Validation of the Spanish Version of the PURE-4 Questionnaire for the Early Detection of Psoriatic Arthritis in Psoriatic Patients. / Validación de la versión española del cuestionario PURE-4 para la detección precoz de la artritis psoriásica en pacientes con psoriasis.

BACKGROUND AND OBJECTIVE: Psoriasis often precedes the onset of psoriatic arthritis (PsA), so dermatologists often face the challenge of early identifying signs of PsA in patients with psoriasis. Our aim was to validate the Spanish version of the PURE-4 questionnaire as a screening tool for PsA, evaluate its performance in terms of sensitivity, specificity, feasibility, reliability, and build validity. METHODS: This was a cross-sectional, observational, multicenter trial of adult patients with psoriasis. Initially, patients were assessed by a dermatologist and completed 2 self-administered versions (in print and online) of the PURE-4 questionnaire. Afterwards, the rheumatologist, blinded to the PURE-4 results, assessed the presence/absence of PsA, being the reference to determine the performance of the PURE-4 questionnaire. RESULTS: A total of 268 patients were included (115 [42.9%] women; mean age, 47.1±12.6). The prevalence of PsA according to rheumatologist diagnosis was 12.7% (34 patients). The mean PURE-4 score for patients with psoriasis diagnosed with PsA was 2.3±1.1, and 1.3±1.3 for patients without PsA (P<.001). The cutoff value ≥2 demonstrated the best performance for detecting PsA, with a negative predictive value of 95.1% (95% confidence interval, 90.3-97.6). CONCLUSIONS: The PURE-4 questionnaire demonstrated good performance in detecting PsA, with an optimal cutoff point ≥2. This simple tool could facilitate early referral of patients to the rheumatology unit.

Mesalazine dose modification based on faecal calprotectin levels in patients with ulcerative colitis in clinical remission. / Modificación de la dosis de mesalazina en función de los niveles de calprotectina fecal en pacientes con colitis ulcerosa en remisión clínica.

BACKGROUND: Faecal calprotectin (FC) shows an excellent correlation with endoscopic and histological activity of ulcerative colitis (UC) and it is the best predictor of clinical relapse. Our aim was to evaluate the usefulness of modifying the dose of mesalazine based on FC levels, in clinical practice. METHODS: Retrospective, single-centre study in UC patients in clinical remission while treated with mesalazine which dosage was decreased (DOWN) or increased (UP) according to FC levels. The main endpoint was the long-term maintenance of clinical remission. RESULTS: A total of 56 patients were included (39 DOWN, 17 UP). In the DOWN group, the median baseline dose of mesalazine was 3.6g/day and the median baseline FC was 36µg/g. After a median follow-up of 22 months, 28% required rescue therapy. The cumulative relapse-free survival after tapering was 91% and 82% at 12 and 24 months, respectively. In the UP group, the median baseline dose of mesalazine was 2.4g/day, with a median baseline FC of 524µg/g. After a median follow-up of 12 months, 29% required rescue therapy. The cumulative relapse-free survival after dose increase was 86% and 72% at 12 and 24 months, respectively. CONCLUSIONS: Mesalazine dose modification based on FC monitoring seems to be a safe strategy in patients with UC in clinical remission, with a probability of clinical relapse around 20% at two years.

Cancer Stem Cells and Treatment of Cancer: An Update and Future Perspectives.

Cancer stem cells (CSCs) play an essential role in tumour progression and metastasis. These cells have the unique ability to self-renew and differentiate into specific tissue cell types. Their capacity for self-renewal enables CSCs to persist over time, thereby contributing to cancer relapse and therapy resistance. Therefore, targeting CSCs has emerged as a promising cancer treatment strategy. CSCs exhibit differentiation, self-renewal, and plasticity, and they contribute to multiple aspects of malignant tumours, such as recurrence, metastasis, heterogeneity, multidrug resistance, and radiation resistance. While conventional treatments predominantly target cancer cells that are not CSCs, CSCs frequently survive, resulting in tumour recurrence and relapse. This article concentrates on the development of novel therapeutic strategies that combine conventional treatments with CSC inhibitors to eradicate cancer cells and CSCs, thereby treating cancer and preventing its recurrence. However, the diversity of CSCs poses a significant obstacle to the development of CSC-targeted therapies, necessitating extensive research for a better understanding and exploration of therapeutic approaches. Future development of CSC-targeted therapies will rely heavily on overcoming this obstacle.

Clinical characteristics of membranous nephropathy with spontaneous remission: An analysis of 24 patients / Características clínicas de la nefropatía membranosa con remisión espontánea: análisis de 24 pacientes

Purpose To investigate the prognosis of patients with spontaneous remission (SR) of phospholipase A2 receptor (PLA2R)-associated membranous nephropathy (MN).Patients and methods Patients diagnosed with MN were recruited after examining their renal biopsy in the Renal Department of China-Japan Friendship Hospital between January 2015 and September 2021. Among them, 24 patients with SR were included in this study and follow-up. Results Twenty-four patients diagnosed with SR of PLA2R-associated MN were recruited; 11 were male, and 13 were female, with a mean age of 49.5±14.5 years (range, 30–77 years). The initial 24-hour urinary total protein and serum albumin levels were 0.29±0.14g/d and 37.5±4.4g/L, respectively, and the initial serum creatinine was 65.0±15.8μmol/L. During the follow-up of 33.9±19.1 months (range, 6–73 months), 22 (91.7%) patients maintained remission; however, one patient had impaired renal function due to acute coronary syndrome and coronary angiography findings, and one patient experienced a repeated relapse caused by respiratory tract infection, at 50 and 70 months. A systematic review of the relevant literature was conducted, and records of patients with SR of PLA2R-associated MN were retrieved from 16 case reports or case series with a total of 97 cases. ConclusionsMost patients with SR of MN had a promising long-term prognosis, with only a few cases of relapse. (AU)

