Factors associated with asymptomatic vertebral fractures in patients with rheumatoid arthritis in a rheumatology service in Bogotá (Colombia)

Introduction: In patients with rheumatoid arthritis (RA), osteoporotic vertebral fractures (OVF) are of multifactorial etiology. The main mechanism is spontaneous and therefore most are asymptomatic. The presence of VF has an impact on the quality of life of patients, and consequently on morbidity and mortality, therefore it should be systematically evaluated in this population, especially when associated factors have been reported. The main objective of this study was to identify clinical characteristics for osteoporosis and poor prognosis in rheumatoid arthritis that could be associated with the development of osteoporotic vertebral fractures identified in the lateral chest X-ray of asymptomatic patients with RA. The secondary objectives were to present the frequency, location, and severity of the fractures, as well as the inter and intra-observer correlation, when analyzing the radiographs. Methodology: Patients with a diagnosis of RA were included, with a lateral chest X-ray and indication dissimilar to spinal symptoms. The mean age was 58 years (IQR 21-88). Three researchers evaluated 151 images in a sequenced and standardized manner using the Algorithm-Base Qualitative approach (ABQ) and Genant methods. Variables associated with the presence of osteoporosis and poor prognosis in RA were identified. Subsequently, a multivariate analysis was carried out to find an association with the presence of VF in this population. Results: We found 39 fractures in 32/151 patients. Identifying multiple fractures in 5 of them. The prevalence of osteoporotic vertebral fractures was 21.2%. The distribution of fractures was mainly at the level of T5, T8 and T9, with a predominance of Genant grade 1 in 46%. In the multivariate analysis, age, duration of RA (mainly greater than 10 years), rheumatoid factor, anti-citrullinated peptide antibodies, DAS28, HAQ, presence of antinuclear antibodies (ANA), smoking and being under treatment for osteoporosis showed a statistically significant association. The interobserver correlation for the ABQ and Genant methods presented a kappa index of .9 and .92, respectively. Conclusion: In patients with RA there is a significant association with the development of VF, independent of the presence of osteoporosis. Furthermore, this research suggests that the presence of some clinical and paraclinical characteristics could be associated with the prevalence of osteoporotic vertebral fractures. Age, duration of arthritis, poor prognostic markers for RA in terms of serology and functionality, as well as being in treatment for osteoporosis had statistical significance of association. This should guide the timely detection of fractures, independent of symptoms, with the respective targeted treatment in this population and thus avoid functional complications and a decrease in quality of life.

Introducción: En los pacientes con artritis reumatoide (AR) las fracturas vertebrales osteoporóticas (FVO) son de etiología multifactorial. El principal mecanismo es espontáneo y por ende la mayoría son asintomáticas. La presencia de FVO impacta en la calidad de vida de los pacientes y, en consecuencia, en la morbilidad y la mortalidad, por lo tanto, se debería evaluar de forma sistemática en esta población, más aún cuando se han reportado factores asociados. Objetivos: Los objetivos principales fueron identificar las características clínicas de osteoporosis y de mal pronóstico en AR, que podrían estar asociadas con el desarrollo de fracturas vertebrales osteoporóticas identificadas en la radiografía lateral de tórax en pacientes asintomáticos con AR, y los objetivos secundarios fueron presentar la frecuencia, la localización y la severidad de las fracturas, como también la correlación inter e intraobservador al analizar las radiografías. Metodología: Se incluyeron pacientes con diagnóstico de AR, con radiografía lateral de tórax e indicación disímil a síntomas en columna. La media de edad fue de 58 arios (RIC 21-88). Tres investigadores evaluaron 151 imágenes, de manera secuencial y estandarizada, utilizando los métodos Algorithm-Base Qualitative approach (ABQ) y de Genant. Se identificaron variables asociadas con la presencia de osteoporosis y de pobre pronóstico en AR. Posteriormente, se hizo un análisis multivariado orientado a encontrar asociación con la presencia de FVO en esta población. Resultados: Se encontraron 39 fracturas en 32/151 pacientes, en cinco de ellos se encontraron múltiples fracturas. La prevalencia de fracturas vertebrales osteoporóticas fue de 21,2%. La distribución de fracturas fue principalmente a nivel de T5, T8 y T9, con predominio de aquellas grado 1 de Genant (46%). En el análisis multivariado, la edad, la duración de la AR (principalmente mayor a 10 anos), el factor reumatoideo, los anticuerpos antipéptidos citrulinados, el Disease Activity Score-28 (DAS28), el Health Assessment Questionnaire (HAQ), la presencia de anticuerpos antinucleares (ANA), el tabaquismo y estar en tratamiento para osteoporosis presentaron una asociación estadísticamente significativa. La correlación interobservador para los métodos ABQ y Genant presentó un índice kappa de 0,9 y 0,92, respectivamente. Conclusión: En pacientes con AR existe una asociación significativa con el desarrollo de FVO, con independencia de la presencia de osteoporosis. Además, esta investigación sugiere que la presencia de algunas características clínicas y paraclínicas podría estar asociada con la prevalencia de fracturas vertebrales osteoporóticas. La edad, la duración de la artritis, los marcadores de mal pronóstico de la AR en cuanto a serología como funcionalidad, así como estar en tratamiento para osteoporosis tuvieron significancia estadística de asociación. Esto debería guiar una detección oportuna de las fracturas, más allá de los síntomas, con el respectivo tratamiento dirigido a esta población y así evitar complicaciones funcionales y una disminución en la calidad de vida.

