Patient-assessed and physician-assessed overall RA activity showed acceptable agreement. Patient self-assessment overestimated disease activity determined by the DAS28. At the patient level, physician-assessed joint swelling showed an acceptable concordance with Doppler US synovitis.
BackgroundUse of biologic therapy (BT) has been determinant in Rheumatoid Arthritis' (RA) change of management and outcomes improvement for the last decade. Classic extraarticular manifestations are now uncommon, except for the pulmonary involvement, which can occur due to different causes and can complicate our patients' treatment and prognosis.ObjectivesThe aim of this study is to evaluate the presence of pulmonary complication in RA patients under BT in our hospital, and assess its severity and the modifications required.MethodsReview of clinical records of 208 RA patients receiving BT in the last 5 years (January 2012 to December 2016). 23 cases of preexisting lung disease for other causes have been excluded and finally 26 patients have been finally included. Demographic data, characteristics of RA, types of pulmonary involvement, evolution and changes in treatment have been collected. Statistical analysis were performed using SPSS v22.Results73.1% are women, mean aged 59 years (31–80); 53.8% never smokers. They suffer from long term RA (median 176.92 months, SD 199.34); only 2 patientes have been recently diagnosed (less than a year). They are mainly seropositive (85% RF positive) with positive CCP antibodies in 69.2%, and with erosive disease in 70%. 25% have other extraarticular manifestations (3 rheumatoid nodules, 4 cardiac involvement).Half of the patients were in remission or low activity (DAS 28) at the time of pulmonary disease diagnosis, and the median of CRP was 0.52 mg/dL (SD 1.72). 90% had received Methotrexate and almost half of them Leflunomide; 30% had been treated with BT (50% TNF alpha inhibitors).Intersticial lung disease (ILD) was the most frequent pulmonary involvement (57.7%) and non-specific intersticial pheumonia (NSIP) the most prevalent pattern (>60%). We also found obstructive pulmonary disease (11.5%) and vascular involvement (7.7%). 40% of the patients had a normal radiograph (all of them a pathological CT).Treatment was modified in 53.8% of the cases (synthetic DMARD was kept in 68% and BT in 64%).The average time of evolution of pulmonary involvement is 37.85 months (1–156). 80% of the patients kept stable or improved from their arthritis and also from respiratory disease. Only one received a lung trasplant and another one died.We haven't found an association between different types of pulmonary involvement and the different variables analyzed in the study. We didn't show significant differences in prognosis related to pulmonary disease distinct patterns; up to 80% of patients with ILD stabilize or improve.ConclusionsPrevalence of pulmonary disease in our experience in RA patients under BT is similar to prevalence in other observational studies (10–20%), because diagnosis here is due to casual detection in a routine chest X-ray or for clinical suspicion for respiratory symptoms (cough, dyspnea, ...). The evolution has been good perhaps for the high prevalence of NSIP, which requires less therapeutic intervention. Protocols for systematic search of lung disease in RA patients seem...
Background Aromatase Inhibitors (AI) are an important component in adjuvant therapy in postmenopausal women with positive estrogenic receptors in breast cancer. They inhibit the enzyme Cytochrome P450 CYP19, which causes a loss of BMD and consequently an increase in the risk of fracture. In patients with early breast cancer (EBC) in treatment with AI, it is estimated that the risk of fracture is 11% at five years. FRAX is used to calculate the probability of fracture at 10 years. Within its limitations, it should be highlighted that among its risk factors it does not include medications such as AI and that the treatment threshold adapted to patients of the Spanish population is not currently valid. Objectives To determine if the therapeutic intervention thresholds according to the FRAX proposed by the NOF (National Osteoporosis Foundation) as well as of the NOGG (National Osteoporosis Guidelines Group) identify appropriately whether patients with early breast cancer have a high risk of fracture at the start of AI treatment. Methods Retrospective and descriptive study of 73 patients with EBC in treatment with AI sent to the medical oncology department of a tertiary hospital (Basurto University Hospital) for monographic consultation of osteoporosis for its diagnosis, control and monitoring in the period from 01/01/2006 to 31/12/2010. A questionnaire was conducted of the risk factors, BMD DXA