Predictive factors of flares in systemic lupus erythematosus patients: data from a multiethnic Latin American cohort.

Purpose The purpose of this paper is to determine the factors predictive of flares in systemic lupus erythematosus (SLE) patients. Methods A case-control study nested within the Grupo Latino Americano De Estudio de Lupus (GLADEL) cohort was conducted. Flare was defined as an increase ≥4 points in the SLEDAI. Cases were defined as patients with at least one flare. Controls were selected by matching cases by length of follow-up. Demographic and clinical manifestations were systematically recorded by a common protocol. Glucocorticoid use was recorded as average daily dose of prednisone and antimalarial use as percentage of time on antimalarial and categorized as never (0%), rarely (>0-25%), occasionally (>25%-50%), commonly (˃50%-75%) and frequently (˃75%). Immunosuppressive drugs were recorded as used or not used. The association between demographic, clinical manifestations, therapy and flares was examined using univariable and multivariable conditional logistic regression models. Results A total of 465 cases and controls were included. Mean age at diagnosis among cases and controls was 27.5 vs 29.9 years, p = 0.003; gender and ethnic distributions were comparable among both groups and so was the baseline SLEDAI. Independent factors protective of flares identified by multivariable analysis were older age at diagnosis (OR = 0.929 per every five years, 95% CI 0.869-0.975; p = 0.004) and antimalarial use (frequently vs never, OR = 0.722, 95% CI 0.522-0.998; p = 0.049) whereas azathioprine use (OR = 1.820, 95% CI 1.309-2.531; p < 0.001) and SLEDAI post-baseline were predictive of them (OR = 1.034, 95% CI 1.005-1.064; p = 0.022). Conclusions In this large, longitudinal Latin American cohort, older age at diagnosis and more frequent antimalarial use were protective whereas azathioprine use and higher disease activity were predictive of flares.

Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL).

Objectives The objectives of this study were to examine the demographic and clinical features associated with the occurrence of pleuropulmonary manifestations, the predictive factors of their occurrence and their impact on mortality in systemic lupus erythematosus (SLE) patients. Materials and methods The association of pleuropulmonary manifestations with demographic and clinical features, the predictive factors of their occurrence and their impact on mortality were examined in GLADEL patients by appropriate univariable and multivariable analyses. Results At least one pleuropulmonary manifestation occurred in 421 of the 1480 SLE patients (28.4%), pleurisy being the most frequent (24.0%). Age at SLE onset ≥30 years (OR 1.42; 95% CI 1.10-1.83), the presence of lower respiratory tract infection (OR 3.19; 95% CI 2.05-4.96), non-ischemic heart disease (OR 3.17; 95% CI 2.41-4.18), ischemic heart disease (OR 3.39; 95% CI 2.08-5.54), systemic (OR 2.00; 95% CI 1.37-2.91), ocular (OR 1.58; 95% CI 1.16-2.14) and renal manifestations (OR 1.44; 95% CI 1.09-1.83) were associated with pleuropulmonary manifestations, whereas cutaneous manifestations were negatively associated (OR 0.47; 95% CI 0.29-0.76). Non-ischemic heart disease (HR 2.24; 95% CI 1.63-3.09), SDI scores ≥1 (OR 1.54; 95% CI 1.10-2.17) and anti-La antibody positivity (OR 2.51; 95% CI 1.39-4.57) independently predicted their subsequent occurrence. Cutaneous manifestations were protective of the subsequent occurrence of pleuropulmonary manifestations (HR 0.62; 95% CI 0.43-0.90). Pleuropulmonary manifestations independently contributed a decreased survival (HR: 2.79 95% CI 1.80-4.31). Conclusion Pleuropulmonary manifestations are frequent in SLE, particularly pleuritis. Older age, respiratory tract infection, cardiac, systemic and renal involvement were associated with them, whereas cutaneous manifestations were negatively associated. Cardiac compromise, SDI scores ≥1 and anti-La positivity at disease onset were predictive of their subsequent occurrence, whereas cutaneous manifestations were protective. They independently contributed to a decreased survival in these patients.

Early discoid lupus erythematosus protects against renal disease in patients with systemic lupus erythematosus: longitudinal data from a large Latin American cohort.

