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Ítem Role of Fms-like tyrosine kinase 3 ligand as a potential biologic marker of lymphoma in primary Sjögren's syndrome.(2013-12-01) Tobón García, Gabriel JaimeObjective: Patients with primary Sjögren's syndrome (SS) are at greater risk of developing lymphoma. This study was undertaken to evaluate whether the Fms-like tyrosine kinase 3 ligand (Flt-3L) might be associated with lymphoma in primary SS. Methods: Serum levels of Flt-3L were measured in 369 patients with primary SS from the French Assessment of Systemic Signs and Evolution of Sjögren's Syndrome study cohort and in 10 patients with primary SS at the time of lymphoma diagnosis in an Italian cohort. Associations between increased levels of Flt-3L and a history of lymphoma, history of previously diagnosed criteria related to a high risk of lymphoma, and greater extent of disease activity were evaluated. Results: Among patients with primary SS, higher levels of Flt-3L were significantly associated with a history of lymphoma (P = 0.0001). Previous markers for risk of lymphoma development, such as presence of purpura, low levels of C4, presence of lymphocytopenia, low levels of IgM, high levels of β2-microglobulin, and a higher primary SS disease activity score, were all associated with higher levels of Flt-3L. The levels of Flt-3L were also increased in serum obtained from patients with primary SS at the time of lymphoma diagnosis. Furthermore, the Flt-3L levels were elevated in the serum of 6 patients up to 94 months (mean 46 months) prior to the diagnosis of lymphoma. Receiver operating characteristic curve analysis showed that an Flt-3L level of 175 pg/ml was the ideal cutoff value for demonstrating an association with lymphoma (specificity 97.5%, sensitivity 44%, negative predictive value 97%). Conclusion: Flt-3L is associated with lymphoma in primary SS, and constitutes a good biologic marker. Higher levels of this cytokine are present several years before the diagnosis of lymphoma, and may be useful as a predictive marker of lymphoproliferative disorders in primary SS. Copyright © 2013 by the American College of Rheumatology.
Ítem Combination of Hypertrophic Pachymeningitis, PR3-ANCA-positive Vasculitis, and Relapsing Polychondritis(J Rheumatol Publ Co, 2011-05-01) Díaz Martínez, Juan CarlosRelapsing polychondritis (RP) is a rare connective tissue disease characterized by inflammation and destruction of cartilaginous tissue1. Although the exact underlying pathologic mechanism is unknown, it is widely accepted that there is a role of an autoimmune response in most cases2. Patients may have lung, renal, ocular, joint, and vascular compromise. Central nervous system (CNS) involvement is rare, and few cases have been described. We describe 3 patients with RP and CNS involvement manifested as hypertrophic pachymeningitis (HP), an inflammatory process that thickens the dura mater.Ítem The CCR5 delta 32 polymorphism (rs333) is not associated with Sjögren's syndrome or Type 1 Diabetes in Colombians(Elsevier, 2013-08-01) Cañas Davila, Carlos Alberto; Maier Moore, Jacen S.; Tobón García, Gabriel Jaime; Arango, Alvaro; Anaya, Juan Manuel; Scofield, Robert H.[No hay resumen disponible]Ítem Terapia con anticuerpos monoclonales en Cardiología y Medicina Interna(Sociedad Colombiana de Cardiologia, 2016-07-12) Adams Sánchez, Christian DavidThe monoclonal antibodies (mAb) constitute a new therapeutic tool in cardiovascular medicine, based in the development of the molecular biology in this area. The understanding of therapeutic principles, types and mechanism of action of these drugs is essential for proper use and management of adverse reactions. We discuss the profile of the PCSK-9 inhibitors, the Dabigatran antidote, the abciximab, the digoxin antidote, the therapy in heart transplantation, and a possible cardiovascular use of monoclonal antibodies used in rheumatology.Ítem A rare case of amyopathic juvenile dermatomyositis associated with psoriasis successfully treated with ustekinumab(Lippincott, Williams & Wilkins, 2017-01-01) Tobón García, Gabriel JaimeCoexistence between two or more immunological-mediated diseases implies a clinical and therapeutic challenge that is uncommon in the clinical field. We report a rare case of a young patient with amyopathic juvenile dermatomyositis and erythrodermic psoriasis, with an excellent response to ustekinumab.