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1.
Med. interna Méx ; 34(3): 443-476, may.-jun. 2018. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-976088

RESUMO

Resumen La osteoartritis es una enfermedad articular crónica degenerativa, es la afección articular observada con más frecuencia en la población adulta y una de las principales causas de discapacidad en todo el mundo, por lo que es de importancia el diagnóstico y tratamiento en las fases tempranas de la enfermedad. En la actualidad los nuevos tratamientos, además de aliviar el dolor, pueden disminuir la limitación funcional y modificar el curso de la enfermedad. El objetivo de este artículo es actualizar la evidencia acerca del diagnóstico y de las nuevas formas de tratamiento de la osteoartritis, así como evaluar los cambios en la evidencia que ha habido en relación con la guía anterior. Para la elaboración de la guía motivo de esta reunión, se contó con la participación de especialistas en Medicina Interna, Reumatología, Ortopedia y Rehabilitación física, un bibliotecario y un experto en metodología; se realizó una búsqueda extensa en PubMed y en otros sitios web especializados. Se estableció una serie de recomendaciones y niveles de evidencia basados en la bibliografía consultada. Se concluye que la osteoartritis es una enfermead compleja que implica múltiples factores de riesgo, por lo que es importante tomar en cuenta que el tratamiento es multidisciplinario y consta de un enfoque no farmacológico y uno farmacológico; sin embargo, es necesario crear una cultura preventiva de la osteoartritis en los médicos tratantes, en la que se eduque y se dé información al paciente para evitar que la enfermedad progrese.


Abstract Osteoarthritis, a chronic degenerative joint disease, is the joint condition most frequently observed in the adult population; is one of the leading causes of disability worldwide. Therefore, it is important the diagnosis and treatment in the early stages of the disease. Currently new therapies, in addition to relieving pain, can reduce functional limitation and modify the course of the disease. The objective of this article is to update the evidence on diagnosis and new forms of osteoarthritis treatment, as well as to evaluate the changes in the evidence that has been in relation to the previous guide. For the elaboration of the guide, there was participation of specialists (Internal Medicine, Rheumatology, Orthopedics and Physical Rehabilitation), a librarian and an expert in methodology; an extensive search was carried out in PubMed and other specialized websites. A series of recommendations and levels of evidence were established based on the bibliography consulted. Concluding that osteoarthritis is a complex pathology involving multiple risk factors, it is important to consider that the treatment is multidisciplinary and consists of a non-pharmacological approach and a pharmacological treatment; however, it is necessary to create a preventive culture on osteoarthritis in treating doctors, in which the patient is educated and given information to prevent the disease from progressing.

2.
J Clin Rheumatol ; 24(2): 57-64, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29232320

RESUMO

OBJECTIVE: The aim of this study was to measure the impact of osteoarthritis on the functioning and health status of individuals living in a low-income urban community in Mexico. METHODS: We conducted a cross-sectional, community-based study from December 2014 to November 2015, using the Community Oriented Program for Control of Rheumatic Diseases methodology to identify cases of musculoskeletal disease in a sample of adults older than 18 years in Pueblo Nuevo, Apodaca, Mexico. Two rheumatologists confirmed all cases of osteoarthritis (OA) using predefined criteria. Functioning was evaluated through (a) self-report of difficulty doing personal care, work, and leisure activities; (b) the modified Stanford Health Assessment Questionnaire-Disability Index; and (c) the Timed Up and Go test. Health status was evaluated using the EuroQoL 5 Dimensions. Statistical analyses were performed using χ tests and logistic regression models. RESULTS: Four hundred thirty-nine individuals with a mean age of 45.2 years were included, and 83 cases of OA were confirmed. The presence of OA was not significantly associated with having difficulties to do personal care, work, or leisure activities, but it was significantly associated with a higher Health Assessment Questionnaire-Disability Index score, longer time to complete the Timed Up and Go, and lower health status. CONCLUSIONS: Osteoarthritis is associated with having higher disability and worse health status in the community studied. A disability paradox was detected as some individuals perceived disability for doing standard activities but did not present disability performing their real-life activities. This underlies the importance of addressing the mental dimension during the management of this population.

