Édgar Peñaranda-Parada

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

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

Gouty arthritis and panniculitis: extensive involvement of the dermis and severe joint damage.

G out is an inflammatory arthritis induced by the deposition of monosodium urate (MSU) crystals in the synovial fluid and other tissues. It is associated with hyperuricemia, which is defined as a serum level of uric acid higher than 6.8 mg/dL (404 mol/L), which is the solubility limit of urate at physiologic pH and temperature. The pathophysiologic mechanisms responsible for the clinical, radiologic, and histologic changes associated to gout are well studied. Panniculitis is an unusual complication of gout characterized by the presence of MSU crystal deposits in the lobular subcutaneous tissue. We present a Colombian patient with panniculitis and unusually severe gouty arthritis.

Historia del tratamiento de las vasculitis primarias

Resumen Las vasculitis primarias constituyen un grupo de enfermedades reumaticas con expresion clinica variable y pronostico reservado cuando no se tratan adecuadamente. En esta revision haremos un analisis pormenorizado del tratamiento en las diferentes formas de vasculitis primaria, iniciando con el uso de los corticoides, desde casi su descubrimiento en 1949, pasando por otros inmunosupresores como: ciclofosfamida, metotrexate, azatioprina, mofetil, micofenolato, al igual que medicamentos biologicos como rituximab y anti-TNF. Una mencion especial se hace sobre las guias de tratamientos para las vasculitis, tanto de grandes como de pequenos vasos, implementadas desde 2009 por el Grupo Europeo de Estudio de las Vasculitis.

Enfermedades osteocondensantes con compromiso de huesos largos: presentación de dos casos y revisión de la literatura*

Summary Sclerosing bone disorders are a rare group of diseases characterized by increased bone mass in both long and flat bones. Traditionally, plain radiography has allowed the diagnosis of these diseases identifying characteristic patterns of bone involvement. At present, the molecular and genetic characterization of these diseases has provided a better understand of their pathophysiology and phenotypic expression, however plain radiography continues to have an important role in the recognition of sclerosing bone disorders.