Prevalencia y características clínicas de la enfermedad pulmonar intersticial difusa sintomática en la artritis reumatoide en una población española / Prevalence and clinical characteristics of symptomatic diffuse interstitial lung disease in rheumatoid arthritis in a Spanish population

Antecedentes y objetivos: En España, los estudios epidemiológicos de prevalencia de enfermedad pulmonar intersticial difusa (EPID) en artritis reumatoide (AR) son escasos y limitados. Nuestro objetivo fue estimar la prevalencia de EPID sintomática en AR y sus características en nuestra área. Materiales y métodos: Se diseñó un estudio observacional longitudinal prospectivo en la consulta interdisciplinar de Reumatología y Neumología, en el que incluimos AR con síntomas respiratorios y EPID confirmada por tomografía computarizada de alta resolución. Resultados: De las 2.729 personas con AR de nuestra área, 47 presentaban EPID sintomática, estimándose una prevalencia de EPID sintomática en AR del 1,72% (intervalo de confianza del 95%: 1,26-2,29) con una edad al diagnóstico de AR de 57,3±13,3 años. Fue más frecuente en hombres, el 60,6% tenía antecedente de tabaquismo y el 84,3 y el 84,7% factor reumatoide y anticuerpos antipéptidos cíclicos citrulinados, respectivamente. El patrón más frecuente fue neumonía intersticial usual (NIU) en 28 (31,1%), la neumonía intersticial no específica (NINE) fue más frecuente en mujeres y el síndrome combinado enfisema-fibrosis (SCEF) exclusivamente en hombres. Conclusiones: En este estudio hemos analizado la prevalencia de AR-EPID sintomática en nuestra área, la cual está por debajo de lo esperado, probablemente en relación con las definiciones utilizadas. Así mismo, hemos descrito que el patrón NIU es el más frecuente en la AR, seguido del NINE y analizado por primera vez la prevalencia de SCEF en la AR, que alcanza el 13% (AU)

Background and objectives: In Spain, epidemiological studies of the prevalence of diffuse interstitial lung disease (ILD) in rheumatoid arthritis (RA) are limited. Our objective was to estimate the prevalence of symptomatic ILD in RA and its characteristics in our area. Materials and methods: In our hospital's interdisciplinary rheumatology and pulmonology clinic, a prospective longitudinal observational study was designed in which we included RA with respiratory symptoms and ILD confirmed by high resolution computed tomography. Results: Of the 2,729 people with RA in our area, 47 had symptomatic ILD, estimating a prevalence of symptomatic ILD in RA of 1.72% (95% CI 1.26 - 2.29) with an age at diagnosis of RA of 57.3±13.3 years. It was more frequent in men, 60.6% had a history of smoking, and 84.3% and 84.7% had rheumatoid factor (RF) and anti-cyclic citrullinated peptide (Anti-CCP) antibodies, respectively. The most frequent pattern was usual interstitial pneumonitis (UIP), appearing in 28 (31.1%). Nonspecific interstitial pneumonia (NSIP) was more frequent in women, while the combined pulmonary fibrosis-emphysema (CPFE) syndrome presented exclusively in men. Conclusions: We have analysed the prevalence of symptomatic RA-ILD in our area, which is lower than expected, probably in relation to the definitions used. We have also described that the UIP pattern is the most frequent in RA in our environment, followed by the NSIP. Lastly, we have analysed the prevalence of CPFE in RA, which reaches 13%, for the first time (AU)

Prevalence and clinical characteristics of symptomatic diffuse interstitial lung disease in rheumatoid arthritis in a Spanish population.

