Eficacia del tratamiento inmunomodulador con interferón-β o acetato de glatirámero en las uveítis asociadas a esclerosis múltiple / Efficacy of immunomodulatory therapy with interferon-β or glatiramer acetate on multiple sclerosis-associated uveitis

Objetivo: Analizar la eficacia del interferón-β o acetato de glatirámero en reducir los episodios de inflamación intraocular en pacientes con uveítis asociada a esclerosis múltiple. Método: Estudio no aleatorizado, retrospectivo de serie de casos de 13 pacientes con diagnóstico definitivo de esclerosis múltiple y uveítis (seguimiento mínimo, 12 meses). Todos los pacientes fueron tratados con terapia inmunomoduladora (interferón-β o acetato de glatirámero) para controlar el curso de la esclerosis múltiple. Los pacientes fueron comparados con ellos mismos antes de iniciar el tratamiento inmunomodulador para valorar la diferencia en los episodios de uveítis. Variable principal de medida: número de episodios de uveítis con/sin tratamiento inmunomodulador. Resultados: Los brotes de uveítis fueron bilaterales en 10 de 13 pacientes (77%). Once pacientes fueron clasificados como uveítis intermedias, 3 pacientes como vasculitis retiniana y un paciente como uveítis posterior. Los pacientes tuvieron una media de 4,15±3,1 episodios de uveítis (rango 1-10) a lo largo del seguimiento (148,6±84,3 meses). Los pacientes bajo tratamiento con interferón-β o acetato de glatirámero mostraron una reducción significativa de 0,36 episodios de inflamación intraocular al año (p = 0,02) comparados con ellos mismos antes de iniciar el tratamiento. Seis pacientes (46%) mostraron efectos secundarios leves asociados al tratamiento inmunomodulador (3 pacientes [23%] síndrome seudogripal; 3 pacientes [23%] rash cutáneo). Conclusiones: El interferón-β o acetato de glatirámero podrían ser efectivos en reducir los brotes de inflamación intraocular en pacientes con uveítis asociada a esclerosis múltiple, siendo bien tolerados por la mayoría de los pacientes (AU)

Aim: To analyse the role of interferon-β or glatiramer acetate in reducing the inflammatory episodes of intra-ocular inflammation in multiple sclerosis-associated uveitis. Method: A study was conducted on a non-randomised, retrospective case series of 13 patients with proven multiple sclerosis and uveitis (minimum follow-up, 12 months). All patients were given immunomodulatory treatment (interferon-β or glatiramer acetate) to control the course of the multiple sclerosis. Patients were compared to themselves before initiating the treatment, in order to assess the difference in uveitis episodes. The main outcome measurements were the number of uveitis episodes with/without immunomodulatory treatment. Results: Uveitis was bilateral in 10 (77%) out of 13 patients. Intermediate uveitis was observed in 11 patients, retinal vasculitis in 3 patients, and one patient was classified as a posterior uveitis. The patients had a mean of 4.15±3.1 episodes of uveitis (range 1-10) during the follow-up period (148.6±84.3 months). When compared to their pre-treatment status, patients on treatment with interferon-β or glatiramer acetate showed a significant decrease of 0.36 episodes of ocular inflammation per year (P =.02). Mild side effects related to immunomodulatory treatment were observed in 6 (46%) patients, 3 (23%) patients with a flu-like syndrome, and 3 (23%) patients with a skin rash. Conclusions: Interferon β or glatiramer acetate could be effective in reducing the uveitis episodes in patients with multiple sclerosis-associated uveitis, and was well tolerated in most patients (AU)

Efficacy of immunomodulatory therapy with interferon-ß or glatiramer acetate on multiple sclerosis-associated uveitis. / Eficacia del tratamiento inmunomodulador con interferón-ß o acetato de glatirámero en las uveítis asociadas a esclerosis múltiple.

AIM: To analyse the role of interferon-ß or glatiramer acetate in reducing the inflammatory episodes of intra-ocular inflammation in multiple sclerosis-associated uveitis. METHOD: A study was conducted on a non-randomised, retrospective case series of 13 patients with proven multiple sclerosis and uveitis (minimum follow-up, 12 months). All patients were given immunomodulatory treatment (interferon-ß or glatiramer acetate) to control the course of the multiple sclerosis. Patients were compared to themselves before initiating the treatment, in order to assess the difference in uveitis episodes. The main outcome measurements were the number of uveitis episodes with/without immunomodulatory treatment. RESULTS: Uveitis was bilateral in 10 (77%) out of 13 patients. Intermediate uveitis was observed in 11 patients, retinal vasculitis in 3 patients, and one patient was classified as a posterior uveitis. The patients had a mean of 4.15±3.1 episodes of uveitis (range 1-10) during the follow-up period (148.6±84.3 months). When compared to their pre-treatment status, patients on treatment with interferon-ß or glatiramer acetate showed a significant decrease of 0.36 episodes of ocular inflammation per year (P=.02). Mild side effects related to immunomodulatory treatment were observed in 6 (46%) patients, 3 (23%) patients with a flu-like syndrome, and 3 (23%) patients with a skin rash. CONCLUSIONS: Interferon ß or glatiramer acetate could be effective in reducing the uveitis episodes in patients with multiple sclerosis-associated uveitis, and was well tolerated in most patients.