Serum chemerin in a cohort of Colombian patients with primary osteoarthritis.

BACKGROUND AND PURPOSE: Osteoarthritis (OA) is considered the most common degenerative joint pathology in the adult population, being an important cause of disability worldwide, and its prevalence is increasingly associated with different factors, including obesity. Obesity together with metabolic syndrome have been associated with a pro-inflammatory state due to the release of cytokines that induce changes in cartilage metabolism. Chemerin is an adipokine secreted mainly by adipocytes and its final action is to increase the production of IL-6, IL-8, IL-1b, TNF-a and metalloproteinases by macrophages, dendritic cells and chondrocytes, which are responsible for damage to the articular cartilage. This is one of the reasons that obesity and inflammation have been linked to OA. The main objective of this study is to determine whether the serum chemerin concentrations of a group of patients with primary OA are higher when compared with control individuals. A further purpose of the study is to determine the relationship between the presence of obesity/overweight with the severity of the disease measured by a radiological scale. PATIENTS AND METHODS: An analytical cross-sectional study was carried out where serum chemerin levels were quantified by enzyme-linked immunoadsorption assay (ELISA), in patients with primary OA of the hip, knee and hand with criteria from the ACR (American College Of Rheumatology) and controls. Radiological studies of patients and controls were analysed to determine the severity of joint involvement using the Kellgren and Lawrence (KL) classification system. The statistical significance of the difference in serum chemerin values between the two groups was verified and the correlation between the variables of body mass index (BMI) with radiological severity, number of joint regions and serum chemerin levels was analysed. RESULTS: During the period from July 2015 to July 2016, serum samples and radiographs of compromised joints were collected from 40 patients with primary OA who met the inclusion criteria, as well as serum samples from 20 controls. The average concentration of chemerin was higher in the group of patients with OA compared to that of the control group, being 373ng / ml and 175.55ng / ml respectively (p<2.2×10-16). No significant associations were found between the different degrees of disease severity measured by the KL radiological scale, such as the number of involved joint regions and BMI. CONCLUSIONS: In a group of patients with primary OA of the hand, knee or hip, the values of chemerin were higher than those found in controls, without significant association with the severity of the disease established radiologically by K/L scale, the number of involved joint regions, and the BMI.

