Enrique Raya Álvarez

Elevada prevalencia de déficit de vitamina D en poblaciones con riesgo de osteoporosis: Un factor relevante en la integridad Ósea

Fundamento En la actualidad, la deficiencia grave de vitamina D es infrecuente en la mayoria de los paises desarrollados. Sin embargo, la prevalencia del deficit subclinico de vitamina D (insuficiencia de vitamina D [IVD]) es mas elevada y puede contribuir al descenso de la masa osea en poblaciones con riesgo de osteoporosis. El objetivo de nuestro estudio fue evaluar la prevalencia de IVD en mujeres posmenopausicas (MPM), pacientes diagnosticados de enfermedad inflamatoria intestinal (EII) y pacientes asmaticos en tratamiento con glucocorticoides (PAC) y analizar su relacion con la densidad mineral osea (DMO) y hormonas calciotropas. Pacientes y metodo Estudiamos a 299 sujetos (MPM 161; EII 61; PAC 77). En todos los casos determinamos los valores sericos de hormona paratiroidea (PTH), 25-hidroxivitamina D (25OHD) y la DMO (DXA, Hologic QDR1000) en columna lumbar y cuello femoral. Resultados La prevalencia de IVD (25OHD Conclusiones En poblaciones con riesgo de osteoporosis, el deficit de vitamina D tiene una elevada prevalencia y un efecto significativo en el deterioro de la integridad osea.

Hiperparatiroidismo secundario en el cancer de prostata avanzado

BACKGROUND AND OBJECTIVE High parathyroid hormone (PTH) concentrations are associated with increased bone resorption and bone matrix degradation. Some studies show elevated PTH concentrations and hypocalcemia in patients with advanced prostate carcinoma, although the pathophysiological significance of these findings is not well defined. MATERIALS AND METHODS We performed a retrospective study of 60 patients diagnosed with advanced prostate cancer (44 nonmetastatic and 16 metastatic) treated with androgen deprivation. In all patients, PTH, calcium, phosphorus, 25 (OH) vitamin D and prostate-specific antigen (PSA) were determined. Bone scintigraphy had previously been performed. RESULTS In patients with bone metastases, mean concentrations were as follows: calcium 9.19 mg/dl, phosphorus 3.47 mg/dl, 25 (OH) vitamin D 13.85 ng/ml, PTH 66.8 pg/ml and total PSA 101.27 ng/ml. For those without bone metastases, the results were calcium 9.39 mg/dl, phosphorus 3.38 mg/dl, 25 (OH) vitamin D 20.50 ng/ml, PTH 52.23 pg/ml and total PSA 2.52 ng/ml. PTH levels were significantly higher in patients with prostate cancer and bone metastases than in those without metastases (p=0.03). Vitamin D levels were also significantly lower in this group (p=0.03). There were no differences in other values. CONCLUSIONS The present study found increased PTH concentrations in patients with advanced prostate cancer. This finding could be useful to predict disease progression.

Factores predictores de respuesta a terapias biológicas en la artritis reumatoide

The advent of biological therapies has revolutionized the management of rheumatoid arthritis, demonstrating effectiveness in controlling clinical and radiological damage. However, 20 to 40% of the patients will not respond to these therapies, which are associated to a very high cost. In addition, non-responder patients are exposed to possible adverse effects. For these reasons, we need to identify predictors of response to these treatments. These predictors are reviewed in this evidence-based paper and classified into genetic and non-genetic. Despite extensive search, nowadays there are no predictors powerful enough to be used in regular clinical practice. Serum factors, the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies, are the only factors currently being used to predict the response to specific biological therapy. In the future, probably thanks to new technologies based on genomics, transcriptomics and proteomics, it will be possible to identify genetic predictors of response to biological drugs that will allow us to select suitable patients for a specific biological therapy.

The impact of therapy with TNF-blockers on health-related quality of life in rheumatoid arthritis patients. A pilot study

Abstract Introduction The aim of this pilot study was to evaluate the initial response to 16 weeks of treatment with infliximab and etanercept of disease activity and quality of life in a cohort of 37 patients with established rheumatoid arthritis. Patients and method Patients were selected from the Unit of Rheumatology in Hospital Clinico San Cecilio from Granada, refractory to conventional treatment with disease modifying antirheumatic drugs. To assess the disease activity, Disease activity score (DAS28) was used and the measurement of quality of life was evaluated with the Spanish version of the SF-36 Health Survey (SF-36) and the RA-specific questionnaire QoL Scale (Quality of Life in Rheumatoid Arthritis). Results Preliminary results show a significant decrease in inflammatory activity of the disease and consequently in HRQL scores. The comparison with the general reference population shows a deviation well below average, especially in the “physical function” dimension with a rising response pattern in all dimensions. The correlation between specific scores (QoL-RA scale) and generic ones (SF-36) for HQ-treatment also showed significance, especially with the physical aggregate. Discussion An important limitation of the present study is the number of patients and the duration of the treatment; despite this, improvements in functional parameters and quality of life are evident and remain roughly stable since the first weeks of treatment. This allows us to continue the study and increase the number of patients. Conclusions The preliminary results obtained with TNF-blockers after 16 weeks of treatment in RA objectively show the effectiveness of these drugs and also the perception by the patients of the effect on their quality of life.

Fibrodisplasia osificante progresiva: comunicación de un caso terminal

Mujer de 29 años, con antecedentes personales de diabetes tipo 1 A y amenorrea primaria secundaria a agenesia cervical. A los 10 años de edad consultó por aparición de tumoración en la región cervical, sin traumatismo previo; se realizó estudio radiológico y biopsia ósea que resultó compatible con miositis osificante. A lo largo de los años fueron apareciendo osificaciones ectópicas de gran tamaño en los hombros, las caderas, las rodillas, los tobillos y la musculatura paravertebral, lo que produjo una marcada escoliosis dorsolumbar secundaria y supuso una importante limitación funcional generalizada. El estudio de radiología simple de las áreas afectadas mostró la existencia de exuberantes puentes óseos en diferentes estadios de maduración, que provocaban bloqueo y anquilosis de múltiples articulaciones, como la rodilla (fig. 1), la columna vertebral (fig. 2) y el hombro (fig. 3). La paciente fue tratada con bisfosfonatos y suplementos de calcio con vitamina D durante 5 años y paralelamente mantuvo seguimiento con el servicio de rehabilitación; sin embargo, ninguna de estas medidas consiguió detener la evolución de la enfermedad hacia la incapacidad física de la paciente. La fibrodisplasia osificante progresiva es una rara enfermedad de origen desconocido que se caracteriza por osificación heterotópica progresiva de los músculos y otras estructuras ricas en tejido conectivo1. En los últimos años se ha producido un avance en el conocimiento de su mecanismo etiopatogénico, en el que se ha implicado al receptor de la proteína morfogenética ósea (BMP) llamada activina A tipo i similar a la activina-cinasa