Objetivo Investigar el pronóstico de los pacientes con remisión espontánea en la nefropatía membranosa (MN, por sus siglas en inglés) asociada al receptor fosfolipasa A2 (PLA2R). Pacientes y métodos Pacientes con MN diagnosticados por biopsia renal en el Departamento Renal del China-Japan Friendship Hospital entre enero de 2015 y septiembre de 2021. Entre ellos, 24 pacientes con remisión espontánea fueron reclutados y seguidos. Resultados Se reclutaron 24 pacientes con MN en remisión espontánea asociada a PLA2R; 11 varones y 13 mujeres, con una edad media de 49,5±14,5 años (rango: 30-77 años) en el momento del diagnóstico. La proteína total y la albúmina sérica en orina de 24h iniciales fueron de 0,29±0,14 y 37,5±4,4g/l, respectivamente; la creatinina sérica inicial fue de 65,0±15,8μmol/l. Durante el seguimiento de 33,9±19,1 (rango: 6-73) meses, 22 pacientes (91,7%) mantienen la remisión. Un paciente presentó insuficiencia renal por síndrome coronario agudo y angiografía coronaria. Otro paciente tuvo una recaída causada por una infección del tracto respiratorio 2 veces, a los 50 y 70 meses. Se realizó una revisión sistemática de la literatura. Los pacientes con MN asociada con PLA2R en remisión espontánea se recuperaron en 16 informes o series de casos, de 97 casos en total. ConclusionesLa mayoría de los pacientes con MN en remisión espontánea tuvieron un pronóstico prometedor a largo plazo, mientras que solo unos pocos casos tuvieron recaída. (AU)

Epilepsias generalizadas idiopáticas: análisis de 101 pacientes / Idiopathic generalized epilepsies: Analysis of 101 patients

Introducción: Las epilepsias generalizadas idiopáticas (EGI) son un síndrome electroclínico que comprende 4 subsíndromes según la clasificación de la ILAE 2017. El pronóstico a largo plazo de estos síndromes es incierto debido a la escasez y a la heterogeneidad de los estudios. El objetivo de este trabajo es analizar el pronóstico a largo plazo de estos síndromes, el tratamiento farmacológico y la recurrencia de crisis.MétodosEstudio observacional y retrospectivo de una serie de pacientes diagnosticados de EGI. Se recogieron variables demográficas, tratamiento farmacológico, libertad de crisis y recurrencia tras su retirada.ResultadosIncluimos 101 pacientes, la mayoría mujeres (56,4%), con una mediana de evolución de la epilepsia de 17 años (rango intercuartílico: 7-31). El síndrome más frecuente fue la epilepsia mioclónica juvenil (46,5%), seguido de la epilepsia con solo crisis tónico-clónicas generalizadas (25,7%), la epilepsia de ausencia juvenil (13,9%) y la epilepsia de ausencia infantil (13,9%). Un 71,29% estaba en monoterapia y un 20,79% en politerapia, con diferencias entre los diferentes síndromes (p=0,001). El fármaco más utilizado fue el ácido valproico. El 39,6% presentaba remisión de crisis a los 5 años, pero no observamos diferencias significativas entre los diferentes síndromes (p=0,982). La tasa de recurrencia fue del 71,4% tras retirada de tratamiento.ConclusionesLa epilepsia mioclónica juvenil fue el subtipo de EGI más frecuente. Observamos diferencias significativas en cuanto a politerapia entre los diferentes síndromes, aunque no en las tasas de remisión al año y a los 5 años. La mayoría de pacientes a los que se retiró la medicación antiepiléptica recidivaron. (AU)

Introduction: Idiopathic generalized epilepsies (IGI) are an electroclinical syndrome that includes four subsyndromes according to the ILAE 2017 classification. The long-term prognosis of these syndromes is uncertain due to the scarcity and heterogeneity of the studies. The objective of this study is to analyze the long-term prognosis of these syndromes, pharmacological treatment and the seizure recurrence.MethodObservational and retrospective study of a serie of patients diagnosed with EGI. Epidemiological variables, pharmacological treatment, freedom of seizures and recurrence after withdrawal of treatment were collected.ResultsWe included 101 patients, the majority women (56.4%), with a median evolution of epilepsy of 17 years (interquartile range: 7–31). The most frequent syndrome was juvenile myoclonic epilepsy (46.5%), followed by epilepsy with generalized tonic–clonic seizures alone (25.7%), juvenile absence epilepsy (13.9%) and childhood absence epilepsy (13.9%). The 71.29% were on monotherapy and 20.79% on polytherapy, with significant differences between the different syndromes (P=.001). The most widely used drug was valproic acid. 39.6% presented seizure remission at 5 years, but we did not observe significant differences between the different syndromes (P=.982). The recurrence rate was 71.4% after withdrawal of treatment.ConclusionJuvenile myoclonic epilepsy was the most frequent subtype of IGE. We observed significant differences in terms of polytherapy in the different syndromes, although not in the rates of remission of seizures at one year and at five years. The majority of patients with treatment withdrawal relapsed. (AU)

Clinical characteristics of membranous nephropathy with spontaneous remission: An analysis of 24 patients.

PURPOSE: To investigate the prognosis of patients with spontaneous remission (SR) of phospholipase A2 receptor (PLA2R)-associated membranous nephropathy (MN). PATIENTS AND METHODS: Patients diagnosed with MN were recruited after examining their renal biopsy in the Renal Department of China-Japan Friendship Hospital between January 2015 and September 2021. Among them, 24 patients with SR were included in this study and follow-up. RESULTS: Twenty-four patients diagnosed with SR of PLA2R-associated MN were recruited; 11 were male, and 13 were female, with a mean age of 49.5±14.5 years (range, 30-77 years). The initial 24-hour urinary total protein and serum albumin levels were 0.29±0.14g/d and 37.5±4.4g/L, respectively, and the initial serum creatinine was 65.0±15.8µmol/L. During the follow-up of 33.9±19.1 months (range, 6-73 months), 22 (91.7%) patients maintained remission; however, one patient had impaired renal function due to acute coronary syndrome and coronary angiography findings, and one patient experienced a repeated relapse caused by respiratory tract infection, at 50 and 70 months. A systematic review of the relevant literature was conducted, and records of patients with SR of PLA2R-associated MN were retrieved from 16 case reports or case series with a total of 97 cases. CONCLUSIONS: Most patients with SR of MN had a promising long-term prognosis, with only a few cases of relapse.