Quemerina sérica en una cohorte de pacientes colombianos con osteoartritis primaria / Serum chemerin in a cohort of Colombian patients with primary osteoarthritis

Antecedentes y objetivo: La osteoartritis (OA) es considerada como la enfermedad articular degenerativa más frecuente en la población adulta, siendo una causa importante de discapacidad a nivel mundial, y su prevalencia va en aumento asociada a diferentes factores entre ellos la obesidad. La obesidad junto con el síndrome metabólico se han asociado con un estado pro inflamatorio debido a la liberación de citocinas que inducen cambios en el metabolismo del cartílago. La quemerina es una adipocina secretada principalmente por adipocitos, y tiene como acción final, el aumento de la producción de IL-6, IL-8, IL-1b, TNF-a y metaloproteinasas por parte de macrófagos, células dendríticas y condrocitos, las cuales son encargadas del daño del cartílago articular. Esta es una de las razones por la que se ha relacionado la obesidad y la inflamación con la OA. El objetivo principal de este estudio consiste en determinar si las concentraciones de quemerina en suero de un grupo de pacientes con OA primaria son mayores al compararlos con individuos controles sanos; y adicionalmente determinar la relación entre la presencia de obesidad/sobrepeso con la severidad de la enfermedad medida por una escala radiológica. Pacientes y métodos: Se realizó un estudio de corte transversal analítico donde se cuantificaron los niveles de quemerina en suero mediante ensayo por inmunoadsorción ligado a enzimas (ELISA), en pacientes con OA primaria de cadera, rodilla y mano con criterios del American College Of Reumathology (ACR) y controles sanos. Se analizaron los estudios radiológicos de los pacientes y controles para determinar la severidad del compromiso articular aplicando el sistema de clasificación de Kellgren y Lawrence (KL).(AU)

Background and purpose: Osteoarthritis (OA) is considered the most common degenerative joint pathology in the adult population, being an important cause of disability worldwide, and its prevalence is increasingly associated with different factors, including obesity. Obesity together with metabolic syndrome have been associated with a pro-inflammatory state due to the release of cytokines that induce changes in cartilage metabolism. Chemerin is an adipokine secreted mainly by adipocytes and its final action is to increase the production of IL-6, IL-8, IL-1b, TNF-α and metalloproteinases by macrophages, dendritic cells and chondrocytes, which are responsible for damage to the articular cartilage. This is one of the reasons that obesity and inflammation have been linked to OA. The main objective of this study is to determine whether the serum chemerin concentrations of a group of patients with primary OA are higher when compared with control individuals. A further purpose of the study is to determine the relationship between the presence of obesity/overweight with the severity of the disease measured by a radiological scale. Patients and methods: An analytical cross-sectional study was carried out where serum chemerin levels were quantified by enzyme-linked immunoadsorption assay (ELISA), in patients with primary OA of the hip, knee and hand with criteria from the American College Of Rheumatology (ACR) and controls. Radiological studies of patients and controls were analysed to determine the severity of joint involvement using the Kellgren and Lawrence (KL) classification system. The statistical significance of the difference in serum chemerin values between the two groups was verified and the correlation between the variables of body mass index (BMI) with radiological severity, number of joint regions and serum chemerin levels was analysed.(AU)

Association between Postural Orthostatic Tachycardia Syndrome and Joint Hypermobility.

Joint hypermobility syndrome refers to increased joint flexibility beyond the normal range of motion. This syndrome has a benign form known as Ehlers-Danlos syndrome type 3. This is a disorder in which hypermobility is accompanied by clinical manifestations in the absence of any systemic disease. A clinical finding associated with this condition is postural orthostatic tachycardia syndrome. The following is a rare case of joint hypermobility syndrome and postural orthostatic tachycardia syndrome. The relevance of this case report lies in the impact that this disease had on the patient's quality of life and the limitation in the performance of activities of daily living.

Variación en la definición del examen articular para la clinimetría de la artritis reumatoide: resultados de una encuesta realizada a un grupo de reumatólogos colombianos / Variation in the definition of the examination of joints in rheumatoid arthritis: Results of a survey conducted on a group of Colombian rheumatologists

