotid atherosclerosis in RA.

Corticoids synergize with IL-1 in the induction of LCN2.

OBJECTIVE: Lipocalin-2 (LCN2) is an adipokine that was first identified in neutrophil granules. In the last years it was recognized as a factor that could impair chondrocyte phenotype, cartilage homeostasis as well as growth plate development. Both pro-inflammatory cytokines and glucocorticoids (GCs) modulate LCN2 expression. Actually, GCs were found to be LCN2 inducers, suggesting that part of the negative actions exerted by these anti-inflammatory drugs at cartilage level could be mediated by this adipokine. So, in this study we wanted to investigate whether corticoids were able to act in synergy with IL-1 in the induction of LCN2 and the signaling pathway involved in this process. MATERIALS AND METHODS: For the realization of this work, ATDC5 mouse chondrogenic cell line was used. We determined the mRNA and protein expression of LCN2 by real-time reverse transcription-polymerase chain reaction (RT-qPCR) and western blot respectively, after GC or mineralcorticoid treatment. Different signaling pathways inhibitors were also used. RESULTS: GC and mineralcorticoid were able to induce the expression of LCN2 in ATDC5 cells. Interestingly, both corticoids synergized with IL-1 in the induction of LCN2. The effect of these corticoids on the expression of LCN2 occurred through GC or mineralcorticoid receptors and the kinases PI3K, ERK1/2 and JAK2. CONCLUSIONS: Prolonged use of corticoids may have detrimental effects on cartilage homeostasis. Based on our results, we conclude that corticoids could increase the negative actions exerted by IL-1 by increasing the expression of LCN2.

EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update.

Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.

Cirugía abdominal híbrida para el tratamiento de los aneurismas toracoabdominales complejos / Abdominal hybrid procedures for treatment of complex thoracoabdominal aortic aneurysms

La cirugía abierta de los aneurismas toracoabdominales (ATA) aún hoy presenta una alta morbimortalidad, habiendo surgido distintas alternativas. El tratamiento híbrido renovisceral, rodeado de controversia, es una de ellas. Los datos disponibles en la bibliografía con respecto a morbimortalidad muestran gran disparidad. Sin embargo, la mayoría de las series incluyen un elevado porcentaje de pacientes de alto riesgo y de ATA extensos, considerando por ello que los procedimientos híbridos renoviscerales todavía juegan un papel en el tratamiento de los ATA

Abdominal hybrid procedures have arisen as an alternative to conventional open surgery for thoracoabdominal aortic aneurysms (TAA), although they are surrounded by controversy. Data available in the literature about morbidity and mortality show a great disparity. However, most series include a large number of high risk patients and of extensive TAA. Considering this, renovisceral debranching still has a role in the treatment of TAA

Reparación de punción iatrogénica de arteria subclavia izquierda con cierre percutáneo / Repair of iatrogenic puncture of left subclavian artery with percutaneous closu

No disponible

Anti-TNF-α therapy reduces retinol-binding protein 4 serum levels in non-diabetic patients with psoriasis: a 6-month prospective study.

BACKGROUND: Retinol-binding protein-4 (RBP4), an adipokine considered as an emerging cardiometabolic risk factor, is increased in patients with moderate-to-severe psoriasis. OBJECTIVE: In this study, we aimed to establish the effect of anti-TNF-α therapy on RBP4 levels in patients with moderate-to-severe psoriasis. We also assessed if RBP4 levels correlate with metabolic syndrome features and disease severity in these patients. METHODS: Prospective study on a series of consecutive non-diabetic patients with moderate-to-severe psoriasis who completed 6 months of therapy with adalimumab. Patients with kidney disease, hypertension or body mass index ≥ 35 kg/m(2) were excluded. Metabolic and clinical evaluation was performed at the onset of treatment (time 0) and at month 6. RESULTS: Twenty-nine patients were assessed. Statistically significant reduction (P = 0.0001) of RBP4 levels was observed after 6 months of therapy (RBP4 at time 0: 55.7 ± 21.4 µg/mL, vs. 35.6 ± 29.9 µg/mL at month 6). No significant correlation between basal RBP4 levels and metabolic syndrome features or disease severity was found. Nevertheless, although RBP4 levels did not correlate with insulin resistance, a negative and significant correlation between RBP4 levels obtained after 6 months of adalimumab therapy and other metabolic syndrome features such as abdominal perimeter and body mass index were observed. At that time, a negative and significant correlation between RBP4 levels and disease activity scores and ultrasensitive CRP levels was also disclosed. CONCLUSION: Our results support an influence of the anti-TNF-α blockade on RBP4 serum levels. This finding is of potential relevance due to increased risk of cardiovascular disease in patients with psoriasis.