3.
J Rheumatol ; 44(12): 1804-1812, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29093158

RESUMO

OBJECTIVE: To define whether Amerindian genetic ancestry correlates with clinical and therapeutic variables in admixed individuals with rheumatoid arthritis (RA) from Latin America. METHODS: Patients with RA (n = 1347) and healthy controls (n = 1012) from Argentina, Mexico, Chile, and Peru were included. Samples were genotyped for the Immunochip v1 using the Illumina platform. Clinical data were obtained through interviews or the clinical history. RESULTS: Percentage of Amerindian ancestry was comparable between cases and controls. Morning stiffness (p < 0.0001, OR 0.05), rheumatoid factor (RF; p < 0.0001, OR 0.22), radiographic changes (p < 0.0001, OR 0.05), and higher number of criteria were associated with lower Amerindian ancestry after Bonferroni correction. Higher Amerindian ancestry correlated only with weight loss (pBonferroni < 0.0001, OR 2.85). Increased Amerindian ancestry correlated with higher doses of azathioprine (p < 0.0001, OR 163.6) and sulfasalazine (p < 0.0001, OR 48.6), and inversely with methotrexate (p = 0.001, OR 0.35), leflunomide (p = 0.001, OR 0.16), and nonsteroidal antiinflammatory drugs (pBonferroni = 0.001, OR 0.37). Only the presence of RF and weight loss were modified after confounders adjustment. CONCLUSION: Amerindian ancestry protects against most major clinical criteria of RA, but regarding the association of RF with increased European ancestry, age, sex, and smoking are modifiers. Ancestry also correlates with the therapeutic profiles.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/genética , Genótipo , Fator Reumatoide/genética , Adulto , Fatores Etários , Idoso , Alelos , Argentina , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Chile , Feminino , Humanos , Índios Norte-Americanos , Índios Sul-Americanos , Isoxazóis/uso terapêutico , Leflunomida , Masculino , Metotrexato/uso terapêutico , México , Pessoa de Meia-Idade , Peru , Radiografia , Fatores Sexuais , Sulfassalazina/uso terapêutico
4.
Nat Commun ; 8: 16021, 2017 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-28714469

RESUMO

Systemic lupus erythematosus (SLE) is an autoimmune disease with marked gender and ethnic disparities. We report a large transancestral association study of SLE using Immunochip genotype data from 27,574 individuals of European (EA), African (AA) and Hispanic Amerindian (HA) ancestry. We identify 58 distinct non-HLA regions in EA, 9 in AA and 16 in HA (∼50% of these regions have multiple independent associations); these include 24 novel SLE regions (P<5 × 10-8), refined association signals in established regions, extended associations to additional ancestries, and a disentangled complex HLA multigenic effect. The risk allele count (genetic load) exhibits an accelerating pattern of SLE risk, leading us to posit a cumulative hit hypothesis for autoimmune disease. Comparing results across the three ancestries identifies both ancestry-dependent and ancestry-independent contributions to SLE risk. Our results are consistent with the unique and complex histories of the populations sampled, and collectively help clarify the genetic architecture and ethnic disparities in SLE.

6.
Reumatol. clín. (Barc.) ; 13(1): 17-20, ene.-feb. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-159881

RESUMO

Introducción. La artritis reumatoide (AR) tiene un efecto indirecto en la composición corporal. El índice de masa corporal (IMC) no se considera un predictor válido de la grasa corporal en pacientes con AR. Objetivo. Evaluar el IMC para identificar la obesidad mediante absorciometría dual por rayos X (DEXA) en pacientes con AR bien controlados. Métodos. Estudio observacional, transversal, descriptivo y analítico. Se utilizaron 3 definiciones de obesidad por DEXA:>35% de grasa total, >40% de grasa total y obesidad central>35%. Resultados. Se incluyó a 101 pacientes. Se encontró un IMC de 24kg/m2 para obesidad >35% con una sensibilidad del 90% y una especificidad del 75% (área bajo la curva [AUC] 0,917), un IMC de 25kg/m2 para obesidad >40% con una sensibilidad del 86% y una especificidad del 39% (AUC 0,822) y un IMC de 22kg/m2 para 35% de la grasa central con una sensibilidad de 97% y una especificidad del 84% (AUC 0,951). Conclusión. Existe un subdiagnóstico de obesidad con el uso de los valores de tradicionales de IMC en pacientes con AR bien controlados (AU)