RESUMEN Introducción: En el seguimiento de los pacientes con artritis reumatoide (AR) el examen articular (determinar el número de articulaciones dolorosas e inflamadas) es la piedra angular para determinar la actividad. El objetivo del estudio fue conocer la opinión de un grupo de reumatólogos acerca del examen articular de los pacientes con AR al definir la articulación tumefacta o dolorosa y, de la misma manera, evaluar la variación en el examen articular entre los participantes. Métodos: Se aplicó un cuestionario, desarrollado por los autores, a un grupo de reumatólogos para explorar aspectos generales y específicos al examinar cada una de las articulaciones, además de conceptos de las definiciones de dolor y de inflamación en el examen físico. Resultados: El 78% de los entrevistados consideró que todos los aspectos eran importantes, como evaluar la movilización pasiva de la articulación, explorar el dolor a la palpación y el dolor espontáneo. El 53,8% consideró la movilidad pasiva sin que haya dolor o edema articular a la palpación. El 62,6% estaba de acuerdo con realizar la presión hasta cuando comienza a palidecer el lecho ungular del dedo del examinador. En el momento de palpar el margen articular para determinar la inflamación, el 55% estuvo de acuerdo y el 14,3% no estuvo seguro. Para el 47,2% eran importantes el derrame articular, la fluctuación y la alteración del rango del movimiento para definir la inflamación en el examen articular. Cerca de las tres cuartas partes estuvo de acuerdo con la técnica de las articulaciones temporomandibular, acromioclavicular, esternoclavicular, hombro y tobillo. Se evidenció que pocos estaban de acuerdo con la técnica en la articulación de la cadera. Al preguntarse por más de una técnica en algunas articulaciones, como las MCF (57,1%) y del tarso medio (45%), el porcentaje de los que estuvieron de acuerdo con una de las 2 técnicas disminuyó. Discusión: Al parecer no existe un método de examen formal, ya que hubo diferentes opiniones en las técnicas propuestas. Esto puede ser crítico, ya que el examen articular es la base de la clinimetría de la AR. Un porcentaje importante del grupo no estuvo de acuerdo o seguro acerca de algunos conceptos sobre componentes del examen, lo que denota una variación en los conceptos y esto podría llevar a la mala clasificación de los pacientes al determinar la actividad de la enfermedad, lo que impactaría en la estrategia T2T o treat to target. Conclusión: Existió una gran variación en la opinión acerca de los conceptos relacionados con el examen articular del paciente que padece AR al definir articulaciones tumefactas o dolorosas, por lo que se recomienda a futuro un proceso de estandarización como la mejor alternativa.

ABSTRACT Introduction: In the follow-up of rheumatoid arthritis (RA) patients, the physical examination of the joints in order to determine the number of painful and swollen joints is the corners-tone for determining activity. The objective of this study was to find out the opinion of a group of rheumatologists as regards the examination of joints of patients with RA to define the swollen or painful joint. At the same time an evaluation was made on the variation in the joints examination between the participants. Methods: A questionnaire was administered to a group of rheumatologists in order to determine general issues and examining each of the joints, as well as concepts of definitions of pain and inflammation in the joints. Results: The majority of the participants (78%) stated that all aspects were important, such as evaluating passive joint mobilisation, pain to palpation, and spontaneous pain. Passive mobility without having pain or swollen joint tenderness was said to be important by 53.8% of the participants, and 62.6% agreed with observing the pressure exerted by the examiner until the nail bed of the finger started to turn pale. As regards touching the margin of joint to determine swelling, 55% agreed, and 14.3% were not sure. Synovial effusion, fluctuation, and the alteration in the range of motion to define inflammation in the examination of joint were important for 47.2% of the examiners. Almost three-quarters agreed with the temporomandibular, acromioclavicular, sternoclavicular, shoulder and ankle joint technique. It was obvious that few were in accordance with the technique in the hip joint. When asked about more than one technique in some joints such as the MCF (57.1%) and mid-tarsal (45%) joints, there was a decrease in the percentage of those who agreed with one of the 2 techniques. Discussion: Apparently, there is no standard joint assessment method, since there were different opinions in the techniques proposed. This could be critical since examination of joints is the basis of the clinimetric examination in RA. A significant percentage of the group did not agree or were unsure of some components of the examination. This could lead to a variation in the concepts and a misclassification of patients in order to determine the activity of RA. This would also have an impact on the T2T or treat to target strategy. Conclusion: There was a wide variation in opinions about the concepts related to the examination of joints, such as defining swollen or painful joints in patients suffering RA. This requires a process of standardisation as the best recommended alternative.