OBJECTIVES: The objective of this study was to examine whether early discoid lupus erythematosus (DLE) would be a protective factor for further lupus nephritis in patients with systemic lupus erythematosus (SLE). METHODS: We studied SLE patients from GLADEL, an inception longitudinal cohort from nine Latin American countries. The main predictor was DLE onset, which was defined as physician-documented DLE at SLE diagnosis. The outcome was time from the diagnosis of SLE to new lupus nephritis. Univariate and multivariate survival analyses were conducted to examine the association of DLE onset with time to lupus nephritis. RESULTS: Among 845 GLADEL patients, 204 (24.1%) developed lupus nephritis after SLE diagnosis. Of them, 10 (4.9%) had DLE onset, compared to 83 (12.9%) in the group of 641 patients that remained free of lupus nephritis (hazard ratio 0.39; P = 0.0033). The cumulative proportion of lupus nephritis at 1 and 5 years since SLE diagnosis was 6% and 14%, respectively, in the DLE onset group, compared to 14% and 29% in those without DLE (P = 0.0023). DLE onset was independently associated with a lower risk of lupus nephritis, after controlling for sociodemographic factors and disease severity at diagnosis (hazard ratio 0.38; 95% confidence interval 0.20-0.71). CONCLUSIONS: Our data indicate that DLE onset reduces the risk of further lupus nephritis in patients with SLE, independently of other factors such as age, ethnicity, disease activity, and organ damage. These findings have relevant prognosis implications for SLE patients and their clinicians. Further studies are warranted to unravel the biological and environmental pathways associated with the protective role of DLE against renal disease in patients with SLE.

Predictors of remission, erosive disease and radiographic progression in a Colombian cohort of early onset rheumatoid arthritis: a 3-year follow-up study.

The objective of the study is to find predictors of remission, radiographic progression (RP), and erosive disease in a cohort of patients with early onset rheumatoid arthritis (EORA) that followed a therapeutic protocol aiming at remission, in a real world tight-control setting. EORA patients were enrolled in a 3-year follow-up study. Clinical, biological, immunogenetic, and radiographical data were analyzed. Radiographs were scored according to Sharp-van der Heijde (SvdH) method. RP was defined by an increase of 3 units in 36 months. Remission was defined as DAS28 <2.6. A stepwise multiple logistic regression model was used to identify independent predictors of the three target outcomes. One hundred twenty-nine patients were included. Baseline disease activity was high. Significant overall improvement was observed, but only 33.3 % achieved remission. At 36 month, 50.4 % (65) of patients showed erosions. RP was observed in 62.7 % (81) of cases. Statistical analysis showed that baseline SvdH score was the only predictive factor associated with the three outcomes evaluated. Lower HAQ-DI and absence of autoantibodies were predictive of remission. Higher levels of ESR and presence of erosions at entry were predictive of RP. Independent baseline predictors of incident erosive disease were anti-CCP and RF positivity, symptom duration at baseline >3 months, and presence of HLA-DRB1 shared epitope. Radiographic damage at baseline was the main predictor of outcomes. Autoantibodies, HAQ and ESR at baseline, symptom duration before diagnosis, and HLA-DRB1 status had influence on clinical course and development of structural joint damage in Colombian RA patients.

Clinical, serologic, and immunogenetic characterization (HLA-DRB1) of late-onset lupus erythematosus in a Colombian population.