BACKGROUND AND OBJECTIVES: In Spain, epidemiological studies of the prevalence of diffuse interstitial lung disease (ILD) in rheumatoid arthritis (RA) are limited. Our objective was to estimate the prevalence of symptomatic ILD in RA and its characteristics in our area. MATERIALS AND METHODS: In our hospital's interdisciplinary rheumatology and pulmonology clinic, a prospective longitudinal observational study was designed in which we included RA with respiratory symptoms and ILD confirmed by high resolution computed tomography. RESULTS: Of the 2729 people with RA in our area, 47 had symptomatic ILD, estimating a prevalence of symptomatic ILD in RA of 1.72% (95% CI 1.26-2.29) with an age at diagnosis of RA of 57.3 ±â€¯13.3 years. It was more frequent in men, 60.6% had a history of smoking, and 84.3% and 84.7% had rheumatoid factor (RF) and anti-cyclic citrullinated peptide (Anti-CCP) antibodies, respectively. The most frequent pattern was usual interstitial pneumonitis (UIP), appearing in 28 (31.1%). Nonspecific interstitial pneumonia (NSIP) was more frequent in women, while the combined pulmonary fibrosis-emphysema (CPFE) syndrome presented exclusively in men. CONCLUSIONS: We have analysed the prevalence of symptomatic RA-ILD in our area, which is lower than expected, probably in relation to the definitions used. We have also described that the UIP pattern is the most frequent in RA in our environment, followed by the NSIP. Lastly, we have analysed the prevalence of CPFE in RA, which reaches 13%, for the first time.

Pronóstico y seguimiento de la enfermedad. Protocolo de Neumomadrid para el seguimiento de pacientes con neumonía por COVID-19 / Prognosis and follow-up of the disease. Neumomadrid protocol for the follow-up of patients with pneumonia due to COVID-19

El nuevo virus ARN betacoronavirus 2 (SARS-CoV-2) se identificó por primera vez en China a finales del año 2019, como agente etiológico de la infección denominada COVID-19. Se manifestaba como neumonía grave hasta en el 20% de los casos, que puede producir un síndrome respiratorio agudo grave y aumento del riesgo de coagulación vascular diseminada y de enfermedad tromboembólica venosa. Además, en la COVID-19 se produce afectación de otros órganos y sistemas como artritis, miocarditis, vasculitis, miopatías, etc. Las secuelas que se producirán a largo plazo son desconocidas. Hasta un 20% de los pacientes con COVID-19 podrían tener como complicación una afectación intersticial y vascular pulmonar, con alteraciones del intercambio gaseoso. Por tanto, es fundamental que los pacientes con una neumonía grave por COVID-19 tengan un seguimiento adecuado, para asegurar el correcto diagnóstico y tratamiento, de las posibles secuelas respiratorias. Aunque el seguimiento neumológico es prioritario, se recomienda que estos pacientes sean valorados por un grupo multidisciplinar que valore las diferentes posibles complicaciones sistémicas

The new RNA virus betacoronavirus 2 (SARS-CoV-2) was identified for the first time in China at the end of 2019, as the etiological agent of the infection called COVID-19. It manifests as severe pneumonia in up to 20% of cases, which can lead to severe acute respiratory syndrome and an increased risk of disseminated vascular coagulation and venous thromboembolic disease. In addition, in COVID-19 other organs and systems are affected such as arthritis, myocarditis, vasculitis, myopathies... The sequelae, which will occur in long term, are unknown. Up to 20% of patients with COVID-19 could have an interstitial and pulmonary vascular involvement as a complication, with alterations in gas exchange. Therefore, it is essential that patients with a severe infection by COVID-19, with pneumonia, have adequate follow-up to ensure the correct diagnosis and treatment of possible respiratory sequelae. Although pneumological follow-up is a priority, it is recommended that these patients be evaluated by a multidisciplinary group that assesses the different systemic complications

How are the ancient cystic fibrosis patients? Cystic fibrosis diagnosed over 60 years-old.

