Luis Alberto Gómez

Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL)

Objective To evaluate disease activity statuses’ (DAS’) impact on systemic lupus erythematosus (SLE) outcomes. Materials and methods Four DAS were defined: remission off-therapy: SLE Disease Activity Index (SLEDAI)=0, no prednisone or immunosuppressive drugs (IS); remission on-therapy: SLEDAI=0, prednisone ≤5u2009mg/day and/or IS (maintenance); low (L) DAS: SLEDAI ≤4, prednisone ≤7.5u2009mg/day and/or IS (maintenance); non-optimally controlled: SLEDAI >4u2009and/or prednisone >7.5u2009mg/day and/or IS (induction). Antimalarials were allowed in all. Predefined outcomes were mortality, new damage (increase of at least one Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) point) and severe new damage (increase of at least 3 SDI points). Univariable and multivariable Cox regression models were performed to define the impact of DAS, as time-dependent variable, on these outcomes. Results 1350 patients were included, 79 died during follow-up, 606 presented new and 177 severe new damage. In multivariable analyses, remission (on/off-therapy) was associated with a lower risk of new (HR 0.60; 95%u2009CI 0.43 to 0.85), and of severe new damage (HR 0.32; 95%u2009CI 0.15 to 0.68); low disease activity status (LDAS) was associated with a lower risk of new damage (HR 0.66; 95%u2009CI 0.48 to 0.93) compared with non-optimally controlled. No significant effect on mortality was observed. Conclusions Remission was associated with a lower risk of new and severe new damage; LDAS with a lower risk of new damage after adjusting for other damage confounders.

Salvamento de extremidad con resección extraarticular de rodilla

Resumen Cuando tenemos un tumor oseo maligno del femur distal con contaminacion de la articulacion, ya sea por extension del tumor, fracturas secundarias al tumor con trazo intraarticular o contaminacion en una biopsia tomada de manera inadecuada, debemos realizar resecciones extraarticulares de rodilla para lograr un control primario del tumor. Podemos emplear varias tecnicas para lograr este fin, y una buena reconstruccion; la tecnica que empleamos es la reseccion extraarticular mas la preservacion del mecanismo extensor, poco conocida en nuestro medio y de la cual es pionera el Instituto Nacional de Cancerologia. Con ella, hemos logrado un adecuado control tumoral primario de las lesiones oseas malignas en el femur distal, menor numero de complicaciones, una rapida rehabilitacion y retorno a sus actividades habituales. Por esto, el interes de dar a conocer dicha tecnica en los grupos de ortopedia oncologica, para que haga parte de su armamentario quirurgico habitual.