Ítem Severe deformans tophaceous gouty arthritis(Elsevier, 2017-03-01) Zuñiga Velásquez, AliciaA 61-year-old man with a 20-year history of gout with severe functional disability was evaluated in our service. He received alopurinol and colchicine without response. Physical examination revealed bilateral great deformity, multiple tophi and edema of hands (Fig. 1), feet and knees. Serum uric acid was elevated: 11.2 mg/dL (reference value: 3.4–7.0 mg/dL). Hands X-ray AP view demonstrated, in both hands (Fig. 2A [left] and B [right]), conserved bone mineralization with severe soft-tissue swelling, extensive erosions with sclerotic borders (white arrows), precipitation of calcium with urate crystals giving density to the tophi (head arrows), bone spiculations (black arrows) and osteolytic expansive lesions in multiple heads of metacarpophalangic joint (double-head arrows).Ítem Catastrophic Antiphospholipid Syndrome Triggered by Fulminant Chikungunya Infection in a Patient with Systemic Lupus Erythematosus(John Wiley and Sons Inc., 2016-03-28) Betancur, Juan FelipeThe patient, a 21-year-old woman, was admitted to the intensive care unit with a 4-day history of fever, arthritis of the hands and feet, oli- guria with anasarca, diarrhea, and widespread skin rash. Systemic lupus erythematosus had been diagnosed 5 years previously. She was positive for lupus anticoagulant and anticardiolipin antibody but had no history of thrombotic or obstetric manifestations. Laboratory tests for infection and immunologic or biochemical abnormalities were performed and, based on multiple abnormal findings, treatment with broad-spectrum antibiotics was instituted.Ítem Direct oral anticoagulants in antiphospholipid syndrome: A real life case series(SAGE Publications Ltd, 2016-01-06) Cañas Dávila, Carlos AlbertoAim The aim of this study was to describe a case series of patients with primary or secondary antiphospholipid syndrome (APS) treated with direct oral anticoagulants (DOACs). Patients and methods Clinical charts of eight patients with thrombotic primary or secondary APS treated with direct oral anticoagulants (DOACs) between January 2012 and May 2015 were reviewed. Results The mean age was 45 ± 14.36 (range 27-69 years). Four patients had secondary APS (50%). All patients were initially treated with warfarin by a mean time of 70.87 ± 57.32 months (range 17-153 months). Changes in anticoagulation were defined by recurring thrombosis in five patients (62.5%) and life-threatening bleeding in the other three cases. Seven patients (87.5%) received rivaroxaban treatment and one patient (12.5%) apixaban. The mean follow-up period with DOACs was 19 ± 10.06 months (range 2-36 months). There was no recurrence of thrombosis by the time of data collection. Conclusions Despite not being the standard treatment in APS, we propose DOACs as a rational alternative for the management of patients with this diagnosis. Further interventional clinical studies are necessary for possible standardization of this therapy in APS patients.Ítem Hepatic and mesenteric vasculitis as presenting manifestation of mixed cryoglobulinemia related to chronic hepatitis C virus infection in a female patient(Lippincott Williams and Wilkins, 2016-06-15) Dávalos Pérez, Diana MaríaApproximately 80% of patients with hepatitis C virus infection develop chronic liver disease as cirrhosis, and 40% develop autoimmune complications as mixed cryoglobulinemia (MC). Gastrointestinal involvement in MC is rare, and even more so is hepatic involvement. We report a case of an 87-year-old woman with a 10-year history of blood transfusion-acquired hepatitis C virus infection, without treatment. She consulted the emergency department for diffuse abdominal pain, associated with vomiting. After 2 weeks of hospitalization in the intensive care unit, a diagnosis of MC was made; cirrhosis and secondary mesenteric and hepatic vasculitis were confirmed by a diagnostic laparoscopy. Unfortunately the condition of the patient worsened with sepsis and resulted in death in the fourth week from admission. This case highlights the importance of having in mind gastrointestinal tract vasculitis as a medical cause of abdominal pain in patients with chronic hepatitis C virus infection and using data laboratory tests, images, and histopathologic studies to aid with the diagnosis.Ítem Indirect carotid-cavernous fistula mimicking scleritis(Lippincott Williams and Wilkins, 2017-03-01) Suso, Juan Pablo[No hay resumen disponible]