Serum chemerin in a cohort of Colombian patients with primary osteoarthritis. / Quemerina sérica en una cohorte de pacientes colombianos con osteoartritis primaria.

BACKGROUND AND PURPOSE: Osteoarthritis (OA) is considered the most common degenerative joint pathology in the adult population, being an important cause of disability worldwide, and its prevalence is increasingly associated with different factors, including obesity. Obesity together with metabolic syndrome have been associated with a pro-inflammatory state due to the release of cytokines that induce changes in cartilage metabolism. Chemerin is an adipokine secreted mainly by adipocytes and its final action is to increase the production of IL-6, IL-8, IL-1b, TNF-α and metalloproteinases by macrophages, dendritic cells and chondrocytes, which are responsible for damage to the articular cartilage. This is one of the reasons that obesity and inflammation have been linked to OA. The main objective of this study is to determine whether the serum chemerin concentrations of a group of patients with primary OA are higher when compared with control individuals. A further purpose of the study is to determine the relationship between the presence of obesity/overweight with the severity of the disease measured by a radiological scale. PATIENTS AND METHODS: An analytical cross-sectional study was carried out where serum chemerin levels were quantified by enzyme-linked immunoadsorption assay (ELISA), in patients with primary OA of the hip, knee and hand with criteria from the American College Of Rheumatology (ACR) and controls. Radiological studies of patients and controls were analysed to determine the severity of joint involvement using the Kellgren and Lawrence (KL) classification system. The statistical significance of the difference in serum chemerin values between the two groups was verified and the correlation between the variables of body mass index (BMI) with radiological severity, number of joint regions and serum chemerin levels was analysed. RESULTS: During the period from July 2015 to July 2016, serum samples and radiographs of compromised joints were collected from 40 patients with primary OA who met the inclusion criteria, as well as serum samples from 20 controls. The average concentration of chemerin was higher in the group of patients with OA compared to that of the control group, being 373 ng / ml and 175.55 ng / ml respectively (p<2.2×10-16). No significant associations were found between the different degrees of disease severity measured by the KL radiological scale, such as the number of involved joint regions and BMI. CONCLUSIONS: In a group of patients with primary OA of the hand, knee or hip, the values of chemerin were higher than those found in controls, without significant association with the severity of the disease established radiologically by K/L scale, the number of involved joint regions, and the BMI.

The impact of smoking on disease activity, disability, and radiographic damage in rheumatoid arthritis: is cigarette protective?

The ojective of this study is to assess the effect of tobacco smoking on disease activity, functional ability, and joint damage in a cohort of patients with early onset rheumatoid arthritis (EORA). 129 EORA patients attending the Rheumatology Unit of the School of Medicine of the "Universidad Nacional de Colombia" and the "Clínica de Artritis y Rehabilitación" in Bogota, Colombia, were enrolled in a prospective observational cohort study with 3-year follow-up. Clinical, biological, immunogenetics, and radiographic data were analyzed. Active disease was defined as DAS28 > 2.6. Smoking status was assessed by self-report as "never smokers" and "ever smokers". Patient groups with different smoking status were compared for RA measures. Status as "never smokers" and "ever smokers" was reported by 81.3 and 18.7%. Ever smokers had less risk of disability (HAQ-DI ≥ 0.5) at 36 month (Ever smokers vs. Never smokers OR for HAQ ≥ 0.5 0.25, 95% CI 0.06-0.97, p = 0.04). When former smokers were excluded in analysis, we found that current smoking was also associated with less disability and less risk of active disease. The percentage of erosive disease, radiographic progression, and SvdH score were similar in all smoking categories. In Colombian patients with EORA, smoking was associated with less disease activity and disability. Radiographic joint damage progressed at an equivalent rate in smokers and non-smokers. These data suggest a more benign, or at least not deleterious clinical course in smokers with RA.

Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort.