Background. Rheumatoid arthritis (RA) has an indirect effect on body composition. Body mass index (BMI) is not a valid predictor of body fat in RA patients. Objective. To evaluate the accuracy of BMI in identifying obesity diagnosed according to dual energy X-ray absorptiometry (DXA) in well-controlled RA patients. Methods. An observational, cross-sectional, descriptive, analytical study. We used 3 different cutoffs for obesity as determined by DXA: >35% total fat, >40% total fat, and >35% central fat mass (central obesity). Results. One hundred one patients were included. We found that 35% total fat corresponded to a BMI of 24kg/m2, with a sensitivity of 90% and specificity of 75% (area under the curve [AUC] 0.917); 40% total fat to a BMI of 25kg/m2, with a sensitivity of 86% and specificity of 39% (AUC 0.822); and 35% central fat mass to a BMI of 22kg/m2, with a sensitivity of 97% and specificity of 84% (AUC 0.951). Conclusion. Obesity according to DXA was underdiagnosed when the classic BMI cutoffs were used in well-controlled RA patients (AU)


Assuntos
Humanos , Masculino , Feminino , Absorciometria de Fóton/instrumentação , Absorciometria de Fóton/tendências , Artrite Reumatoide/complicações , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide , Índice de Massa Corporal , Absorciometria de Fóton/métodos , Obesidade/complicações , Obesidade , Estudos Transversais/instrumentação , Estudos Transversais/métodos , Sensibilidade e Especificidade , Análise Estatística , Composição Corporal/fisiologia
7.
Reumatol Clin ; 13(1): 17-20, 2017 Jan - Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27032755

RESUMO

BACKGROUND: Rheumatoid arthritis (RA) has an indirect effect on body composition. Body mass index (BMI) is not a valid predictor of body fat in RA patients. OBJECTIVE: To evaluate the accuracy of BMI in identifying obesity diagnosed according to dual energy X-ray absorptiometry (DXA) in well-controlled RA patients. METHODS: An observational, cross-sectional, descriptive, analytical study. We used 3 different cutoffs for obesity as determined by DXA: >35% total fat, >40% total fat, and >35% central fat mass (central obesity). RESULTS: One hundred one patients were included. We found that 35% total fat corresponded to a BMI of 24kg/m2, with a sensitivity of 90% and specificity of 75% (area under the curve [AUC] 0.917); 40% total fat to a BMI of 25kg/m2, with a sensitivity of 86% and specificity of 39% (AUC 0.822); and 35% central fat mass to a BMI of 22kg/m2, with a sensitivity of 97% and specificity of 84% (AUC 0.951). CONCLUSION: Obesity according to DXA was underdiagnosed when the classic BMI cutoffs were used in well-controlled RA patients.


Assuntos
Absorciometria de Fóton , Artrite Reumatoide/complicações , Índice de Massa Corporal , Obesidade/diagnóstico , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Sensibilidade e Especificidade
9.
Arthritis Rheumatol ; 68(4): 932-43, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26606652

RESUMO

OBJECTIVE: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a strong genetic component. We undertook the present work to perform the first genome-wide association study on individuals from the Americas who are enriched for Native American heritage. METHODS: We analyzed 3,710 individuals from the US and 4 countries of Latin America who were diagnosed as having SLE, and healthy controls. Samples were genotyped with HumanOmni1 BeadChip. Data on out-of-study controls genotyped with HumanOmni2.5 were also included. Statistical analyses were performed using SNPtest and SNPGWA. Data were adjusted for genomic control and false discovery rate. Imputation was performed using Impute2 and, for classic HLA alleles, HiBag. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: The IRF5-TNPO3 region showed the strongest association and largest OR for SLE (rs10488631: genomic control-adjusted P [Pgcadj ] = 2.61 × 10(-29), OR 2.12 [95% CI 1.88-2.39]), followed by HLA class II on the DQA2-DQB1 loci (rs9275572: Pgcadj = 1.11 × 10(-16), OR 1.62 [95% CI 1.46-1.80] and rs9271366: Pgcadj = 6.46 × 10(-12), OR 2.06 [95% CI 1.71-2.50]). Other known SLE loci found to be associated in this population were ITGAM, STAT4, TNIP1, NCF2, and IRAK1. We identified a novel locus on 10q24.33 (rs4917385: Pgcadj = 1.39 × 10(-8)) with an expression quantitative trait locus (eQTL) effect (Peqtl = 8.0 × 10(-37) at USMG5/miR1307), and several new suggestive loci. SLE risk loci previously identified in Europeans and Asians were corroborated. Local ancestry estimation showed that the HLA allele risk contribution is of European ancestral origin. Imputation of HLA alleles suggested that autochthonous Native American haplotypes provide protection against development of SLE. CONCLUSION: Our results demonstrate that studying admixed populations provides new insights in the delineation of the genetic architecture that underlies autoimmune and complex diseases.


