Estrogen-dependent osteoarthritis (EDPOA) is a disease of perimenopausal-age women. Their manifestations are polyarticular pain with common co-morbidities (carpal tunnel syndrome, insomnia, fatigue, depression, and fibromyalgia). Based on dual role of glucocorticoids, its trophic action on the chondrocyte and its anti-inflammatory effect, we conducted a prospective interventional cohort study where we evaluate the efficacy and safety of oral low-dose GC in one hundred women with EDPOA. The pain intensity, number of tender joints as well as impact in co-morbidities were analyzed. We conclude that the use of low-dose GC in patients with EDPOA can be an effective and a safe therapeutic option.
La infección por Clostridium difficile (CD) es una de la causas más comunes de diarrea adquirida en el ámbito hospitalario, y su espectro clínico puede ir desde casos leves, autolimitados, hasta situaciones como colitis de muy difícil manejo que pueden poner en riesgo la vida del paciente (1). Generalmente se ha asociado al uso crónico de antibióticos de amplio espectro (2). La incidencia de la enfermedad ha aumentado en los últimos años, haciendo que aparezcan nuevas opciones terapéuticas y diagnosticas a las ya conocidas. El objetivo de es articulo es hacer la revisión de un caso de un paciente con infección por CD documentada de difícil manejo, que respondió satisfactoriamente al manejo con Rifaximine.
La hemofilia adquirida es un trastorno de difícil diagnóstico, poco prevalente, con una edad de aparición bifásica. En el 40-50% de los casos suele existir una causa subyacente. Se presenta el caso de un paciente de 79 años con equimosis atraumáticas generalizadas y hematuria de dos meses de evolución. Se documentó TTPa prolongado con TP normal, factor VIII (0,3%) y IX (53,1%); título de inhibidores contra factor VIII de 48U Bethesda. Inició manejo con complejo coagulante antiinhibidor asociado a ciclofosfamida y prednisolona. Se documentó carcinoma urotelial de bajo grado que se resecó, posterior a lo cual se logró control del sangrado, normalización de los niveles de factor VIII y desaparición del inhibidor.
Background Estrogen hormone dependent osteoarthritis (EDPOA) is presented in peri-menopausal age women. Their manifestations are polyarticular pain with common co-morbidities (carpal tunnel syndrome, insomnia, fatigue, depression and fibromyalgia). Based on dual role of glucocorticoids (GC) (trophic action on the chondrocyte and anti-inflammatory effect we conducted this work. Objectives to evaluate the efficacy and safety of low doses of GC to control both the joint pathology condition as well the co-morbidities associated with EDPOA. Methods A prospective interventional cohort study was conducted. A hundred peri-menopausal women treated between July 2008 and July 2011 with diagnostic of EDPOA. Prednisolone at an initial dosage of 5 mgr/day was used. The patients were evaluated every month, and according to the clinical course of steroid dose it was reduced. The outcome measures used to determine response (at onset and at the end of the study) were tender joint counts, visual analogue scale (VAS) to assess pain, symptoms or signs presented or absent associated to co-morbidities (carpal tunnel syndrome, insomnia, fatigue, depression and fibromyalgia). The doses reduction or withdrawal of GC and NSAID was evaluated too. This study has been approved by the Fundaciόn Valle del Lili ethics committee. Data was analyzed using STATA version 11.0 for Windows and statistical significance was taken to be p<0.05. Results The average age of patients in admission was 57 years (Range: 52-65). The average age of onset of the symptoms was 53.5 years (Range: 49 -61). Eighty-two patients (82%) were consuming NSAIDs at baseline, of which 23 (28.05%) were consuming unmodified and 49 (59.76%) had dose reduction at 24 weeks. Three patients (3%) had retired for improvements of joint pain. At onset the tender joint count was 27.5 (range: 20-34), and at 24 weeks was 3 (range: 1-8) (p<0.01). The VAS at onset of the study was 7 (range: 6-8), and at 24 weeks was 2 (range: 1-3) (p<0.01) (See Figure 1 and Table 2). The numbers of patients with co-morbidities were presented as follow: at onset, carpal tunnel syndrome 30 (30%), insomnia 33 (33%), fatigue 79 (79%), depression 16 (16%) and fibromyalgia 18 (18%); at 24 weeks, 11 (11%) (p<0.01), 2 (2%) (p<0.01), 11(11%) (p<0.01), 2(2%) (p<0.01) and 6 (6%) (p<0.01) respectively At a 24 weeks follow up, 44 patients (44%) had decreased GC doses, 42 (42%) had unchanged the initial dose and 4 (4%) withdrew due to improvement. Adverse effects attributed to the medication occurred in seven patients: three with hypertension de novo, two with previous hypertension showed increased blood pressure, one with osteoporotic fracture and one with diabetes mellitus de novo. Conclusions The use of low-dose GC in patients with EDPOA can be an effective and a safe therapeutic option. Disclosure of Interest None Declared
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