BACKGROUND AND AIMS: To specify the prevalence of patients diagnosed with CF at age of ≥60 year-old and to analyze their characteristics. PATIENTS AND METHODS: Observational study of CF patients which were diagnosed at age ≥60 year-old. The analyzed variables were: age, sex, nationality, lung function parameters, conditions present at diagnosis, microbiological characteristics and genetic findings. RESULTS: eight patients were included. 7 patients were female (87.5%) with a mean age of 70.6 years (median 71.5 years, range 60-78 years). The most important findings were: sweat test >60 mEq/l; heterozygotes F508del; bronchiectasis in CT; methicillin-sensitive Staphylococcus aureus (50%) in sputum. The most patients presented a normal or mild obstructive lung function. CONCLUSIONS: CF must also be considered a disease diagnosed in adulthood, incorporating the sweat test within the usual techniques of differential diagnosis in patients with different diseases associated with CF, because genetic counselling is esencial.

Enfermedades intersticiales en las conectivopatías / No disponible

No disponible

Infección por micobacterias no tuberculosas en pacientes con bronquiectasias no causadas por fibrosis quística / Non-tuberculous mycobacterial infection in patients with non-cystic fibrosis bronchiectasias

Objetivo. Conocer la prevalencia y características de la infección por micobacterias no tuberculosas en enfermos con bronquiectasias no relacionadas con la fibrosis quística. Pacientes y métodos. Estudio descriptivo retrospectivo de pacientes adultos con bronquiectasias no relacionadas con la fibrosis quística con un seguimiento de al menos dos años. Resultados. Se incluyeron 68 pacientes, 50 mujeres (73,5%), con una edad media de 63,31±16,2 años. La etiología más frecuente fue la enfermedad pulmonar obstructiva crónica (28 pacientes, 41,2%) con una afectación leve-moderada y colonización por Pseudomonas aeruginosa (P. aeruginosa) (70,6%). Siete pacientes (10,3%) presentaron infección por micobacterias no tuberculosas, tratándose de Mycobacterium avium complex en 6 ocasiones (7,35%). Cuatro (57,14%) pacientes recibieron tratamiento antimicrobiano específico. En los enfermos infectados fue menor la frecuencia de P. aeruginosa y el uso de corticoides inhalados. No hubo diferencias espirométricas significativas entre los pacientes infectados por micobacterias no tuberculosas y los no infectados. Conclusiones. Las bronquiectasias no relacionadas con la fibrosis quística podrían considerarse un factor de riesgo para la infección por micobacterias no tuberculosas(AU)

Aims. To know the characteristics and prevalence of non-tuberculous mycobacterial infection infection in patients with non-cystic fibrosis bronchiectasis. Patients and methods. A retrospective descriptive study of NCFB adult patients whose disease had been followed-up for at least two years was performed. Results. A total of 68 subjects were included, 50 females (73.5%), with mean age of 63.31± 16.2 years. The most frequent etiology of the non-cystic fibrosis bronchiectasis was COPD in 28 cases (41.2%) with a light-moderate pulmonary involvement and Pseudomonas aeruginosa (P. aeruginosa) colonization (70.6%). Seven patients (10.3%) had MNT infection, six of whom had Mycobacterium avium complex (7.35%). Four patients (57.14%) were treated. In the infected patients, P. aeruginosa and the use of inhaled steroids were observed with less frequency. There were no significant differences between the infected and non-infected patients in relation to spirometric values. Conclusions. The non-cystic fibrosis bronchiectasis could be considered a risk factor for non-tuberculous mycobacterial infection(AU)

[Non-tuberculous mycobacterial infection in patients with non-cystic fibrosis bronchiectasias]. / Infección por micobacterias no tuberculosas en pacientes con bronquiectasias no causadas por fibrosis quística.

AIMS: To know the characteristics and prevalence of non-tuberculous mycobacterial infection infection in patients with non-cystic fibrosis bronchiectasis. PATIENTS AND METHODS: A retrospective descriptive study of NCFB adult patients whose disease had been followed-up for at least two years was performed. RESULTS: A total of 68 subjects were included, 50 females (73.5%), with mean age of 63.31± 16.2 years. The most frequent etiology of the non-cystic fibrosis bronchiectasis was COPD in 28 cases (41.2%) with a light-moderate pulmonary involvement and Pseudomonas aeruginosa (P. aeruginosa) colonization (70.6%). Seven patients (10.3%) had MNT infection, six of whom had Mycobacterium avium complex (7.35%). Four patients (57.14%) were treated. In the infected patients, P. aeruginosa and the use of inhaled steroids were observed with less frequency. There were no significant differences between the infected and non-infected patients in relation to spirometric values. CONCLUSIONS: The non-cystic fibrosis bronchiectasis could be considered a risk factor for non-tuberculous mycobacterial infection.