Assuntos
Grupo com Ancestrais Nativos do Continente Americano/genética , Lúpus Eritematoso Sistêmico/genética , Argentina , Antígeno CD11b/genética , Estudos de Casos e Controles , Chile , Cromossomos Humanos Par 10/genética , Proteínas de Ligação a DNA/genética , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Antígenos HLA-DQ/genética , Cadeias beta de HLA-DQ/genética , Haplótipos , Humanos , Fatores Reguladores de Interferon , Quinases Associadas a Receptores de Interleucina-1/genética , Masculino , México , ATPases Mitocondriais Próton-Translocadoras/genética , NADPH Oxidases/genética , Razão de Chances , Peru , Análise de Componente Principal , Fator de Transcrição STAT4/genética , Estados Unidos , beta Carioferinas
10.
Arthritis Rheum ; 65(6): 1457-67, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23460240

RESUMO

OBJECTIVE: To identify susceptibility loci for rheumatoid arthritis (RA) in Latin American individuals with admixed European and Amerindian genetic ancestry. METHODS: Genotyping was performed in 1,475 patients with RA and 1,213 control subjects, using a customized BeadArray containing 196,524 markers covering loci previously associated with various autoimmune diseases. Principal components analysis (EigenSoft package) and Structure software were used to identify outliers and define the population substructure. REAP software was used to define cryptic relatedness and duplicates, and genetic association analyses were conducted using Plink statistical software. RESULTS: A strong genetic association between RA and the major histocompatibility complex region was observed, localized within BTNL2/DRA-DQB1- DQA2 (P = 7.6 × 10(-10) ), with 3 independent effects. We identified an association in the PLCH2-HES5-TNFRSF14-MMEL1 region of chromosome 1 (P = 9.77 × 10(-6) ), which was previously reported in Europeans, Asians, and Native Canadians. We identified one novel putative association in ENOX1 on chromosome 13 (P = 3.24 × 10(-7) ). Previously reported associations were observed in the current study, including PTPN22, SPRED2, STAT4, IRF5, CCL21, and IL2RA, although the significance was relatively moderate. Adjustment for Amerindian ancestry improved the association of a novel locus in chromosome 12 at C12orf30 (NAA25) (P = 3.9 × 10(-6) ). Associations with the HLA region, SPRED2, and PTPN22 improved in individuals positive for anti-cyclic citrullinated peptide antibodies. CONCLUSION: Our data define, for the first time, the contribution of Amerindian ancestry to the genetic architecture of RA in an admixed Latin American population by confirming the role of the HLA region and supporting the association with a locus in chromosome 1. In addition, we provide data for novel putative loci in chromosomes 12 and 13.


Assuntos
Artrite Reumatoide/genética , Cromossomos Humanos Par 12/genética , Cromossomos Humanos Par 13/genética , Cromossomos Humanos Par 1/genética , Antígenos HLA/genética , Feminino , Genótipo , Humanos , Índios Sul-Americanos , América Latina , Masculino , Análise de Sequência com Séries de Oligonucleotídeos
11.
J Clin Rheumatol ; 18(7): 327-35, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23047532