OBJECTIVE: To examine hematological manifestations' correlates and their impact on damage accrual and mortality in SLE patients from the multiethnic, Latin American, GLADEL cohort. METHODS: In patients with recent SLE diagnosis (≤2 years), the association between follow-up hematological manifestations (per ACR criteria) and socio-demographic and clinical variables was examined by univariable and multivariable logistic regressions; their impact on damage accrual and mortality was examined by Poisson and Cox proportional-hazards regression analyses, respectively. RESULTS: Of 1437 patients, 948 (66.0%) developed ≥1 hematological manifestation [5.5% hemolytic anemia (AHA), 16.3% thrombocytopenia, and 56.4% lymphopenia] over 4.3 (3.3) follow-up years. Younger age, Mestizo ethnicity, hematologic disorder (at/or before SLE diagnosis), and first damage recorded were associated with hematological manifestations while antimalarials were negatively associated. AHA (at/or before SLE diagnosis), anti-Sm, and anti-RNP antibodies were associated with subsequent AHA occurrence while musculoskeletal involvement was negatively associated. Thrombocytopenia (at/or before SLE diagnosis), AHA, anti-phospholipid antibodies (aPLs), anti-SSA/Ro, anti-SSB/La antibodies, and first damage recorded were associated with later thrombocytopenia occurrence. Lymphopenia (at/or before SLE diagnosis), younger age at diagnosis, Mestizo ethnicity, having medical insurance, and first damage recorded were associated with subsequent lymphopenia occurrence while antimalarials and azathioprine treatment were negatively associated. AHA was associated with damage accrual and mortality after adjusting for variables known to affect these outcomes. CONCLUSIONS: Mestizo ethnicity and early hematological manifestations are risk factors for their subsequent occurrence while antimalarials have a protective effect. The associations between AHA and aPLs and thrombocytopenia were corroborated. AHA contributes independently to damage accrual and diminished survival.

Fibrosis retroperitoneal asociada a una hiperostosis corticalgeneralizada: presentación de un caso / Retroperitoneal fibrosis associated with a generalized cortical hyperostosis: presentation of a case

La fibrosis retroperitoneal es una entidad clínica, de presentación poco frecuente,caracterizada por un trastorno fibroso e inflamatorio crónico, que rodea estructurasabdominales, principalmente los aspectos peri vasculares de las mismas, y que esexplicada por diferentes etiologías, siendo las más importantes la fibrosis retroperitonealidiopática y la fibrosis secundaria a trastornos relacionados con la subclase de IgG4. Por suparte, la hiperostosis cortical generalizada pertenece a un grupo de enfermedades raras depatologías metabólicas óseas osteocondensantes. En este caso, se presenta una pacientede 45 años de edad con fibrosis retroperitoneal, de etiología no establecida, asociada ahiperostosis cortical generalizada. La asociación de estas dos patologías, no reportadaanteriormente en la literatura, parece ser una relación espuria, sin embargo, existenalgunos mecanismos patogénicos entrelazados.

Retroperitoneal fibrosis is a rare clinical condition, characterized by a fibro-inflammatory disorder that surrounds abdominal structures, principally at perivascular level, and that is explained by different etiologies like idiopathic fibrosis and IgG4 related disorders. Generalized cortical hyperostosis belongs to a group of rare metabolic bone condensation diseases.The case is presented of a 45 year old female patient with a retroperitoneal fibrosis of unknown origin associated with generalized cortical hyperostosis. The association of these two conditions has not previously reported in the literature. This appears to be a spurious relationship, although some pathogenic mechanisms are intertwined.

Historia del compromiso cutáneo de la esclerosis sistémica / History of skin commitment in systemic sclerosis