Hipertensión arterial pulmonar en paciente con neumonía intersticial no específica y con test de vasorreactividad positivo / Pulmonary arterial hypertension in patients with non-specific interstitial pneumonia and with positive vasoreactivity test

La hipertensión pulmonar (HP) es una enfermedad que se caracteriza por un aumento progresivo de la resistencia vascular pulmonar, que da lugar a insuficiencia ventricular derecha y a una muerte prematura. Esta puede ser idiopática o asociarse a diferentes entidades, entre las que destacan las colagenopatías, los tóxicos y las enfermedades pulmonares, como son las neumopatías intersticiales. Presentamos el caso de una paciente con diagnóstico de HP e imágenes indicativas de enfermedad intersticial en la tomografía computarizada de alta resolución y que posteriormente fue diagnosticada de una neumonía intersticial no específica. Es importante destacar la prueba de vasorreactividad positiva en el cateterismo cardíaco, que posiblemente indicaría la presencia de dos entidades independientes en el presente caso (AU)

Pulmonary hypertension (PH) is a disease characterized by a progressive increase of pulmonary vascular resistance, which gives rise to right ventricular failure and premature death. This may be idiopathic or be associated to different conditions, standing out among them collagen, toxic diseases and lung conditions such as interstitial lung diseases. We present the case of a female patient diagnosed of PH with images suggestive of interstitial disease in the high resolution computed tomography and who was subsequently diagnosed of a non-specific interstitial pneumonia. It is important to stress the positive vaso-reactivity test in cardiac catheterization that may indicate the presence of two independent conditions in the present case (AU)

¿Qué saben los pacientes adultos con fibrosis quística de su enfermedad? Adherencia al tratamiento / What do patients suffering cystic fibrosis know about their disease?

Introducción: La fibrosis quística (FQ) ha aumentado la supervivencia debido al avance del tratamiento multidisciplinar. Nos hemos propuesto averiguar si los pacientes de una unidad de adultos con FQ cumplen su tratamiento habitual, así como observar qué nivel de conocimiento tienen sobre su enfermedad, sus terapias y sus implicaciones. Material y métodos: Hemos realizado un estudio descriptivo transversal, con variable cualitativo ordinal y ciego simple, en una Unidad de adultos con FQ que contestaron un cuestionario donde se preguntó sobre el tratamiento de la enfermedad y su administración, hábitos tóxicos, conocimiento de su enfermedad y preocupación por su presente o futuro. Resultados: El cuestionario fue contestado por 35 pacientes (40%) durante los años 2000-2001, lo que suponía el 40% del total de enfermos, con una edad media de 31,43 ± 8,49 años. Un 85,7% (30 pacientes) contestaron saber qué tratamiento llevaban y lo anotaron correctamente. Un total de 24 pacientes (68,57%) precisaban enzimas pancreáticas. Al preguntar sobre el conocimiento de la enfermedad, el 94,3% (33 pacientes) se consideraba informado sobre la misma y el 91,4% (32 pacientes) dijo que la información dada por sus médicos era adecuada. Lo que más les preocupaba era el empeoramiento de su calidad de vida, 14,3% (5 pacientes), la preocupación por el futuro, 11,4% (4 pacientes), las limitaciones en la vida diaria, 8,6% (3 pacientes) y su mortalidad o tener recaídas, 2,9% (1 paciente). No respondieron a esta pregunta un 11,4% (4 pacientes). Conclusiones: la mayoría de los enfermos que contestaron la encuesta están enterados de su enfermedad y de su tratamiento y tiene claras sus preocupaciones por el futuro. Sin embargo, contestaron menos de la mitad del total de los pacientes, lo que indica que se deberían indagar las causas de este problema (AU)

