Luis Francisco Linares Ferrando

Documento SER de consenso sobre el uso de terapias biológicas en la espondilitis anquilosante y otras espondiloartritis, excepto la artritis psoriásica

OBJECTIVE Due to the amount and variability in quality regarding the use of biologic therapy (BT) in patients with spondyloarthritis (SpA), except for psoriatic arthritis (PsA) patients, the Spanish Society of Rheumatology has promoted the generation of recommendations based on the best evidence available. These recommendations should be a reference for rheumatologists and those involved in the treatment of patients with spondyloarthritis (SpA), except for psoriatic arthritis (PsA), who are using, or about to use BT. METHODS Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. RESULTS We have produced recommendations on the use of BT currently available for SpA (but not PsA) in our country. These recommendations include disease assessment, treatment objectives, therapeutic scheme and switching. CONCLUSIONS We present an update on the SER recommendations for the use of BT in patients with SpA, except for PsA.

Consensus Statement of the Spanish Society of Rheumatology on the management of biologic therapies in Spondyloarthritis except for Psoriatic Arthritis

Abstract Objective Due to the amount and variability in quality regarding the use of biologic therapy (BT) in patients with spondyloarthritis (SpA), except for psoriatic arthritis (PsA) patients, the Spanish Society of Rheumatology has promoted the generation of recommendations based on the best evidence available. These recommendations should be a reference for rheumatologists and those involved in the treatment of patients with spondyloarthritis (SpA), except for psoriatic arthritis (PsA), who are using, or about to use BT. Methods Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Results We have produced recommendations on the use of BT currently available for SpA (but not PsA) in our country. These recommendations include disease assessment, treatment objectives, therapeutic scheme and switching. Conclusions We present an update on the SER recommendations for the use of BT in patients with SpA, except for PsA.

Artritis séptica esternoclavicular y empiema

Attention of a patient with a swollen joint and fever is a medical emergency due to the possibility of septic arthritis. The sternoclavicular joint is a rare localization for septic arthritis in patients without risk factors (intravenous drug users [IDU]), immunocompromised patients, diabetes, etc.).1 In this type of involvement there are serious possible complications such as abscesses, mediastinitis, osteomyelitis and empyema.1 Here, we report the case of a patient with sternoclavicular septic arthritis and secondary empyema. The patient, a 63-year-old male was admitted to our hospital for right shoulder pain lasting one week and three days with high fever. He had a painful tumor on the right sternoclavicular region and discrete pulmonary hypoventilation at the base of the same side. The rest of the examination was unremarkable and revealed no history of risk factors. He had leukocytosis with neutrophilia, elevated erythrocyte sedimentation rate (ESR) and fibrinogen, no other laboratory abnormalities. Chest X-ray showed a condensing image in the right upper lobe and a diffuse condensation of the right base (Fig. 1). Shoulder X-rays showed no abnormalities. The chest CT observed disintegration of the articular margins and periarticular fluid collection which continued to the subclavicular region, anterior pleural and right lung base (Fig. 1). We performed arthrocentesis of the acromioclavicular joint, isolating Staphylococcus aureus (S. aureus) in the synovial fluid and in blood cultures. According to the antibiogram, the patient

Relación de calprotectina fecal y anticuerpos antisacaromices con otros marcadores de actividad en pacientes con espondiloartritis

OBJECTIVE To assess the relationship between the increase of fecal calprotectin, anti-Saccharomyces cerevisiae antibodies (ASCA) and disease markers in a group of patients with spondyloarthritis. METHODS We evaluated patients who were at least 18-years-old and met the Assessment in Spondyloarthritis International Society (ASAS) criteria for spondyloarthritis or the New York modified criteria. We analyzed activity criteria, physical function, analytical criteria (human leukocyte antigen [HLA] B27, fecal calprotectin, presence of ASCA, among others) and demographic data. RESULTS We included 33 patients. All but one patient had normal ASCA values. We found statistical significance in the correlation of calprotectin with C-reactive protein (CRP) but not with other parameters. We also found a relationship between calprotectin levels and nonsteroidal anti-inflammatory drug (NSAID) intake (P=.001). We found no relationship between CRP levels and NSAID use. After discontinuation of NSAIDs for one month, we found no significant differences in calprotectin levels (P=.9). CONCLUSION Fecal calprotectin is elevated in patients with spondyloarthritis and correlates positively with CRP. Level of fecal calprotectin is not altered by NSAID use. The amount of ASCA present does not change and does not correlate with any clinical parameters in the study population.

Sacroilitis por pirofosfato cálcico

We report the case of a 50-year-old woman who presented with a 3-month history of inflammatory low back pain and arthritis of the knees, with no other type of manifestations. Laboratory analyses demonstrated an elevated C-reactive protein level (2.5 mg/dL) and erythrocyte sedimentation rate (43 mm/h) and she was found to be negative for human leukocyte antigen (HLA) B27; there were no other abnormal findings. In the initial radiological study, plain radiography demonstrated meniscal calcification in both knees and sclerosis in both sacroiliac joints; magnetic resonance imaging (MRI) showed bone marrow edema in a short-tau inversion recovery (STIR) sequence (Fig. 1A and B). We observed no syndesmophytes affecting the axial skeleton. These findings led us to consider a differential diagnosis including spondyloarthritis (SpA) and pyrophosphate arthropathy. There were rectangular extracellular crystals with positive birefringence in synovial fluid obtained from knee. We requested computed tomography (CT) of the sacroiliac joints (Fig. 1C), which showed sclerosis with linear intra-articular calcifications in both joints. The patient was diagnosed with arthritis