Resumen La esclerosis sistémica (escleroderma) es una enfermedad autoinmune del tejido conectivo cuya causa no ha sido definida, con gran morbilidad y mortalidad, dadas sus múltiples complicaciones tanto cutáneas como sistémicas. A pesar de ser reconocida desde hace siglos, aún no se cuenta con intervenciones óptimas para controlar definitivamente su progresión y evitar la aparición de lesiones en órganos diferentes a la piel. Teniendo como características clínicas sobresalientes el fenómeno de Raynaud y los cambios fibróticos cutáneos, el objetivo de esta investigación histórica es presentar las descripciones clínicas y patológicas históricas, mostrando la evolución en el enfoque y manejo de estos pacientes, desde siglos atrás hasta la actualidad. Objetivos: Hacer una aproximación a las primeras descripciones históricas de los aspectos clínicos relacionados con las manifestaciones cutáneas y de anexos de la esclerosis sistémica progresiva, resaltando a los individuos que por siglos han aportado al entendimiento de la enfermedad. Materiales y métodos: Investigación de corte histórico, con revisión de la literatura desde el siglo xvii hasta el año 2013, en especial, de textos que impactan en el entendimiento de la evolución clínica de los aspectos cutáneos de la enfermedad. Se realiza una búsqueda sistémica de la información disponible en medios virtuales y físicos, en bibliotecas de América y Europa, teniendo acceso a textos originales en diferentes idiomas y realizando la traducción de los mismos, con miras a enmarcar los resultados de las descripciones en una línea de tiempo.

Abstract Systemic sclerosis (scleroderma) is a connective tissue autoimmune disease with an unknown etiology, with a wide range of skin and cutaneous complications wich explains the morbility and mortality of this entity. Recognized since centuries, there are not optimal interventions yet to control its progression and avoid lesions in different organs besides skin. The most characteristic clinical pictures are Raynaud phenomenon and cutaneous fibrosis, this is why the first objective of this historical investigation is to present the clinical and pathological historical descriptions of these disease, showing the evolution in the approach and management of patients with this malady in an historical view. Objectives: To make an approximation to the first historical descriptions of the clinical aspects related with de cutaneous commitment in patients with progressive systemic sclerosis, highlighting some persons who have made seminal contributions to the understanding of this disease. Material and methods: Historical investigation with an extensive literature review from century xvii to xxi, we include electronic and physical information from different libraries from America and Europe. We describe all the information in a time line.

Historia del tratamiento de las vasculitis primarias / History of treatment of primary vasculitis

(AU)Las vasculitis primarias constituyen un grupo de enfermedades reumáticas con expresión clínicavariable y pronóstico reservado cuando no se tratan adecuadamente. En esta revisión haremosun análisis pormenorizado del tratamiento en las diferentes formas de vasculitis primaria, iniciandocon el uso de los corticoides, desde casi su descubrimiento en 1949, pasando por otrosinmunosupresores como: ciclofosfamida, metotrexate, azatioprina, mofetil, micofenolato, aligual que medicamentos biológicos como rituximab y anti-TNF. Una mención especial se hacesobre las guías de tratamientos para las vasculitis, tanto de grandes como de pequeños vasos,implementadas desde 2009 por el Grupo Europeo de Estudio de las Vasculitis

Historia sobre el papel de las hormonas y los anticonceptivos en el lupus / History on the role of hormones and contraceptives in lupus

En este artículo presentamos los diferentes eventos que llevaron a conocer a profundidad la interrelación que existe entre las hormonas y el lupus, así como los autores que participaron en estas investigaciones. Revisamos los artículos publicados sobre el tema desde los inicios del siglo XX. Hacemos un recuento especial sobre la píldora anticonceptiva, cómo se gesto su descubrimiento y cómo se interrelaciona ésta con el lupus, al igual que las demás hormonas. Finalmente hacemos un recuento de las principales investigaciones que se realizan entre las hormonas y el lupus.

In this paper we present the diverse events leading up to know in depth the relationship between hormones and lupus, and the authors who participated in this research. We reviewed published articles on the subject since the early twentieth century. We especially count on the birth control pill, how it was discovered and how this interacts with lupus, as well as other hormones. Finally we review the major research being conducted between hormones and lupus.

Historia de los glucocorticoides / History of glucocorticoids

En este artículo hacemos una completa revisión de la Historia de los corticoides desde Thomas Addison quien describió las características de la enfermedad que lleva su nombre, pasando por Edward Kendall quien fue el primero en sintetizar el compuesto E o cortisona, Philipe Hench y su grupo quienes hicieron la aplicación clínica de los glucorticoides en una paciente con artritis reumatoide, hasta llegar a Meyer Hermann con los conceptos actuales sobre ciclo circadioano. Es una historia fascinante que nos permite conocer en detalle todos los pasos que llevaron al descubrimiento de los corticoides y su aplicación clínica en diferentes enfermedades como la artritris reumatoide y el lupus eritematoso sistémico.