Nueva formulación de tobramicina inhalada en polvo seco para la colonización crónica por Pseudomonas aeruginosa en fibrosis quística / A new inhaled dry-powder formulation of tobramycin for chronic colonization by pseudomonas aeruginosa in cystic fibrosis

La sobreinfección por Pseudomonas aeruginosa (PA) es frecuente en los pacientes con fibrosis quística (FQ). El tratamiento antibiótico por via inhalatoria es el más recomendado (..) (AU)

Superinfection with Pseudomonas aeruginosa (PA) is common in patients with cystic (..) (AU)

Diagnóstico de supuesto cáncer pulmonar asociado al uso de metotrexato / Diagnosis of the supposed lung cancer associated to the use of methotrexate

Resumen. La atritis reumatoide es una enfermedad que engloba manifestaciones articulares y extraarticulares como la neumonitis. Igualmente, ciertas medicaciones usadas para su tratamiento, como el metotrexato, se han asociado a neumopatías y a la presencia de atipias epiteliales y bronquiales. Reportamos el caso de una mujer de 63 años, diagnosticada de artritis reumatoide y con tratamiento con metotrexato, que presentó una neumonía intersticial, la cual inicialmente fue etiquetada de carcinoma pulmonar (AU)

Abstract. Rheumatoid arthritis is a disease that includes articular and extraarticular manifestations such as pneumonitis. Equally, certain medications used for its treatment, such as methotrexate, have been associated to lung diseases and the presence of epithelial and bronchial atypias. We report the case of a 63-year old woman diagnosed of rheumatoid arthritis and under treatment with methotrexate, who had interstitial pneumonia, which was initially labeled as lung cancer (AU)

Tratamiento con TOBI en pacientes con fibrosis quística mayores de 18 años / Treatment with TOBI (Tobramycin Inhalation) in patients over 18 years old with cystic

La fibrosis quística (FQ) es una enfermedad autosómica recesiva causada por mutaciones, siendo la más conocida la delección F508del (70%). Se han descrito más de 1.000 mutaciones asociadas a esta enfermedad. La enfermedad pulmonar es una de las causas más importantes de morbilidad y mortalidad relacionadas con la FQ. Es muy frecuente que se colonicen por determinados gérmenes, siendo uno de los más importantes la P. aeruginosa. Una vez que existe una infección crónica, los enfermos se tratan con antibioterapia en aerosol, empleando con más frecuencia la colimicina y la tobramicina libre de conservantes (TOBI®). Son pocos los estudios que han analizado este último antibiótico en nuestro país, por lo que nos hemos propuesto observar la evolución funcional y la clínica de los pacientes mayores de 18 años que lo están empleando. Hemos estudiado a 13 enfermos, 7 hombres y 6 mujeres, con una edad media de 28,0 ± 11,0 años, con un IMC medio de 20,84 ± 1,99 y 11,0 ± 4,0 años de colonización por P. aeruginosa. Se comprobó la función pulmonar desde 6 meses antes (FEV1: 37,7 ± 9,98%, FVC: 57,10 ± 8,97%, FEV1/FVC: 56,20 ± 12,90) hasta los 6 primeros meses tras iniciar el TOBI® (FEV1: 36,50 ± 10,70%, FVC: 55,57 ± 13,69%, FEV1/FVC: 56,0 ± 11,70%), así como el número de exacerbaciones e ingresoshospitalarios, en este espacio de tiempo. El número de exacerbaciones fue significativamente mayor en el período analizado antes de empezar con TOBI® (p < 0,05). No hemos encontrado otros hallazgos significativos en el resto de las variables analizados. Los efectos secundarios han sido muy escasos. Creemos que se podrían realizar más trabajos entre nuestros enfermos para conocer la eficacia y la seguridad de este antibiótico administrado por vía inhalada y ajustar los períodos on-off (AU)