and FRAX. The FRAX results are described in the basal visit and the incidence of fractures in this population in December 2012 (monitoring period of 2 to 7 years). The patients with densitometric osteopenia and high risk of fracture according to the FRAX and the patients with both densitometric and established osteoporosis received treatment with bone agents by the Osteoporosis Unit. Results The mean age of our series is 63 years (40-83). The median time from the start of the AI and the realization of the basal BMD is 4 months. The initial densitometry identified 36 patients (49%) with osteoporosis, 35 patients (48%) osteopenia and 2 patients (3%) normal. According to the FRAX applying the treatment thresholds of the NOF (FMO >= 20% and FC >=3%): 19 patients (25%) have high risk of fracture: 16 patients (21%) of FMO and 18 patients (23.6%) of FC. Applying the treatment thresholds of the NOGG in which the values vary according to age: 3 patients (4%) have high risk of fracture, 1 patient (1%) of FMO and 3 patients (4%) of FC. Of the 73 patients, 15 (20%) present fracture, all vertebral, with 5 (33%) of high risk by FRAX according to NOF and only 1 (6%) according to NOGG. Conclusions In our series, the treatment thresholds for the FRAX of the NOF are more sensitive by identifying a greater number of patients with high risk of fracture (25%) than the NOGG (6%). Of the patients with fractures of the study (20%), only 33% of them were identified previously as high risk according to the NOF and 6% according to the NOGG. Both thresholds clearly underestimate the risk of fracture. It is necessary to validate the FRAX in prospe...
Background Systemic mastocytosis is a clonal disease of mast cell progenitors in bone marrow which causes abnormal growth and accumulation of mast cells in skin and other organs. Bone involvement occurs in 70% of cases; sclerotic, lytic lesions, and osteoporosis have been described, but they are rare as a form of disease presentation. Objectives To describe the main epidemiological and clinical features of systemic mastocytosis, focusing especially on bone involvement. Methods We make a review of systemic mastocytosis patients diagnosed in our hospital (by Rheumatology, Allergy and Hematology departments) and describe the main epidemiological and clinical characteristics. Results We found 5 cases of systemic mastocytosis diagnosed in a 22 year period. The study includes 3 women and 2 men, ages ranged 27 to 59 years. The delay of diagnosis from the onset of symptoms varies between 3 and 13 years. It presented with respiratory involvement in 2 cases, digestive in 1 case, skin in 1 case, and bone in only 1 case. 3 patients had allergic reactions in some stage of evolution, 3 skin symptoms, 3 patients had episodes of hypotension, dizziness, palpitations and syncope. Regarding to the musculoeskeletal system, 4 patients had bone involvement, 1 patient previously diagnosed with chronic osteomyelitis and 3 patients with osteoporosis and multiple vertebral collapses, one patient also had multiple rib fractures. The skeletal survey study showed 3 patients with lytic bone lesions and 2 patients with sclerotic lesions. Tryptase levels were elevated in 4 patients, whereas urine histamine levels were elevated in all 5 patients. Every patient had a bone marrow biopsy with diagnosis of systemic mastocytosis. Conclusions Systemic mastocytosis is a rare disease in our environment, the diagnosis uses to be late and requires high index of suspicion. Osteoporosis secondary to mastocytosis is usually severe, and it is very rare as the first manifestation of the disease. Two of the cases reviewed in this series had been admitted to our department for vertebral compression fractures, and we made the diagnosis in one of them, a middle-aged man with no other cause of osteoporosis, with initial bone marrow aspirate apparently normal. It has been reported that up to 9% of cases of “idiopathic” male osteoporosis may be caused by mastocytosis. We believe that tryptase and histamine levels should be included in the lab exams in patients with osteoporosis and fractures after ruling out other common causes. References References: Barete S, Assous N, de Gennes C, Grandpeix C, Feger F, Palmerini F, Dubreuil P, Arock M, Roux C, Launay JM, Fraitag S, Canioni D, Billemont B, Suarez F, Lanternier F, Lortholary O, Hermine O, Francès C. Systemic mastocytosis and bone involvement in a cohort of 75 patients. Ann Rheum Dis. 2010 Oct;69(10):1838-41. doi: 10.1136/ard.2009.124511. Epub 2010 Jun 22. Salles M. Holgado S. Navarro J.-T. Ribera J.-M. Riera E. Milla F. Tena X. Osteoporosis as a first manifestation of systemic mastocytosis. Study of 6 cases. M...
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