Endofugas tipo 2 en una población tratada con endoprótesis Gore(R) Excluder: incidencia, persistencia y crecimiento del saco aneurismático / Type 2 endoleaks in a population treated with a Gore (R) Excluder endoprosthesis: incidence, persistence and aneurysmal sac growth

INTRODUCCIÓN: La endofuga tipo 2 (EF2) es la complicación más frecuente tras EVAR, con una tasa de crecimiento del saco variable y un tratamiento de resultados poco efectivos. Se pretende analizar la incidencia de EF2, su persistencia y evolución en una población homogénea, buscando variables predictoras de crecimiento del saco. MATERIAL Y MÉTODOS: Setenta EF2 (32,2%) detectadas en 217 EVAR aortoilíacos tratados con GORE(R) Excluder entre 2003 y 2011. Seguimiento clínico y con angiotomografía computarizada (media 32,5 meses). Análisis univariante de datos recogidos de forma prospectiva. Función de supervivencia de Kaplan-Meier y regresión de Cox. RESULTADOS: Un 90% de varones con edad media 75,5 ± 8 años y diámetro aórtico 59,6 ± 10 mm. El vaso aferente más frecuente fue una arteria lumbar (n = 42), con un 30% de endofugas complejas (n = 21). Veinticinco endofugas fueron transitorias (35,7%) y 45 persistentes, grupo este último con mayor número de mujeres (p = 0,044) y de colaterales aferentes al saco (1,5 ± 0,7 vs. 1,2 ± 0,4, p = 0,022). Crecimiento > 5 mm en un 38,6% de casos (mediana 8,5 mm, rango 5-24); once se trataron con embolización (éxito 63,6%). Las endofugas complejas no incrementaron el riesgo. El único predictor independiente de crecimiento en la regresión de Cox fue la edad (HR 2,71 IC 95% 1,01-7,19 p = 0,046). CONCLUSIONES: Las EF2 constituyen una complicación frecuente y sin factores predictores sólidos que permitan estratificar el riesgo de crecimiento del saco, por lo que es necesario un seguimiento exhaustivo

INTRODUCTION: Type 2 endoleaks (T2E) are the most common finding after endovascular aortic repair (EVAR), with a variable sac growth rate and a treatment with unpromising results. The aim of this study is to analyze the incidence of T2E and their evolution in a homogeneous population, seeking predictors for sac growth. MATERIAL AND METHODS: A total of 70 T2E (32.2%) were detected in 217 aorto-iliac EVAR treated with a GORE(R) Excluder endograft from 2003 to 2011. They were systematically followed-up with contrast enhanced tomography (mean 32.5 months). Univariate analysis of prospectively collected data; Kaplan-Meier survival functions and multivariate Cox regression. RESULTS: 90% of patients with T2E were males, with a mean age 75.8 ± 8 years, and mean aortic diameter 59.5 ± 10 mm. The most common persistent collateral vessel was a lumbar artery (n = 42), with 30% of complex T2E (n = 21). The endoleaks were transient in 25 cases (35.7%), and 45 persisted for more than 6 months, the latter with a higher percentage of women (p = 0 .044), and total number of afferent vessels (1.5 ± 0.7 vs. 1.2 ± 0.4, p = 0 .022). Sac growth over 5 mm was observed in 38.6% of cases (median 8.5 mm, rank 5-24), with eleven of those treated with trans-arterial or trans-lumbar embolization (63.6% success). Complex endoleaks did not show a higher risk profile. Age was the only independent risk factor in the Cox regression analysis (HR 2.71, 95% CI; 1.01-7.19 p = 0 .046). Conclusions : T2E are a frequent complication, with no solid predictive factors for stratifying sac growth risk, thus needing close surveillance