Cefaleas primarias con inicio en la infancia y la adolescencia: historia natural y factores pronósticos en una población portuguesa / Primary headache with onset in childhood and adolescence: natural history and prognostic factors in a Portuguese population

Introducción: Las cefaleas son el trastorno neurológico más habitual en la población pediátrica e influyen notablemente en su calidad de vida. La finalidad de este estudio es caracterizar una cohorte de pacientes en seguimiento en una unidad de neurología pediátrica entre el 1 de enero de 2013 y el 31 de diciembre de 2021. Materiales y métodos: Hemos revisado informes médicos y seleccionado a pacientes con cefaleas primarias y un seguimiento mínimo de 12 meses.Resultados: Se incluyó a un total de 226 pacientes, el 54,4% mujeres, con una media de edad al comenzar las cefaleas de 9 ± 3,5 (3,1-16,5) años; el 63,5% eran prepuberales. Se identificó un historial familiar positivo de cefalea en el 76,6% de los casos y factores desencadenantes en el 63,6%. En una primera evaluación clínica, el 45,1% se identificó como migrañas sin aura; el 10,6%, como migrañas con aura; el 3,5%, como cefalea tensional; el 8%, como de tipo mixto (cefalea tensional y migraña); el 1,3%, de otro tipo; y el 31,4% resultó inclasificable. Los pacientes se sometieron a un seguimiento promedio de 2,4 (1,8-3,3) años. El diagnóstico de cefalea tensional se mantuvo estable en el 75% de los pacientes y se solucionó en un 25%; para el 13% de los pacientes con migraña sin aura, el diagnóstico cambió a otro tipo de cefalea, y para el 17,4%, se solucionó; para el 44,4% de los pacientes sin migraña con aura, el diagnóstico cambió por el de otro tipo de cefalea, y para el 11,1%, se resolvió. De las variables estudiadas, sólo la duración del episodio de cefalea tuvo una asociación significativa con la remisión de la cefalea, con una odds ratio de 0,16 (p = 0,03; intervalo de confianza al 95%: 0,032-0,84).Conclusiones: Nuestro estudio muestra que el tipo de cefalea en la población pediátrica cambia con el paso del tiempo, especialmente en los pacientes con migraña con aura. La duración de cada uno de los episodios de cefalea se presentó como un predictor de la remisión de la cefalea con el paso del...(AU)

Introduction: Headaches are the most frequent neurological disorder in the pediatric population, with great impact on quality of life. This study aims to characterize a cohort of patients followed at a pediatric neurology unit between January 1st 2013 and December 31st, 2021. Materials and methods: We reviewed medical records and selected patients with primary headaches and a minimum follow-up of 12 months. Results: A total of 226 patients were included, 54.4% female, with an average age at headache onset of 9 ± 3.5 (3.1-16.5) years; 63.5% were prepubertal. A positive family history of headache was identified in 76.6% of cases and triggers in 63.6%. At first clinical assessment, 45.1% were classified as migraine without aura, 10.6% as migraine with aura, 3.5% tension-type, 8% mixed (tension and migraine), 1.3% other type and 31.4% were unclassifiable. The patients had a median follow-up of 2.4 (1.8-3.3) years. The diagnosis of tension-type headaches remained stable in 75% of the patients and resolved in 25%; 13% of the patients with migraine without aura changed into another type of headache and 17.4% resolved; 44.4% of the patients with migraine with aura turned into another type of headache and 11.1% resolved. Of the variables studied, only duration of headache episode had a significant association with headache remission, with odds ratio 0.16 (p = 0.03; 95% confidence interval: 0.032-0.84).Conclusions: Our study shows that headache type in pediatric population changes over time, especially in those with migraine with aura. The duration of each headache episode was presented as a predictor of headache remission over time.(AU)

[Idiopathic generalized epilepsies: Analysis of 101 patients]. / Epilepsias generalizadas idiopáticas: análisis de 101 pacientes.

INTRODUCTION: Idiopathic generalized epilepsies (IGI) are an electroclinical syndrome that includes four subsyndromes according to the ILAE 2017 classification. The long-term prognosis of these syndromes is uncertain due to the scarcity and heterogeneity of the studies. The objective of this study is to analyze the long-term prognosis of these syndromes, pharmacological treatment and the seizure recurrence. METHOD: Observational and retrospective study of a serie of patients diagnosed with EGI. Epidemiological variables, pharmacological treatment, freedom of seizures and recurrence after withdrawal of treatment were collected. RESULTS: We included 101 patients, the majority women (56.4%), with a median evolution of epilepsy of 17 years (interquartile range: 7-31). The most frequent syndrome was juvenile myoclonic epilepsy (46.5%), followed by epilepsy with generalized tonic-clonic seizures alone (25.7%), juvenile absence epilepsy (13.9%) and childhood absence epilepsy (13.9%). The 71.29% were on monotherapy and 20.79% on polytherapy, with significant differences between the different syndromes (P=.001). The most widely used drug was valproic acid. 39.6% presented seizure remission at 5 years, but we did not observe significant differences between the different syndromes (P=.982). The recurrence rate was 71.4% after withdrawal of treatment. CONCLUSION: Juvenile myoclonic epilepsy was the most frequent subtype of IGE. We observed significant differences in terms of polytherapy in the different syndromes, although not in the rates of remission of seizures at one year and at five years. The majority of patients with treatment withdrawal relapsed.

Datos de remisión y manejo de una población oncológica a una unidad de dolor. ¿Qué podemos mejorar? / Review of the remission and management of a cancer related pain population to a pain unit. What can we improve?