INTRODUCTION: Late-onset systemic lupus erythematosus (SLE) represents a specific subgroup that is defined as onset after 50 years of age. Late-onset lupus may have a different clinical course and serological findings, which may delay diagnosis and timely treatment. OBJECTIVES: The objective of this paper is to determine the clinical, serologic, and immunogenetic differences among Colombian patients with late-onset SLE versus conventional SLE patients. METHODOLOGY: This was a cross-sectional study in a Colombian population. Patients and their medical records were analyzed from the services of Rheumatology in Bogotá and met the criteria for SLE, according to the American College of Rheumatology (ACR) revised criteria for the classification of SLE.In a reference group of late-onset SLE patients (98 participants, with an onset after 50 years of age) and a group of conventional SLE patients (72 participants, with an onset of age of 49 years or less), multiple clinical variables (age, clinical criteria for lupus, alopecia, weight loss, fever, Raynaud's phenomenon) and multiple serological variables (blood count, blood chemistry profile, autoantibodies) were analyzed. Additionally, the HLA class II (DRB1) of all the patients was genotyped, including an additional group of patients without the autoimmune disease. Statistical analysis was performed using the STATA 10.0 package. RESULTS: In the group of late-onset lupus, there was a higher frequency of pleurisy (p = 0.002), pericarditis (p = 0.026), dry symptoms (p = 0.029), lymphopenia (p = 0.007), and higher titers of rheumatoid factor (p = 0.001) compared with the group of conventional SLE. Late-onset SLE patients had a lower seizure frequency (p = 0.019), weight loss (p = 0.009), alopecia (p < 0.001), and Raynaud's phenomenon (p = 0.013) compared to the conventional SLE group. In late-onset SLE, HLA DR17 (DR3) was found more frequently compared with individuals without autoimmune disease (OR 3.81, 95% CI 1.47 to 10.59) (p = 0.0016). CONCLUSION: In the Colombian SLE population analyzed, there may be a probable association of several clinical and serologic variants, which would allow the differentiation of variables in the presentation of the disease among patients with late-onset SLE vs. conventional SLE.

Mestizos with systemic lupus erythematosus develop renal disease early while antimalarials retard its appearance: data from a Latin American cohort.

OBJECTIVES: The objective of this paper is to assess the predictors of time-to-lupus renal disease in Latin American patients. METHODS: Systemic lupus erythematosus (SLE) patients (n = 1480) from Grupo Latino Americano De Estudio de Lupus (GLADEL's) longitudinal inception cohort were studied. Endpoint was ACR renal criterion development after SLE diagnosis (prevalent cases excluded). Renal disease predictors were examined by univariable and multivariable Cox proportional hazards regression analyses. Antimalarials were considered time dependent in alternative analyses. RESULTS: Of the entire cohort, 265 patients (17.9%) developed renal disease after entering the cohort. Of them, 88 (33.2%) developed persistent proteinuria, 44 (16.6%) cellular casts and 133 (50.2%) both; 233 patients (87.9%) were women; mean (± SD) age at diagnosis was 28.0 (11.9) years; 12.2% were African-Latin Americans, 42.5% Mestizos, and 45.3% Caucasians (p = 0.0016). Mestizo ethnicity (HR 1.61, 95% CI 1.19-2.17), hypertension (HR 3.99, 95% CI 3.02-5.26) and SLEDAI at diagnosis (HR 1.04, 95% CI 1.01-1.06) were associated with a shorter time-to-renal disease occurrence; antimalarial use (HR 0.57, 95% CI 0.43-0.77), older age at onset (HR 0.90, 95% CI 0.85-0.95, for every five years) and photosensitivity (HR 0.74, 95% CI 0.56-0.98) were associated with a longer time. Alternative model results were consistent with the antimalarial protective effect (HR 0.70, 95% CI 0.50-0.99). CONCLUSIONS: Our data strongly support the fact that Mestizo patients are at increased risk of developing renal disease early while antimalarials seem to delay the appearance of this SLE manifestation. These data have important implications for the treatment of these patients regardless of their geographic location.

Patients with relapsing polychondritis and previous cartilage trauma present more autoimmunity phenomena.

Relapsing polychondritis (RP) is an autoimmune disease characterized by inflammation and destruction of all type of body cartilage, and the cartilage trauma may be a trigger of the disease in a susceptible person. We describe the clinical and laboratory findings in a group of 18 patients with RP with (7 cases) or without (11 cases) anteceding cartilage trauma. The mean age was 41 years in the group with cartilage trauma and 55 years in the group without cartilage trauma. For both groups, female gender was predominant. All patients presented with auricular chondritis. Systemic manifestations and autoimmunity were more common in patients with anteceding trauma.

Validation of the Spanish, Portuguese and French versions of the Lupus Damage Index questionnaire: data from North and South America, Spain and Portugal.