RESUMO

BACKGROUND: Treatment of rheumatoid arthritis (RA) has evolved dramatically in the last decade. However, little is known about the way rheumatologists in Latin America treat their patients in clinical practice, outside the scope of clinical trials. OBJECTIVE: The objective of this study was to describe treatment patterns at disease onset in early RA with data from a large, multicenter, multinational inception cohort of Latin American patients. METHODS: Consecutive patients with early RA (<1 year of disease duration as diagnosed by a rheumatologist) from 46 centers in 14 Latin American countries were enrolled in the study. Clinical data, laboratory assessments, and a detailed registry on type of prescriptions were collected at baseline and at 3, 6, 12, 18, and 24 months of follow-up. Hands and feet x-rays were obtained at baseline and at 12 and 24 months. All data were captured in Arthros 6.1 database. Continuous variables were expressed as means and SDs, and categorical variables were expressed as percentages and 95% confidence intervals (95% CIs). Only therapeutic data at baseline are presented, corresponding to the period between disease onset and second visit (3 months). RESULTS: A total of 1093 patients were included. Eighty-five percent were female, and 76% had a positive rheumatoid factor. Mean age at diagnosis was 46.5 (SD, 14.2) years, and mean disease duration at the first visit was 5.8 (SD, 3.8) months. Between baseline and second visit (3 months), 75% of patients (95% CI, 72%-78%) received disease-modifying antirheumatic drugs. Methotrexate (MTX) alone or in combination was the most frequently used (60.5%), followed by antimalarials (chloroquine or hydroxychloroquine, 32.1%), sulfasalazine (7.1%), and leflunomide (LEF, 4%). In 474 patients (43%), initiation of disease-modifying antirheumatic drugs was within the first month after the first visit. In addition, 290 patients (26%; 95% CI, 23%-29%) received combination therapy as initial treatment. The most frequently used combinations were MTX + chloroquine (45%), MTX + hydroxychloroquine (25%), and MTX + sulfasalazine (16%). Eleven patients (1%; 95% CI, 0.5%-1.8%) received biologics. Sixty-four percent (95% CI, 60%-66%) received corticosteroids. Of those, 80% (95% CI, 77%-84%) received 10 mg of oral prednisone or less. CONCLUSIONS: In this cohort of Latin American patients with early RA, most patients received MTX very early in their disease course. Combination therapy was used approximately in 1 of every 4 patients as initial therapy. Biologics were rarely used at this early stage, and low-dose prednisone was commonly used.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/etnologia , Gerenciamento Clínico , Adulto , Antimaláricos/uso terapêutico , Artrite Reumatoide/epidemiologia , Estudos de Coortes , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Isoxazóis/uso terapêutico , América Latina/epidemiologia , Leflunomida , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Sistema de Registros , Sulfassalazina/uso terapêutico , Resultado do Tratamento
12.
Arthritis Rheum ; 64(11): 3687-94, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22886787

RESUMO

OBJECTIVE: American Indian-Europeans, Asians, and African Americans have an excess morbidity from systemic lupus erythematosus (SLE) and a higher prevalence of lupus nephritis than do Caucasians. The aim of this study was to analyze the relationship between genetic ancestry and sociodemographic characteristics and clinical features in a large cohort of American Indian-European SLE patients. METHODS: A total of 2,116 SLE patients of American Indian-European origin and 4,001 SLE patients of European descent for whom we had clinical data were included in the study. Genotyping of 253 continental ancestry-informative markers was performed on the Illumina platform. Structure and Admixture software were used to determine genetic ancestry proportions of each individual. Logistic regression was used to test the association between genetic ancestry and sociodemographic and clinical characteristics. Odds ratios (ORs) were calculated with 95% confidence intervals (95% CIs). RESULTS: The average American Indian genetic ancestry of 2,116 SLE patients was 40.7%. American Indian genetic ancestry conferred increased risks of renal involvement (P < 0.0001, OR 3.50 [95% CI 2.63- 4.63]) and early age at onset (P < 0.0001). American Indian ancestry protected against photosensitivity (P < 0.0001, OR 0.58 [95% CI 0.44-0.76]), oral ulcers (P < 0.0001, OR 0.55 [95% CI 0.42-0.72]), and serositis (P < 0.0001, OR 0.56 [95% CI 0.41-0.75]) after adjustment for age, sex, and age at onset. However, age and sex had stronger effects than genetic ancestry on malar rash, discoid rash, arthritis, and neurologic involvement. CONCLUSION: In general, American Indian genetic ancestry correlates with lower sociodemographic status and increases the risk of developing renal involvement and SLE at an earlier age.


Assuntos
Grupo com Ancestrais do Continente Europeu/genética , Índios Norte-Americanos/genética , Índios Sul-Americanos/genética , Lúpus Eritematoso Sistêmico/etnologia , Lúpus Eritematoso Sistêmico/genética , Adolescente , Adulto , Criança , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Predisposição Genética para Doença/etnologia , Genótipo , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Índios Sul-Americanos/estatística & dados numéricos , Nefrite Lúpica/etnologia , Nefrite Lúpica/genética , Masculino , Pessoa de Meia-Idade , Morbidade , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
13.
J Rheumatol ; 37(8): 1743-8, 2010 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-20551101