Objetivos: Determinar las características demográficas, clínicas y de manejo analgésico de una población con dolor oncológico remitida a nuestra unidad de dolor (UD). Descripción de su manejo clínico una vez recibidos en la unidad. Detectar aspectos de mejora.Material y métodos: Estudio retrospectivo y descriptivo, realizado durante un periodo de 23 meses, entre noviembre de 2019 y diciembre de 2021, de todos los pacientes oncológicos derivados a la UD, cuya causa de derivación fuera dolor de origen oncológico.Resultados: Se analizaron 78 pacientes, el 63,2 % hombres y el 46,8 % mujeres. La edad media poblacional fue de 64,84 ± 12,623 años. El 44,7 % fueron remitidos por servicios quirúrgicos. El 75 % presentaba dolor moderado o severo. Los tumores más frecuentes fueron los abdominales (31,6 %), y cabeza y cuello (22,4 %). La causa del dolor fue en 48,7 % de los casos de la infiltración tumoral y en un 60,5 % un dolor de origen de mixto. En el momento de la remisión el 60 % de los pacientes recibía opioides mayores, con una dosis de equivalentes diarios de morfina (EDM) de 163,57 ± 167,10 mg y el 38 % recibía antineuropáticos. El tiempo medio para atender a estos pacientes desde el momento de solicitarla fue de 9,18 ± 9,73 días. Se realizó intervencionismo menor en el 56,6 % (43) de los pacientes y mayor en el 2,6 % (2). Se inició en la UD el tratamiento con fármacos antineuropáticos en el 68,4 % de los casos. Tras el manejo en la UD, un 72,4 % de los pacientes refirieron mejoría del dolor.Conclusiones: Mejorar la tasa de remisión de pacientes desde servicios como Oncología médica y Atención primaria. Mejorar los tiempos de remisión a las unidades de dolor. Ajustar mejor los tratamientos analgésicos antes de la remisión. Generar un protocolo de remisión sencillo de pacientes que incluyan pautas básicas de manejo del dolor. Mejorar el diagnóstico de dolor neuropático. Aumentar la cartera de servicios de intervencionismos de la UD....(AU)

Aim: Studying the demographic profile, clinical characteristics and analgesic management of an oncologic population sent to our pain unit. To describe the pain management in our unit. To detect management aspects to be improved.Methodology: Retrospective and descriptive study, performed in a period of 23 months, between November 2019 and December 2021, of all patients sent to our pain unit for cancer pain management.Results: A total of 78 patients were analyzed, 63,2 % men and 46,8 % women. The average age was 64,84 ± 12,623 years. 44,7 % were sent by surgical services. In 75% the pain was moderate or severe. The main cancer location was abdominal (31,6 %), and head and neck (22,4 %). In 48,7 % the pain was originated by tumoral infiltration and in 60,5 % the pain was judged to be mixed. At the moment of the arrival 60 % of patients were on opioids, with an average dose of 163,57 ± 167,10 mg EDM and 38 % were on antineurophatic drugs. The average time to attend the patients from the moment or request was 9,18 ± 9,73 days. A minor interventional procedure was performed in 56,6 % (43) of the patients, and a major intervention in 2,6 % (2). We started antineurophatic drugs in 68,4 % of the cases. During the period of pain management in our unit a 72,4% of the patients referred an improvement of their cancer related pain.Conclusions: It is necessary to improve the rate of remission from medical oncology departments and primary care physicians. To reduce the remission time to our unit from the referral services. To improve analgesic management before referral. To create an easy protocol for remission of patients that includes basic pain management instructions. To improve the rate of neuropathic pain diagnosis before referral. To expand our interventional technics portfolio. Pain units can improve cancer related pain management. To create multidisciplinary cancer pain comities.(AU)

Effectiveness and safety of tocilizumab in monotherapy in biologic-naïve and non-naïve patients with rheumatoid arthritis in a real-world setting / Eficacia y seguridad de tocilizumab en monoterapia en pacientes con artritis reumatoide naive y no naive a biológicos en un entorno del mundo real

Objective: To evaluate the effectiveness and safety of tocilizumab (TCZ) monotherapy in biologic-naïve patients with rheumatoid arthritis (RA) versus patients with previous biologic exposure in a real-world setting. Materials and methods: Non-controlled clinical-trial, 32-week prospective multicenter study including RA patients with moderate-severe disease activity starting TCZ in monotherapy who had a prior inadequate response or were intolerant to methotrexate (MTX). Effectiveness according to EULAR response evaluated at 24-week and safety at 32-weekwere assessed. Results: Of the 93 were enrolled of whom 84 (90%) were eligible for the effectiveness analysis. Biologic-naïve patients (n=46, 54.8%) were younger (51.5 versus 57.9) with shorter disease duration (6.4 versus 13.3) but presented similar comorbidities in comparison with non-naïve patients. DAS28 remission was achieved in a higher percentage in the group of patients with prior biological treatment. 89 adverse events (AE) were recorded in 50 patients, most of them non-serious AE (non-SAE) (86.3%). Conclusions: In a real world setting, TCZ exhibit similar effectiveness and safety in monotherapy in patients with RA regardless previous exposure to other biologic therapies. This study provides additional and valuable real-world findings on the use of TCZ in patients with RA.(AU)

Objetivo: Evaluar la efectividad y seguridad de la monoterapia con tocilizumab (TCZ) en pacientes con artritis reumatoide (AR) sin tratamiento biológico en comparación con pacientes con exposición previa a biológico en un entorno real.Materiales y métodos: Ensayo clínico no controlado, estudio multicéntrico prospectivo de 32 semanas que incluyó pacientes con AR con actividad de la enfermedad moderada-grave que comenzaron con TCZ en monoterapia y que tuvieron una respuesta inadecuada previa o fueron intolerantes al metotrexato. La eficacia de acuerdo con la respuesta EULAR fue evaluada a las 24 semanas y la seguridad a las 32 semanas. Resultados: De los 93 pacientes seleccionados, 84 (90%) fueron elegibles para el análisis de efectividad. Los pacientes sin tratamiento biológico previo (n=46, 54,8%) eran más jóvenes (51,5 frente a 57,9 años), con una duración más corta de la enfermedad (6,4 frente a 13,3 años), pero presentaban comorbilidades similares en comparación con los pacientes con tratamiento previo. La remisión de DAS28 se logró en un mayor porcentaje en el grupo de pacientes con tratamiento biológico previo. Se registraron 89 eventos adversos en 50 pacientes, la mayoría de ellos no graves (86,3%). Conclusiones: En un entorno del mundo real, TCZ exhibe una eficacia y seguridad similares en monoterapia en pacientes con AR, independientemente de la exposición previa a otras terapias biológicas. Este estudio proporciona hallazgos adicionales y valiosos en el contexto del mundo real sobre el uso de TCZ en pacientes con AR.(UA)