We have previously developed and validated a self-administered questionnaire, modelled after the Systemic Lupus International Collaborating Clinics Damage Index (SDI), the Lupus Damage Index Questionnaire (LDIQ), which may allow the ascertainment of this construct in systemic lupus erythematosus (SLE) patients followed in the community and thus expand observations made about damage. We have now translated, back-translated and adapted the LDIQ to Spanish, Portuguese and French and applied it to patients followed at academic and non-academic centres in North and South America, Portugal and Spain while their physicians scored the SDI. A total of 887 patients (659 Spanish-speaking, 140 Portuguese-speaking and 80 French-speaking patients) and 40 physicians participated. Overall, patients scored all LDIQ versions higher than their physicians (total score and all domains). Infrequent manifestations had less optimal clinimetric properties but overall agreement was more than 95% for the majority of items. Higher correlations were observed among the Spanish-speaking patients than the Portuguese-speaking and French-speaking patients; further adjustments may be needed before the Portuguese and French versions of the LDIQ are applied in community-based studies. The relationship between the LDIQ and other outcome parameters is currently being investigated in a different patient sample.

Epidemiología de las vasculitis primarias en Colombia y su relación con lo informado para Latinoamérica / Epidemiology of primary vasculitis in Colombia and its relation with reported for latin america

Propuesta: las vasculitis primarias se expresan de forma variable entre pacientes y entre regiones, con frecuencias variables a través del mundo. Su incidencia promedio está calculada en 0,3 a 20 casos por millón de habitantes. Nosotros describimos la frecuencia de las vasculitis primarias en Colombia y la comparamos con lo informado en otros países de Latinoamérica (LA). Métodos: se revisó lo publicado en la literatura de vasculitis primaria en Colombia y en LA desde 1945 hasta 2007 en OLD Medline, Pub Med, BIREME, SciELO Colombia, LILACS. FEPAFEN, incluyendo publicaciones en inglés, español y portugués. La literatura incluye la información publicada del Hospital San Juan de Dios, Bogotá, Colombia y casos sin publicación enviados directamente por los autores. Nosotros calculamos el porcentaje para todos los casos que fueron informados para Colombia. Resultados: se identificaron 857 casos de vasculitis primaria en Colombia. La arteritis de Takayasu fue la vasculitis más frecuente en un 13,3% (114 casos) seguida de la enfermedad de Buerger en 11,2% (96 casos), las vasculitis cutáneas primarias y la poliarteritis nodosa en un 10% (86 casos) cada una. En niños, la vasculitis más frecuente fue la púrpura de Henoch Schönlein en un 24% (206 casos). En Latinoamérica se publicaron 177 artículos con 1605 casos informados. Se evidenció mayor presencia de arteritis de Takayasu en México y Brasil, y de poliangeítis microscópica en Chile y Perú. Conclusión: la mayoría de publicaciones sobre vasculitis primarias provienen de Europa, Norteamérica, Japón, Kuwait y Nueva Zelanda. Existen una serie de publicaciones y experiencia con estas patologías en LA. Un número considerable de publicaciones y casos con vasculitis primarias se han informado en Colombia en los recientes años, incluyendo la reciente descripción de la variante nodular de la vasculitis cutánea. La arteritis de Takayasu fue la variante más reportada del promedio de vasculitis, al igual que en Brasil y México. En contraposición a los hallazgos realizados en Brasil, Colombia y Mexico, las vasculitis asociadas a ANCA fueron la forma más informada en países como Chile y Perú. La mayoría de casos informados en LA provienen de México, siendo Colombia el segundo país en frecuencia. Es posible que exista más información pero no la conocemos, por no estar publicada. No existen estudios de incidencia y prevalencia. A escala mundial solo existen estudios de incidencia de las vasculitis primarias, y solo se han realizado estudios de incidencia y prevalencia en la granulomatosis de Wegener.

Purpose: primary vasculitis occurs with variable expression in individual patients and regions, and variable frequency throughout the world. Their overall incidence has been calculated to be 40 cases per million populations. We sought to describe the frequency of vasculitis in Colombia and compare it with vasculitis reported from other countries of Latin America (LA). Methods: review of available published literature on vasculitis in LA from 1945 to 2007 in OLD Medline, Pub Med, BIREME, SciELO Colombia, LILACS, FEPAFEN, including publications in English, Spanish and Portuguese. The literature included published information from San Juan de Dios hospital, Bogota, Colombia, and unpublished cases submitted directly to the authors. We calculated the percentage of all cases which are reported from Colombia. Results: we identified 857 cases of primary vasculitis in Colombia. Takayasu arteritis was the most common vasculitis in 13.3% (114 cases) followed by Buerger's disease in 11.2% (96 cases), primary cutaneous vasculitis and polyarteritis nodosa in a 10% (86 cases) each. In children, the vasculitis was more frequent in Henoch Schonlein purpura in 24% (206 cases). In Latin America, 177 articles were published in 1605 reported cases. It showed increased presence of Takayasu's arteritis in Mexico and Brazil, and microscopic poliangeiitis in Peru and Chile. Conclusion: while the majority of publications on primary vasculitis are from Europe and North America, there is a substantial literature and experience with these disorders in LA. A considerable number of publications and cases have emerged from Colombia in recent years, including case descriptions of a recently described variant of nodular cutaneous vasculitis. Takayasu arteritis was the most frequently reported form of primary vasculitis overall, and also from Brazil and Mexico. However, ANCA related vasculitis were the most commonly reported forms in Chile and Peru instead. The greatest numbers of cases were reported from Mexico, the LA's most populous country, with Colombia a close second.