Cystic fibrosis (CF) is a genetic disease, authosomic recesive, caused by more than 1.000 mutations, being the most known F508del (70%). The pulmonary disease is one of the cause of morbility and mortality related to CF. It is very common they are colonized by several microorganims, being one of the most important P. aeruginosa. Once, patients present chronic infection, they are treated with aerosolized antibiotics, using more colistin and free-preservative tobramicin (TOBI®). There are few studies that they are analized the last antibiotic in our country, so we have proponed to observe the functional and clinic evolution of the patients older than 18 years, who have used it. We have studied 13 patients, 7 males and 6 females, with and age of 28.0 ± 11.0 years, with a BMI of 20.84 ± 1.99 and 11.0 ± 4.0 years of colonization due to P. aeruginosa. The pulmonary function was studied since 6 months before (FEV1: 37.7 ± 9.98%, FVC: 57.10 ± 8.97%, FEV1/FVC: 56.20 ± 12.90) until six months later the begining of using TOBI® (FEV1: 36.50 ± 10.70%, FVC: 55.57 ± 13.69%, FEV1/FVC: 56.0 ± 11.70%), as well as the number of exacerbations and hospitalizations in this period of time. The number of exacerbations was significatively higher during the period analized before starting with TOBI® (p < 0.05). We have not seen other significative findings in the other studied variables. The secundary effects have been very little. We think that more works could carry out between aur patients to know the efficacy and security of this antibiotic administered by inhaled way adjusting the periods on-off (AU)

Proteinosis alveolar o laimportancia de identificarinfecciones sobreañadidas / Alveolar proteinosis or the importance of identifying concurrent infections

No disponible

An evaluation of tissue polypeptide antigen (TPA) in the two bronchoalveolar lavage fractions of lung cancer patients.

BACKGROUND: It has been proven that cytokeratins (CKs) are useful tumor markers for the follow-up, treatment monitoring and prognosis evaluation of lung cancer and among these, tissue polypeptide antigen (TPA) plays an important role. Nevertheless, only a small number of studies have been reported about their diagnostic capacity. Bronchoalveolar lavage (BAL) can be divided into two fractions: bronchiolar (BF) and alveolar (AF). For the above reasons, our aims were (1) to analyze the diagnostic usefulness of TPA in the BAL of lung cancer patients and (2) to observe if, in lung cancer patients, TPA levels in the two BAL fractions are different. This should mean that the study of tumor markers in the BAL should be carried out in both fractions to increase their diagnostic capacity. METHODS: We studied 289 BALs divided into two phases. In phase I, TPA was analyzed in the BAL of six groups of subjects (healthy persons, chronic bronchitis, asthma, respiratory infections, diffuse interstitial pulmonary diseases and lung cancer). In phase II, TPA was studied in both BAL fractions of a group of patients with lung cancer. RESULTS: We observed that TPA levels were significantly higher in the BAL of patients with bronchogenic neoplasias. In these patients, TPA was increased in the BF of the lavage in relation to the AF. In smoker patients with pulmonary carcinomas, TPA was higher in the AF of the BAL than in the lavage of non-smokers. This did not occur in the BF. We found no relation between the TPA concentrations and cancer histology. CONCLUSIONS: We believe that TPA is a useful tumor marker with diagnostic capacity and this capacity is increased when it is studied in the two BAL fractions. Smoking habit may play a role in the secretion of tumor markers by the tumor cells.

[Cystic adenoid carcinoma. Apropos of a case with very prolonged survival]. / Carcinoma adenoide quístico. A propósito de un caso con supervivencia muy prolongada.

Adenoid cystic carcinoma is an infrequent tumor, but not a rare one. Its primary location is most often the salivary glands, although it can be found in many other organs, including the lung, which is the most frequent site of remote metastasis. The tumor's two main features, which indicate a need for long-term monitoring, are 1) its high level of local aggressivity and rate of recidivism in spite of radical excision, with recurrence sometimes taking place long after the primary tumor appears, and 2) its slow natural history even when disseminated disease is present. Type of tumoral tissue is an important prognostic factor.