Clinical Advantage of Attaining Index-Based Remission Prior to Composite Remission in Treating Rheumatoid Arthritis / Ventaja clínica de lograr la remisión basada en índices antes que la remisión compuesta en el tratamiento de la artritis reumatoide

Background and objectives: The clinical advantage of targeting index-based remission prior to Boolean remission was evaluated retrospectively. Materials and methods: A total of 578 patients with rheumatoid arthritis (RA), who were treated for more than three years, were recruited. Patients who were treated to targeted index-based remission and composite measure remission criteria such as Boolean remission from the first consultation were divided according to the turn of attaining Boolean remission and index-based remission: G-IBR, a group that matched index-based remission at the same time Boolean remission is attained or earlier; G-BR_IF, a group that attained Boolean remission followed by index-based remission or failed; G-IR_BF, a group that could not attain Boolean remission despite attaining index-based remission; G-BothF, a group that failed to attain either Boolean remission or index-based remission. Background factors were statistically compared among groups. The Boolean remission rate in patients who attained index-based remission (BRR) and the rate of failure to attain index-based remission in patients who failed to attain Boolean remission (BFR) were statistically evaluated. Results: Groups comprising 225, 231, and 482 in G-IBR; 160, 154, and 8 in G-BR_IF; 18, 18, and 75 in G-IR_BF; and 175, 175, and 13 in G-BothF when indexing the clinical disease activity index (CDAI), simplified disease activity index (SDAI), and 28-joints disease activity score with C-reactive protein (DAS28-CRP), respectively. Disease activity indices’ scores after Boolean remission were demonstrated to be significantly higher in the G-BR_IF group than in the G-IBR group. BRR was 92.6%, 92.8%, and 86.5%, while BFR was 71.3%, 71.3%, and 13.8% when indexing CDAI, SDAI, and DAS28-CRP, respectively. Conclusions: Targeting CDAI and SDAI remission prior to Boolean remission contributes to a stable clinical course.(AU)

Antecedentes y objetivos: Se evaluó prospectivamente la ventaja clínica de centrarse en la remisión basada en índices de manera previa a la remisión booleana. Materiales y métodos: Se seleccionó a un total de 578 pacientes con artritis reumatoide que habían sido tratados durante más de 3 años. Se dividió en grupos a los pacientes según los criterios de remisión: remisión basada en índices o remisión de medidas compuestas, tales como remisión booleana desde la primera consulta, de acuerdo con el plazo de logro: G-IBR, un grupo que equiparó la remisión basada en índices al mismo tiempo que logró la remisión booleana o antes; G-BR_IF, un grupo que logró la remisión booleana seguida de remisión basada en índices o que fracasó; G-IR_BF, un grupo que no logró la remisión booleana a pesar de lograr la remisión basada en índices; G-BothF, un grupo que no logró la remisión booleana ni la remisión basada en índices. Se compararon entre los grupos los factores antecedentes. Se evaluaron estadísticamente la tasa de remisión booleana en los pacientes que lograron la remisión basada en índices (BRR) y la tasa de fracaso en el logro de la remisión booleana (BFR). Resultados: Los grupos estuvieron formados por 225, 231 y 482 en G-IBR; 160, 154 y 8 en G-BR_IF; 18, 18 y 75 en G-IR_BF y 175, 175 y 13 en G-BothF al indexar el índice de actividad de la enfermedad clínica (CDAI), el índice simplificado de actividad de la enfermedad (SDAI) y el índice DAS-28 con proteína C reactiva (DAS28-CRP), respectivamente. Las puntuaciones de los índices de actividad de la enfermedad tras la remisión booleana fueron significativamente más altas en el grupo G-BR_IF que en el grupo G-IBR. BRR fue del 92,6; 92,8 y 86,5%, mientras que BFR fue del 71,3; 71,3 y 13,8% al indexar CDAI, SDAI y DAS28-CRP, respectivamente. Conclusiones: Centrarse en las remisiones CDAI y SDAI de forma previa a la remisión booleana contribuye a un curso clínico estable.(AU)

Psoríase vulgar em remissão após profilaxia com isoniazida para tuberculose latente: relato de caso / Psoriasis vulgar in remission after prophylaxis with isoniazid for latent tuberculosis: case report / Psoriasis vulgar en remisión tras profilaxis con isoniazida para tuberculosis latente: reporte de caso

Introdução: A psoríase é uma patologia sistêmica, multifatorial e com lesões cutâneas bem características. Objetivo: Investigar a possibilidade de existir uma correlação entre a infecção latente pelo Mycobacterium tuberculosis e a patogênese da Psoríase, a fim de contribuir com a terapêutica de casos de Psoríase grave ou refratários. Material e Método: Relato de caso de psoríase vulgar não responsiva aos tratamentos de primeira linha, em que a Isoniazida para ILTB induziu à remissão sustentada do quadro clínico. Baseada no caso, foi realizada uma revisão sobre o uso da Isoniazida no tratamento da ILTB nos pacientes com psoríase e que obtiveram regressão das lesões psoriáticas. O estudo utilizou dados da plataforma Pubmed. Resultados: Dos 50 artigos encontrados, 08 foram selecionados para leitura completa. Foram descritos apenas quatro casos como este na literatura internacional. Os achados desse estudo mostram que a possibilidade de existir uma correlação entre a infecção latente pelo Mycobacterium tuberculosis e a patogênese da Psoríase, a fim de contribuir com a terapêutica de casos de Psoríase grave ou refratários, ainda é incerta. Conclusão: Pesquisas mais detalhadas são necessárias para elucidar o real mecanismo dos anti tuberculínicos (especialmente a Isoniazida) no tratamento da Psoríase, quanto a possibilidade de existir uma correlação entre a infecção pelo Mycobacterium tuberculosis e a patogênese da Psoríase. Se isto for comprovado, teremos um grande incremento no arsenal terapêutico destinado aos pacientes com Psoríase grave ou refratários (AU)