[Primary Sjögren's syndrome: clinical and immunological characteristics of 114 patients]. / Síndrome de Sjögren primario: características clínicas e inmunológicas de 114 pacientes.

BACKGROUND: To analyze the clinical and immunological characteristics of a series of 114 patients with primary Sjögren's syndrome (PSS), and to evaluate the different diagnostic criteria and the association to lymphoproliferative disorders. PATIENTS AND METHOD: We included 114 patients (108 female and 6 male) with a diagnosis of PSS. All patients fulfilled the 1993 European Community criteria for the diagnosis of PSS and 76 patients fulfilled the San Diego Criteria. RESULTS: Mean age was 51 years with a mean follow-up of 7.3 years. The commonest clinical manifestation at onset (70%) was xerostomia/xerophtalmia (sicca syndrome). Extra glandular involvement was articular in 42% of cases, neurologic (35%), respiratory (21%) and hepatic (13%). Eleven patients (9%) developed vasculitis, and three (2%) developed a lympho-proliferative disorder. No statistically significant differences regarding symptoms at onset, frequency of glandular or extra glandular manifestations and severity of disease were observed between the two diagnostic criteria groups. HCV infection was associated with vasculitis (p < 0.001; OR: 20.6; CI 95%, 3.2-129) and lymphoproliferative disorders (p < 0.001). CONCLUSIONS: The clinical evolution of PSS does not vary when using different diagnostic criteria (San Diego and European Community criteria). A subset of patients with vasculitis and lymphoproliferative diseases is found to have an associated HCV infection.

[Analysis of factors associated with anticoagulant treatment indication in chronic atrial fibrillation. Prospective study of 170 patients admitted at an internal medicine service]. / Análisis de los factores asociados a la indicación de tratamiento anticoagulante en la fibrilación auricular crónica. Estudio prospectivo de 170 pacientes ingresados en un servicio de Medicina Interna.

BACKGROUND: Anticoagulant therapy reduces the risk of stroke among patients with chronic atrial fibrillation. The objective of this study was to evaluate the use of anticoagulant therapy and to analyze the factors associated with the indication of anticoagulants in patients with chronic atrial fibrillation. PATIENTS AND METHODS: Prospective study of all patients with chronic atrial fibrillation admitted to our Department of Internal Medicine from February 1997 to September 1998. From each patient data related to the cause of atrial fibrillation, other associated vascular risk factors, use of anticoagulant and/or antiplatelet agents and contraindication to anticoagulants were recorded. RESULTS: A total of 170 patients with chronic atrial fibrillation were studied. The mean age of patients was 77 years (range: 49-94). One hundred and four patients (61%) were older than 75 years. Atrial fibrillation was the main cause for admission only in 11 patients (6.5%). One hundred and sixty-seven patients (98%) had indication for receiving anticoagulant therapy; however, it was indicated in only 67 patients (39%). In other 68 patients (40%), antiplatelet agents were used. Patients over 75 years received anticoagulants less frequently (p < 0.0001). Factors associated with the prescription of anticoagulants in the bivariate analysis included: diabetes mellitus (p = 0.046), high cholesterol level (p = 0.023), age < or = 75 years old (p < 0.0001), history of previous embolic events (p = 0.001) and valvular atrial fibrillation (p < 0.0001). The multivariate analysis showed that only two factors were indeed associated with the prescription of anticoagulants: age < or = 75 years (OR: 6.15) and valvular atrial fibrillation (OR: 4.24). CONCLUSIONS: Anticoagulant therapy is underused in patients with chronic atrial fibrillation, particularly in elderly patients.

[Addison's disease: a clinico-epidemiologic study of 45 cases]. / Enfermedad de Addison: estudio clinicoepidemiológico de 45 casos.

We present the clinical-epidemiological results obtained in a series of 45 patients diagnosed of Addison disease between 1967 and 1988. The incidence was 0.83 cases/100,000 inhabitants/year and the prevalence was 10 cases/100,000 inhabitants. The etiology was unknown in 44.4% of cases tuberculous in 24.4% and in 31.1% of cases the caused could not be established with the classical clinical and radiological criteria. Amongst the studied variables in each etiological group, we highlight the association with other autoimmune processes and the development of extraadrenal tuberculous infection after Addison disease diagnosis. We discuss the approach to etiological diagnosis and the convenience of tuberculostatic treatment in EAT cases.

[Evolution of hypothyroidism to hyperthyroidism in a case of autoimmune thyroid disease]. / Evolución de hipotiroidismo hacia hipertiroidismo en un caso de enfermedad autoinmune tiroidea.

We present the clinical case of a patient affected of Hashimoto thyroiditis who after suffering hypothyroidism for 11 years developed Grave's disease with hyperthyroidism. This is a very rare evolution of the autoimmune thyroid disease. We discuss the possible etiopathogenesis with a literature review.