Erosive arthropathy: clinical variance in lupus erythematosus and association with anti-CCP case series and review of the literature.

OBJECTIVE: To describe the occurrence of erosive arthropathy in systemic lupus erythematosus (SLE) and its relationship to anti-CCP antibodies. METHODS: Retrospective medical record review of a case series of five female patients with SLE and erosive arthropathies. RESULTS: The initial disease presentation in all patients was a polyarthritis. Anti-CCP antibodies were detected in 4 out of 5 (80%) patients, 2 of whom had a positive rheumatoid factor. CONCLUSION: Erosive arthritis was strongly associated with the presence of anti-CCP antibodies in these patients with SLE, who presented with polyarthritis. Anti-CCP in patients with SLE may be a marker of a more severe joint disease.

Osteopoiquilia. Estudio de 12 pacientes / Osteopoikilia. Study of 12 patients

La osteopoiquilia y osteopatía condensante diseminada es una rara entidad, de carácter hereditaria-familiar, que afecta especialmente al sexo masculino y de curso asintomático, caracterizada por el hallazgo radiológico de pequeños focos ovoides o lenticulares entre 2 mm y 2 cm, paralelos al eje longitudinal del hueso. Se ha descrito asociada a la dermatofibrosis conocida como síndrome de Buschke-Ollendorff. Se describe una serie de 12 pacientes, con diagnóstico de osteopoiquilia de acuerdo a los criterios diagnósticos establecidos, observando en todos ellos adecuado modelado óseo, razón por la que se propone clasificar esta entidad en un grupo diferente al de las llamadas enfermedades displásicas de hueso. Se describe la primera asociación en la literatura mundial entre osteopoiquilia, dermatofibrosis lenticular y condrocalcinosis (AU)

Psoriasis y artritis psoriásica / Psoriasis and psoriasica arthritis

La psoriasis es una enfermedad inflamatoria de la piel, de carácter crónico y recurrente, caracterizada por lesiones eritemato - descamativas. En su patogénesis se conjugan factores inmunogenéticos y ambientales. La artritis psoriática, que es una artropatía seronegativa, en la mayoría de los casos sigue a un curso crónico de psoriasis cutánea. En este artículo analizamos las formas mas frecuentes de presentación de la psoriasis cutánea y revisamos la artropatía psoriática, con indicaciones para el tratamiento de esta última

Osteoporosis de un hemicuerpo en paciente con esclerodermia localizada. posible relación con disfunción en el mecanostato óseo. Informe de un caso / Osteoporosis of Hemmibody in a patient with localizated scleroderma. Posible relation with disfuntion of mechanostat bone

Se presenta el caso de una paciente con esclerodermia localizada inusualmente extendida en el hemicuerpo izquierdo, con atrofia muscular y desarrollado de osteoporosis en dicho hemicuerpo. Nos ilustra esta condición una posible disfunción regional del mecanostato óseo, la cual determina el desarrollo de un hueso osteoporótico, quizá secundario a la falta de estímulo generado por una contracción muscular efectiva (AU)

Acro-osteólisis primaria. Un síndrome con múltiples expresiones clínicas. Presentación de un caso y análisis de la literatura / Primary acro-osteolysis. A syndrome with multiple clinical expressions. Presentation of one case and review of the literature

Las acro-osteólisis son un proceso de resorción ósea y se clasifican en primarias y secundarias. La etiopatogénesis de la acro-osteolisis primaria es desconocida, presenta un grupo de manifestaciones clínicas heterogéneas asociadas, la consideramos como un síndrome con múltiples expresiones clínicas, y por ello debemos considerarla como una enfermedad multifactorial y poligénica. Presentamos un caso de una mujer con acro-osteólisis primaria y poliartritis simétrica similar a artritis reumatoidea (AU)

Calcinosis universal: una manifestación atípica de las colagenosis. ¿Es una vía común o vías diferentes del proceso inflamatorio? / Universal calcinosis: an atypical manifestation of collagenosis. Is it a commom pathway or different pathways of the imflammatory state?