Introduction: Psoriasis is a systemic pathology, multifactorial and with well characteristic skin lesions. Objective: To investigate the possibility of a correlation between latent infection by Mycobacterium tuberculosis and the pathogenesis of Psoriasis, in order to contribute to the therapy of severe or refractory Psoriasis cases. Material and Method: Case report of vulgar psoriasis not responsive to first-line treatments, in which Isoniazid for LTBI induced sustained remission of the clinical picture. Based on the case, a review was performed on the use of Isoniazid in the treatment of LTBI in patients with psoriasis and who obtained regression of psoriatic lesions. The study used data from the Pubmed platform. Results: Of the 50 articles found, 08 were selected for full reading. Only four cases like this have been described in the international literature. The findings of this study show that the possibility of a correlation between latent infection by Mycobacterium tuberculosis and the pathogenesis of Psoriasis, in order to contribute to the therapy of severe or refractory Psoriasis cases, is still uncertain. Conclusion: More detailed research is needed to elucidate the real mechanism of anti tuberculins (especially Isoniazid) in the treatment of Psoriasis, the possibility of a correlation between infection by Mycobacterium tuberculosis and the pathogenesis of Psoriasis. If this is proven, we will have a large increase in the therapeutic arsenal for patients with severe or refractory psoriasis (AU)

Introducción: La psoriasis es una patología sistémica, multifactorial, con lesiones cutáneas muy características. Objetivo: Investigar la posibilidad de una correlación entre la infección latente por Mycobacterium tuberculosis y la patogenia de la Psoriasis, con el fin de contribuir al tratamiento de casos severos o refractarios de Psoriasis. Material y Método: Reporte de caso de psoriasis vulgar sin respuesta a tratamientos de primera línea, en el cual Isoniazida para ITBL indujo remisión sostenida del cuadro clínico. En base al caso se realizó una revisión sobre el uso de Isoniazida en el tratamiento de la ITBL en pacientes con psoriasis y que lograron la regresión de las lesiones psoriásicas. El estudio utilizó datos de la plataforma Pubmed. Resultados: De los 50 artículos encontrados, 08 fueron seleccionados para lectura completa. Solo cuatro casos como este han sido descritos en la literatura internacional. Los hallazgos de este estudio muestran que la posibilidad de una correlación entre la infección latente por Mycobacterium tuberculosis y la patogenia de la Psoriasis, para contribuir al tratamiento de casos severos o refractarios de Psoriasis, es aún incierta. Conclusión: Se necesita una investigación más detallada para dilucidar el mecanismo real de los fármacos antituberculínicos (especialmente la Isoniazida) en el tratamiento de la Psoriasis, en cuanto a la posibilidad de una correlación entre la infección por Mycobacterium tuberculosis y la patogenia de la Psoriasis. De demostrarse esto, tendremos un gran incremento en el arsenal terapéutico destinado a pacientes con psoriasis severa o refractaria (AU)

Effectiveness and safety of tocilizumab in monotherapy in biologic-naïve and non-naïve patients with rheumatoid arthritis in a real-world setting.

OBJECTIVE: To evaluate the effectiveness and safety of tocilizumab (TCZ) monotherapy in biologic-naïve patients with rheumatoid arthritis (RA) versus patients with previous biologic exposure in a real-world setting. MATERIALS AND METHODS: Non-controlled clinical-trial, 32-week prospective multicenter study including RA patients with moderate-severe disease activity starting TCZ in monotherapy who had a prior inadequate response or were intolerant to methotrexate (MTX). Effectiveness according to EULAR response evaluated at 24-week and safety at 32-weekwere assessed. RESULTS: Of the 93 were enrolled of whom 84 (90%) were eligible for the effectiveness analysis. Biologic-naïve patients (n=46, 54.8%) were younger (51.5 versus 57.9) with shorter disease duration (6.4 versus 13.3) but presented similar comorbidities in comparison with non-naïve patients. DAS28 remission was achieved in a higher percentage in the group of patients with prior biological treatment. 89 adverse events (AE) were recorded in 50 patients, most of them non-serious AE (non-SAE) (86.3%). CONCLUSIONS: In a real world setting, TCZ exhibit similar effectiveness and safety in monotherapy in patients with RA regardless previous exposure to other biologic therapies. This study provides additional and valuable real-world findings on the use of TCZ in patients with RA.

Clinical Advantage of Attaining Index-Based Remission Prior to Composite Remission in Treating Rheumatoid Arthritis.

BACKGROUND AND OBJECTIVES: The clinical advantage of targeting index-based remission prior to Boolean remission was evaluated retrospectively. MATERIALS AND METHODS: A total of 578 patients with rheumatoid arthritis (RA), who were treated for more than three years, were recruited. Patients who were treated to targeted index-based remission and composite measure remission criteria such as Boolean remission from the first consultation were divided according to the turn of attaining Boolean remission and index-based remission: G-IBR, a group that matched index-based remission at the same time Boolean remission is attained or earlier; G-BR_IF, a group that attained Boolean remission followed by index-based remission or failed; G-IR_BF, a group that could not attain Boolean remission despite attaining index-based remission; G-BothF, a group that failed to attain either Boolean remission or index-based remission. Background factors were statistically compared among groups. The Boolean remission rate in patients who attained index-based remission (BRR) and the rate of failure to attain index-based remission in patients who failed to attain Boolean remission (BFR) were statistically evaluated. RESULTS: Groups comprising 225, 231, and 482 in G-IBR; 160, 154, and 8 in G-BR_IF; 18, 18, and 75 in G-IR_BF; and 175, 175, and 13 in G-BothF when indexing the clinical disease activity index (CDAI), simplified disease activity index (SDAI), and 28-joints disease activity score with C-reactive protein (DAS28-CRP), respectively. Disease activity indices' scores after Boolean remission were demonstrated to be significantly higher in the G-BR_IF group than in the G-IBR group. BRR was 92.6%, 92.8%, and 86.5%, while BFR was 71.3%, 71.3%, and 13.8% when indexing CDAI, SDAI, and DAS28-CRP, respectively. CONCLUSIONS: Targeting CDAI and SDAI remission prior to Boolean remission contributes to a stable clinical course.