RESUMO

OBJECTIVE: Observation of monosodium urate (MSU) crystal is the gold standard for diagnosis of gout, but is rarely performed in daily clinical practice, and diagnosis is based on clinical judgment. Our aim was to identify clinical and paraclinical data included in the European League Against Rheumatism recommendations (EULARr) and American College of Rheumatology proposed criteria (ACRp) for diagnosis of gout in patients with chronic gout according to their attending rheumatologists. METHODS: This cross-sectional and multicenter study included consecutive patients from outpatient clinics with a diagnosis of gout by their attending rheumatologists according to their expertise. The frequency of each item from the ACRp and EULARr was determined. Possible combinations of the items that were frequent, clinically relevant, and simple to evaluate in daily practice were determined. RESULTS: We studied 549 patients (96% men), mean age 50 +/- 14 years. Analysis of MSU crystals was performed in 15%. We selected 7 clinical criteria and 1 laboratory measure because of their frequency, importance, and simplicity to obtain: current or past history of: > 1 attack of acute arthritis (93%); mono or oligoarthritis attacks (74%); rapid progression of pain and swelling (< 24 hours; 74%); podagra (70%); erythema (56%); unilateral tarsitis (33%); tophi (52%); and hyperuricemia (93%). The chronic gout diagnosis (CGD) proposal comprised >or= 4/8 of these; 88% of patients had the criteria of the CGD proposal while 75% had 6/11 ACRp criteria (p = 0.001). When analysis of MSU crystals was added, 90.1% (CGD) and 83.9% (ACRp) met the criteria (p = 0.004). CONCLUSION: Current or past history of >or= 4/8 CGD parameters is highly suggestive of chronic gout.


Assuntos
Gota/diagnóstico , Guias como Assunto , Reumatologia/métodos , Doença Crônica , Estudos de Coortes , Estudos Transversais , Cristalização , União Europeia , Feminino , Gota/epidemiologia , Gota/metabolismo , Humanos , Hiperuricemia/epidemiologia , Hiperuricemia/metabolismo , Hiperuricemia/patologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Dor/fisiopatologia , Reumatologia/normas , Articulação do Dedo do Pé/fisiopatologia , Ácido Úrico/isolamento & purificação
14.
J Rheumatol ; 30(1): 193-5, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12508412

RESUMO

Extracutaneous calcifications are rare in scleroderma and related conditions. We describe a female patient with linear scleroderma en coup de sabre and a longstanding clinical history of tonic and clonic convulsions. Radiographic study showed extensive cerebral calcifications in the right occipital hemisphere, homolateral to the involved side of her face. This report further suggests a relationship between localized scleroderma and neurological manifestations. Brain imaging studies should be routinely performed in scleroderma patients exhibiting neurological manifestations, especially seizure disorder.


Assuntos
Calcinose/patologia , Epilepsia Tônico-Clônica/patologia , Lobo Occipital/patologia , Couro Cabeludo/patologia , Esclerodermia Localizada/patologia , Adulto , Alopecia em Áreas/patologia , Feminino , Humanos , Tomografia Computadorizada por Raios X
15.
Rev. mex. reumatol ; 16(6): 381-394, nov.-dic. 2001. tab
Artigo em Espanhol | LILACS | ID: lil-312328

RESUMO

En el presente la infección por virus de la inmunodeficiencia humana (VIH) es considerada como una de las grandes mimetizadoras de otras enfermedades. Un número variable de hallazgos clínicos asociados con esta infección pueden ser descritos como afección autoinmune y/o reumática. Estos incluyen enfermedades del tejido conectivo (linfocitosis infiltrativa difusa, síndrome de Sjögren),síndromes articulares (sépticos, psoriásicos, Reiter), miopatías (por zidovudina, síndrome de desgaste, asociada a VIH, infecciones oportunistas), síndromes vasculíticos (necrotizante sistémica, hipersensibilidad, lesiones angiocéntricas inmuno-proliferativas) y alteración en estudios de laboratorio (anticuerpos anticardiolipina, anticuerpos anticelulares, anticuerpos antinucleares, complejos inmunes circulantes, hipergammaglobulinemia, factor reumatoide). El tratamiento de esta afección incluye terapia antiretroviral, esteroides, antinflamatorios no esteroideos y terapia inmunosupresora. La coexistencia de infección por VIH y enfermedad reumática ofrece nuevos conocimientos acerca de la patogénesis de ambas condiciones.


Assuntos
Artrite Psoriásica , Artrite Reativa , Citocinas , Infecções por HIV , Hospedeiro Imunocomprometido , Doenças Musculares , Síndrome de Sjogren
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