La calcificación y osificación extraesquelética son patologías que observamos frecuentemente en la práctica clínica. En este artículo presentamos tres casos de calcinosis universalis, una con dermatomiositis, una con lupus y otra con esclerodermia sin esclerodermia. Aun cuando la patogénesis del proceso inflamatorio es diferente en las tres enfermedades, existe una vía común que conduce al depósito de sales de calcio en los tejidos. El proceso inflamatorio deja un sustrato tisular lesionado que predispone al desarrollo de calcificaciones distróficas (AU)

Hiperfosfatasia. ¿Una displasia ósea o una verdadera enfermedad metabólica ósea? A propósito de un caso / Hyperphosphatasia. Bone dysplasia or a renal bone metabolic disease?

En este artículo presentamos el caso de una niña de 4 años de edad con hiperfosfatasia, una enfermedad caracterizada por elevación de la fosfatasa alcalina por un defecto enzimático, con alteraciones en la formación de hueso membranoso dando lugar a macrohuesos en el cráneo, huesos largos, costilla y columna. La paciente que se revisa presentaba además una hipercalcemia, hallazgo para el cual no encontraron una explicación clara, pero que sin embargo, constituye una asociación que no ha sido descrita en la literatura. Presentamos finalmente una revisión de los casos de hiperfosfatasia informados hasta ahora en la literatura y planteamos la necesidad de clasificar mejor las enfermedades óseas e incluirla como una enfermedad metabólica ósea y no una displasia (AU)

Factores de riesgo para osteoporosis y osteopenia en 707 mujeres seleccionadas en bogotá / Risk factors for osteoporosis and osteopenia among 707 selected women in Bogotà

Antecedente. La osteoporosis tiene una prevalencia elevada en la población femenina de Bogotá, como se estableció en un estudio previo.Objetivo. Determinar la asociación para antecedentes de cirugía, fractura, enfermedades y uso de medicinas como factores de riesgo para la pérdida de masa ósea en mujeres con 45 o más años de edad.Diseño. Análisis retrospectivo de cohorte.Ubicación. Centro de diagnóstico de densidad mineral ósea.Pacientes. Setecientas siete mujeres remitidas para estudio de densidad mineral ósea por sospecha clínica de osteoporosis u osteopenia.Mediciones. Absorciometría de rayos X de fotón dual.Resultados. La prevalencia de osteopenia (-1,0 DE T-score > -2,5 DE) y osteoporosis (T-score -2,5 SD) fue 32,3 por ciento y 51,8 por ciento respectivamente, para ambos, la columna y el cuello femoral tomados juntos. La mayoría de las mujeres estuvieron en el grupo de edad de 50 a 59 años, 40,3 por ciento, con antecedente quirúrgico 78,6 por ciento, incluidas indicaciones generales, ginecológicas 17 por ciento y obstétricas 11 por ciento. El antecedente de enfermedad más frecuente fue el grupo de osteoarticulares 62,1 por ciento y endocrina 22,3 por ciento. El uso de estrógenos y otros medicamentos al momento del examen se presentó en el 10,6 por ciento de las mujeres. El 82,3 por ciento tuvieron antecedente de fractura de antebrazo, cadera 7,8 por ciento, columna 5,3 por ciento y otras 4,6 por ciento. La fractura de cadera está asociada con baja densidad mineral ósea (RR=1,18; IC.: 1,14-1,22), la de columna también (RR=1,18; IC.: 1,14-1,22), pero para antebrazo no fue significativa (RR=1,03; IC: 0,90-1,16). Para haber tenido enfermedad previa hubo asociación significativa con osteoporosis u osteopenia (RR=1,15; CI: 1,08-1,22), y específicamente para enfermedad osteoarticular hubo asociación estadísticamente significativa (RR=1,11; CI: 1,03-1,18). El antecedente quirúrgico no mostró asociación ni con osteoporosis ni con osteopenia (RR=0,94; CI: 0,881,02).Conclusiones. La densidad mineral ósea está reducida en diversos sitios esqueléticos en muchas mujeres sobre los 45 años de edad. La edad, el antecedente de fractura, el antecedente de enfermedad previa y la osteoartrosis son predictores de baja densidad mineral del hueso en esta población. Se recomienda la implementación de programas educativos para la prevención de la osteoporosis (AU)

Poststreptococcal reactive arthritis in adults: long-term follow-up.