Presurgical predictive factors of surgical remission in Cushing's disease. Study of 32 cases.

PURPOSE: Identify presurgical factors associated with surgical remission in Cushing's disease (CD). METHODS: All the patients with ACTH-dependent Cushing's Syndrome in follow-up at our centre between 2014-2021 (n=40) were identified. Those patients with CD diagnosis who underwent transsphenoidal surgery by the same neurosurgeon (n=32) were included. Surgical remission was defined as plasma cortisol <1.8µg/dl and normal or low urinary free cortisol (UFC) after surgery. RESULTS: Sixty-three per cent (n=20) were women, and the mean age at diagnosis was 42.3±17.9 years. Six patients had macroadenomas, 17 had microadenomas, and in the other 9 patients, no pituitary lesion was identified on the MRI. Seven patients were previously operated on in another centre. Surgical remission was achieved in 75% (n=24). Only three patients experienced recurrence. No association between pre-surgical demographic (age, sex, comorbidities) or hormonal (UFC, ACTH, late-night salivary cortisol levels) characteristics and the probability of surgical remission was observed. The only variable associated with a greater chance of remission was the presurgical visualisation of the adenoma on MRI (OR 8.3, P=0.02). It was also observed that patients with a history of a previous pituitary surgery had a lower tendency to achieve remission, although statistical significance was not reached (OR 0.17, P=0.09). CONCLUSIONS: In our experience, 75% of patients with CD achieved biochemical cure after the intervention. Surgical remission was up to eight times more frequent in those patients in whom the adenoma was visualised before the intervention, but no other presurgical predictive factors of cure were identified.

Budesonide in the first line treatment of patients with autoimmune hepatitis / Budesonida en primera línea de tratamiento de pacientes con hepatitis autoinmune

Budesonide is a glucocorticoid characterized by its local action, with a low systemic bioavailability. Since the original trial comparing budesonide with prednisone in 2010, it is recommended as an effective alternative for the treatment of non-severe acute or chronic autoimmune hepatitis. In this document, we review the general pharmacologic properties of glucocorticoids, the available evidence for the use of budesonide as first line option for autoimmune hepatitis as well as the safety profile of the drug.(AU)

La budesonida es un glucocorticoide que se caracteriza por su acción local, con una baja biodisponibilidad sistémica. Desde el ensayo original publicado en 2010, en el que se comparó la budesonida con prednisona, se recomienda como una alternativa eficaz en el tratamiento de los pacientes con hepatitis autoinmune aguda o crónica no grave. En este documento, revisamos las propiedades farmacológicas generales de los glucocorticoides, la evidencia disponible para el uso de budesonida como fármaco de primera línea en estos pacientes, así como el perfil de seguridad del fármaco.(AU)

Gran aneurisma de la vena ácigos y su resolución espontánea por oclusión / Large azygos vein aneurysm with spontaneous remission

Introducción: los aneurismas de la vena ácigos son una entidad extremadamente rara. Hasta la fecha solo hay 57 casos descritos en la literatura. Caso clínico: describimos el caso de una mujer de 45 años en cuya tomografía computarizada, realizada como parte del estudio de linfoma no Hodgkin, presentó como hallazgo casual una masa paratraqueal de 6 cm compatible con aneurisma de la ácigos. Durante los tres primeros años tras el diagnóstico el aneurisma permaneció estable. Sin embargo, la tomografía computarizada realizada al cuarto año de seguimiento demostró una oclusión espontánea.Discusión:hasta la fecha no existe ninguna guía clínica o protocolo que determine la mejor actitud terapéutica para esta inusual entidad.(AU)

Introduction: azygos vein aneurysms are extremely rare. To date, no more than 57 cases have been reported. Case report: herein we report a 45-year-old woman whose CT-scan, during a routine health examination for non-Hodgkin lymphoma, showed a 6 cm paratracheal mass compatible with aneurysm of the azygos vein. The stability of the aneurysm was confirmed during the first three years of follow-up. On the fourth year, however, the CT-scan showed a spontaneous occlusion and intraluminal thrombosis.Discussion:to date, no guidelines or reviews exist on the optimal treatment strategies for these patients due to the infrequent nature of the disease.(AU)

Defining negative symptoms remission in schizophrenia using the Brief Negative Symptom Scale.

INTRODUCTION: This study aimed to propose criteria for negative symptoms remission (NSR) in schizophrenia using the Brief Negative Symptom Scale (BNSS). MATERIAL AND METHODS: 274 participants were assessed on the Positive and Negative Syndrome Scale (PANSS), BNSS and Social and Occupational Functioning Assessment Scale (SOFAS). Two criteria for NSR on the BNSS were proposed - NSR based on the BNSS domains scores (NSRBNSS_DOMAINS) and NSR based on 5 key items of the BNSS (NSRBNSS_5ITEMS). A SOFAS score of 61 and above was considered as functional remission (FR). Logistic regressions were run to examine the association between FR and NSR. Receiver operating characteristic (ROC) curve analysis was performed for the NSR criteria on FR. Kappa agreement statistic was used to evaluate the agreement between the two NSR criteria. RESULTS: Eighty-nine (32.5%) participants fulfilled NSRBNSS_DOMAINS criterion whereas 70 (25.6%) participants fulfilled NSRBNSS_5ITEMS criterion. The two NSR criteria had substantial agreement (Kappa statistic=0.797) with each other. Sixty-one (25.3%) participants were in FR. FR was significantly associated with NSR, irrespective of the criterion used. To predict FR, the Area Under the Curve for NSRBNSS_DOMAINS and NSRBNSS_5ITEMS were 0.761 (CI: 0.696-0.826, p<0.001) and 0.723 (CI: 0.656-0.790, p<0.001), respectively. Hence, both NSR criteria demonstrated a fair ability to discriminate between functional remitters and non-remitters. CONCLUSIONS: Depending on the setting and needs, clinicians and researchers might employ either the full BNSS or an abbreviated 5-item BNSS scale to identify NSR in schizophrenia. More research is needed to further examine the validity of these criteria in schizophrenia.