In this paper we do a complete review of the history of steroids from Thomas Addison, who described the characteristics of the disease that bears his name, through Edward Kendall who was the first to synthesize the compound E or cortisone, Philipe Hench and his group who made the clinical application of glucocorticoids in a patient with rheumatoid arthritis, up to Hermann Meyer with current concept on circadian rhytms. It is a fascinating story that lets us know in detail all the steps that led to the discovery of steroids and its clinical application in various diseases such as rheumatoid arthritis and systemic lupus erythematosus.

Enfermedades Autoinflamatorias / Autoinflammatory Diseases

Presentamos un artículo de revisión sobre las enfermedades autoinflamatorias, narrando su origen histórico y describiendo la estructura proteica y molecular del Inflamosoma, la clasificación actual de los trastornos autoinflamatorios y una descripción de las características inmunogenéticas y clínicas más sobresalientes de cada enfermedad.

We present a review article on the autoinflammatory diseases, narrating its historical origin and describing the protein and molecular structure of the Inflammasome, the current classification of the autoinflammatory diseases and a description of the immunogenetics and clinical characteristics more important of every disease.

HiperCKemia asintomática benigna. A propósito de dos casos / Benign asymptomatic hyperCKemia. With regard to two cases

La hiperCKemia asintomática es definida como una elevación persistente de niveles séricos de Creatin Fosfoquinasa (CPK), sin manifestaciones clínicas, electromiográficas o histológicas. Su curso es benigno a largo plazo y en muchos casos no es necesario un seguimiento continuo. Si la hiperCKemia es un hallazgo incidental en unos exámenes de laboratorio de rutina, no se justifican estudios extensivos más aun si los pacientes no presentan alteraciones al exámen físico y si los estudios electromiográficos son normales. En este artículo, presentamos dos casos con hiperCKemia asintomática, que son los primeros informados en Hispanoamérica.

Asymptomatic hyperCKemia is defined as a persistent elevation of serum CPK levels, without clinical manifestation abnormal electrodiagnostic, or histologic findings. It has a long-term benign course and in many cases it is not necessary a continuous follow-up. If hyperCKemia is an incidental finding during a routine laboratory check-up, extensive studies are not justified still more if the patients do not present alterations in the physical exam and if the electrodiagnostic studies are normal. In this paper we present two cases of asymptomatic hyperCKemia, that are the first reported in Hispano-America.

Asociación de artritis reumatoide y enfermedad de Rendu-Osler-Weber complicada con el virus hepatitis C / Association between rheumatoid arthritis and Rendu Osler Weber disease, complicated with hepatitis C virus infection

La enfermedad de Rendu-Osler-Weber es una enfermedad que se caracteriza por telangiectasias en múltiples órganos del organismo. La artritis reumatoide es una enfermedad que, según se ha informado, se presenta en asociación con múltiples patologías, pero no ha sido descrita su asociación con la enfermedad de Rendu-Osler-Weber. En este artículo informamos sobre un paciente que presenta la asociación de artritis reumatoide con la enfermedad de Rendu-Osler-Weber y hepatitis tipo C

Gota. Aspectos radiologicos / Clinical and radiological aspects of gout

En este artículo realizamos una revisión sobre los aspectos clínicos y radiológicos de la gota, con ilustraciones de los hallazgos radiológicos mas frecuentes que orienten hacia un diagnóstico correcto de la enfermedad. Los casos presentados los hemos analizado durante muchos años en nuestro servicio de reumatología de la Universidad Nacional de Colombia, Hospital San Juan de Dios, Bogotá.

Artritis reumatoide: aspectos radiologicos / Radiographic characteristics of rheumatoid arthritis

En este artículo revisamos los aspectos radiológicos de la artritis reumatoide, haciendo énfasis en las articulaciones que mas se comprometen en esta entidad. Se presenta una completa ilustración fotográfica resultado de la experiencia de muchos años de práctica docente asistencial en la Universidad Nacional de Colombia, Hospital San Juan de Dios de Bogotá.