BACKGROUND: Poststreptococcal reactive arthritis (PSReA) is a recognized inflammatory articular syndrome that follows group A streptococcal infection in persons not fulfilling the Jones criteria for the diagnosis of acute rheumatic fever. Characteristic features include nonmigratory arthritis, lack of response to aspirin or nonsteroidal anti-inflammatory agents, and the presence of extra-articular manifestations, including vasculitis and glomerulonephritis. Whether or not patients with PSReA develop carditis is a point of contention. METHODS: We analyzed the clinical features, laboratory findings, response to therapy, and outcome in patients diagnosed with PSReA between 1983 and 1998 and observed through April 2000. All patients were contacted, reexamined, and repeat antistreptolysin, rheumatoid factor, C3 and C4 complement components, and echocardiograms were performed. RESULTS: Seventeen patients (4 men and 13 women) were included. All were of low socioeconomic status. All patients had acute severe arthritis that began shortly after a sore throat episode. Extra-articular involvement including tenosynovitis, vasculitis, and glomerulonephritis was relatively common. More importantly, none exhibited clinical and/or echocardiographic evidence of cardiac involvement. Longterm antibiotic therapy was not given. CONCLUSION: Cardiac involvement did not occur in this group of patients with PSReA. Prolonged prophylactic antibiotic therapy may not be required for adult patients presenting with PSReA.

Estudio de la osteomalacia y raquitismo en diferentes períodos históricos en colombia / Study of osteomalacia in diferent historical periods in Colombia

Dividimos el trabajo en tres etapas. En la primera buscamos la recopilación de la información sobre raquitismo y osteomalacia desde finales del siglo XIX hasta 1960. En la segunda etapa revisamos los archivos estadísticos de la Unidad de Reumatología del Hospital San Juan de Dios desde su creación en 1967, y los pacientes que se consultaban desde esa época. La tercera etapa fue dividida en dos sub-etapas, la primera sub-etapa se refiere al estudio prospectivo del foco de raquitismo en el municipio de Suárez en 1991, y la segunda sub-etapa trata sobre los casos prospectivos desde 1984 hasta Marzo del 2000 en la Clínica de Fracturas de Barranquilla, el Hospital San Juan de Dios de Bogotá, y los casos remitidos a uno de los investigadores. En la primera etapa sólo encontramos la tesis del Dr. Francisco Sorzano, publicada en 1899. Estudió 6 casos de raquitismo secundario, hipovitaminosis D y de desnutrición proteico calórica. Se utilizan por primera vez el aceite de hígado de bacalao y sales de calcio y fosfatos. A partir de 1960 se estudian 7 familias y se describen por primera vez en Colombia el raquitismo hipofosfatémico ligado al cromosoma X, es el caso de cuatro familias con raquitismo hipofosfatémico y dos familias con raquitismo hipocalcémico. En 1991 describimos el clúster más grande del mundo, aproximadamente 400 pacientes, pero sólo informamos sobre 64 pacientes. Demostramos qué es un raquitismo dependiente de vitamina D tipo IIB; es estudiado con más detenimiento el receptor de la vitamina D, el cual fue encontrado normal, aunque el defecto se encuentra a nivel posttranslacional. De forma prospectiva, a partir de 1984 estudiamos 19 pacientes con raquitismo y osteomalacia, asociadas a diferentes etiologías e introducimos los estudios de desintometría ósea, los niveles polares de vitamina D, hormona paratiroidea (PTH), y las iso-enzimas de la fosfatasa alcalina (AU)

Osteomalacia y raquitismo. análisis y estudio en diferentes períodos históricos en colombia / Osteomalacia and riketts. Analysis and study of different historic periods in Colombia

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