Lupus en Argentina. Pacientes no respondedores al tratamiento estándar y belimumab como posible opción. Datos del registro RELESSAR / Lupus in Argentina. Non-responders to standard treatment and belimumab as a possible option. RELESSAR record data

Introducción: el lupus es una enfermedad compleja y varias veces de difícil abordaje. Alcanzar la remisión es uno de los objetivos, incorporando opciones terapéuticas. Objetivos: describir las características generales de los pacientes según el estado de la enfermedad y el uso de belimumab. Materiales y métodos: estudio de corte transversal, registro RELESSAR. Se definió el estado de la enfermedad como: remisión: SLEDAI=0 y sin corticoides; baja actividad de la enfermedad: SLEDAI >0 y ≤4 y sin corticoides; control no óptimo: SLEDAI >4 y cualquier dosis de corticoides. Resultados: se incluyeron 1.277 pacientes, 23,4% en remisión, 12,6% en baja actividad y 63,8% con control no óptimo. En este último grupo eran más jóvenes y con menor duración de la enfermedad; presentaban mayores índices de actividad y cronicidad, y mayor empleo de inmunosupresores. Solo el 22,3% de los pacientes con criterio potencial de uso de belimumab (lupus eritematoso sistémico activo a pesar del tratamiento estándar) lo recibía en ese momento. Las variables asociadas a hospitalizaciones fueron: terapia con corticoides, ciclofosfamida y mayor SLICC. Conclusiones: se refleja la complejidad del manejo de estos pacientes y se visualizan aspectos estructurales como la desigualdad. El uso del belimumab resultaría beneficioso en los pacientes seleccionados.

Introduction: lupus is a complex disease and often difficult to approach. Achieving remission is one of the objectives, incorporating therapeutic options. Objectives: to describe the characteristics of the patients and the use of belimumab, according to the status of the disease. Materials and methods: cross-sectional study. Patients of the RELESSAR registry. Stratification: Remission: SLEDAI=0 and without corticosteroids. Low disease activity SLEDAI> 0 and ≤4 and without corticosteroids and non-optimal control: SLEDAI> 4 and any dose of corticosteroids. Results: a total of 1,277 patients were included, 23.4% in remission, 12.6% in low disease activity and 63.8% in non-optimal control. The last group was younger and had a shorter duration of the disease. They had higher activity and chronicity indices and greater use of immunosuppressants. Only 22.3% of the patients with potential criteria for the use of belimumab (activity disease despite standard treatment) were receiving it. The variables associated with hospitalizations were: corticosteroids, cyclophosphamide and higher SLICC. Those associated with severe infection: mycophenolate mofetil, azathioprine, corticosteroids, and higher SLICC. Conclusions: the complexity of the management of these patients is reflected, visualizing structural aspects such as inequality. The use of belimumab could be beneficial in selected patients.

Lupus en Argentina. Pacientes no respondedores al tratamiento estándar y belimumab como posible opción. Datos del registro RELESSAR / Lupus in Argentina. Non-responders to standard treatment and belimumab as a possible option. RELESSAR record data

Introducción: el lupus es una enfermedad compleja y varias veces de difícil abordaje. Alcanzar la remisión es uno de los objetivos, incorporando opciones terapéuticas. Objetivos: describir las características generales de los pacientes según el estado de la enfermedad y el uso de belimumab. Materiales y métodos: estudio de corte transversal, registro RELESSAR. Se definió el estado de la enfermedad como: remisión: SLEDAI=0 y sin corticoides; baja actividad de la enfermedad: SLEDAI >0 y ≤4 y sin corticoides; control no óptimo: SLEDAI >4 y cualquier dosis de corticoides. Resultados: se incluyeron 1.277 pacientes, 23,4% en remisión, 12,6% en baja actividad y 63,8% con control no óptimo. En este último grupo eran más jóvenes y con menor duración de la enfermedad; presentaban mayores índices de actividad y cronicidad, y mayor empleo de inmunosupresores. Solo el 22,3% de los pacientes con criterio potencial de uso de belimumab (lupus eritematoso sistémico activo a pesar del tratamiento estándar) lo recibía en ese momento. Las variables asociadas a hospitalizaciones fueron: terapia con corticoides, ciclofosfamida y mayor SLICC. Conclusiones: se refleja la complejidad del manejo de estos pacientes y se visualizan aspectos estructurales como la desigualdad. El uso del belimumab resultaría beneficioso en los pacientes seleccionados.

Introduction: lupus is a complex disease and often difficult to approach. Achieving remission is one of the objectives, incorporating therapeutic options. Objectives: to describe the characteristics of the patients and the use of belimumab, according to the status of the disease. Materials and methods: cross-sectional study. Patients of the RELESSAR registry. Stratification: Remission: SLEDAI=0 and without corticosteroids. Low disease activity SLEDAI> 0 and ≤4 and without corticosteroids and non-optimal control: SLEDAI> 4 and any dose of corticosteroids. Results: a total of 1,277 patients were included, 23.4% in remission, 12.6% in low disease activity and 63.8% in non-optimal control. The last group was younger and had a shorter duration of the disease. They had higher activity and chronicity indices and greater use of immunosuppressants. Only 22.3% of the patients with potential criteria for the use of belimumab (activity disease despite standard treatment) were receiving it. The variables associated with hospitalizations were: corticosteroids, cyclophosphamide and higher SLICC. Those associated with severe infection: mycophenolate mofetil, azathioprine, corticosteroids, and higher SLICC. Conclusions: the complexity of the management of these patients is reflected, visualizing structural aspects such as inequality. The use of belimumab could be beneficial in selected patients.