Frecuencia de ANA/DFS70 en familiares de pacientes con artritis reumatoide comparados con pacientes con artritis reumatoide y población sana y su asociación con el estado de salud

IntroductionDFS70 ANAs have attracted interest due to their frequency in individuals with no clinical evidence of systemic autoimmune rheumatic disease, groups with genetic risk for rheumatoid arthritis (RA) were not assessed.ObjectiveTo determine the frequency of ANA and DFS70 ANA in blood relatives (BR) of people with RA compared to patients with early RA (ERA), and control individuals, and its association with health status.MethodologyA cross-sectional study with an analytical component. Sixty ERA patients, 60 BR and 120 control individuals paired by age and sex were studied. Hep2-ANA and DFS70 ANA were studied. The absolute and relative frequencies and associations were established using logistic regression models, with a significance level of 95%.Results43% ANA in ERA, 30% in BR, and 25.8% in control individuals 1:80. The fine dense granular pattern based on conventional Hep2 was found in 12.9% of the positive samples, and 1.66% of the total samples. There was no detection of DFS70 ANAs in patients with ERA. In ERA there was an association between the presence of ANA and inflamed joints (p = .02), CRP (p = .01), DAS28CRP (p = .03) and HAQ (p = .04). There was an association between ANA and elevated CRP (p = .05) in the BR. In the control individuals, there was an association between ANA and painful joints (p = 02). In DFS70 ANA individuals we observed an association between a normal ESR p = .032, BR (-), p = .044 and absence of painful joints, p = .039.ConclusionsThe frequency of DFS70 ANA in the groups studied was low, none of the patients with ERA was positive. The presence of DFS70 ANA was only confirmed in systemically healthy individuals.     

Inmunización y quimioprofilaxis en pacientes con artritis reumatoide

The incidence of severe infections has been estimated to be higher in patients with rheumatoid arthritis. In particular, respiratory infections are up to twice as frequent in these patients as in the general population, which often increases mortality due to immune disorders related to the disease itself and to the immunosuppressive treatment. Nowadays, some of these infections can be prevented by vaccines, which provide a window of opportunity for prophylaxis and for the prevention of complications arising from infection.The most widely used vaccines in rheumatic diseases are the pneumococcal and influenza vaccines, which are recommended in vaccination guidelines. The data accumulated on the safety and efficacy of these vaccines support their use in patients with chronic autoimmune or inflammatory diseases. Immunization recommendations for this population should be applied in our daily clinical practice, as the evidence is sufficiently strong to encourage general vaccination against influenza, pneumococcus and hepatitis B in patients with rheumatic diseases. Screening strategies for tuberculosis, with the use of chemoprophylaxis if required, should also be applied in rheumatoid arthritis patients receiving immunosuppressive therapy.     

Implantación y evaluación de una prestación de gastroscopia precoz para pacientes con dispepsia y datos de alarma en Atención Primaria

Introduction

Dyspepsia is a common disorder in both Primary (PC) and Specialised Care (SC). Gastroscopy is recommended at the start of the study if there are warning signs, although it is not always available in PC.

Reactivación de citomegalovirus en pacientes con gastritis inmunomediada

IntroductionReactivation of cytomegalovirus can complicate the evolution of patients with gastritis induced by immune checkpoint inhibitors.MethodsThe experience in our center is described and a review of the literature is performed.ResultsA case of severe gastritis induced by treatment with a programmed cell death receptor-1 (anti-PD1) inhibitor, associated with reactivation of cytomegalovirus (CMV) is described. In the systematic review, we identified 5 cases of immune-related gastritis associated with CMV reactivation. Ganciclovir treatment contributed to clinical improvement in most patients.ConclusionThe early identification of a CMV infection in patients with severe or refractory immune-related gastritis will allow the initiation of targeted treatment, and may avoid increasing immunosuppressive therapy.