Caracterización y prevalencia del compromiso ocular en pacientes con enfermedad autoinmune y autoinflamatoria en un centro de referencia reumatológica en Colombia entre los años 2000 a 2015
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De la Torre Cifuentes, Alejandra Mantilla Hernández, Rubén Darío |
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| Data(s) |
08/10/2016
31/12/1969
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| Resumo |
RESUMEN Objetivo: Estimar la prevalencia de las diferentes enfermedades oftalmológicas que aparecen en el contexto de una enfermedad autoinmune (EAI) en pacientes de un centro de referencia reumatológica en Colombia, según características clínicas y sociodemográficas durante un período de 15 años, comprendido entre los años 2000 a 2015. Métodos: Se realizó un estudio descriptivo, observacional de prevalencia. El tipo de muestreo fue aleatorio estratificado con asignación proporcional en el programa Epidat 3.4. Los datos se analizaron en el programa SPSS v22.0 y se realizó análisis univariado de las variables categóricas, para las variables cuantitativas se realizaron medidas de tendencia central. Resultados: De 1640 historias clínicas revisadas, se encontraron 634 pacientes (38,65%) con compromiso ocular. Si excluimos los pacientes con SS, que por definición presentan ojo seco, 222 pacientes (13,53%) presentaron compromiso oftalmológico. Del total de pacientes, el 83,3% fueron mujeres. La AR fue la enfermedad autoinmune con mayor compromiso oftalmológico con 138 pacientes (62,2%), y en último lugar la sarcoidosis con 1 solo paciente afectado. La QCS fue la manifestación más común en todos los grupos diagnósticos de EAI, con 146 pacientes (63,5%). De 414 pacientes con Síndrome de Sjögren (SS) y QCS 8 presentaron compromiso ocular adicional, siendo la uveítis la segunda patología ocular asociada en pacientes con SS y la primera causa en las espondiloartropatias (71,4 %). Los pacientes con catarata (4,1%) presentaron la mayor prevalencia de uso de corticoide (88.8%). De 222 pacientes, 28 (12,6%) presentaron uveítis. Del total de pacientes, 16 (7,2%) presentaron maculopatía por antimalaráricos y 6 (18,75%) de los pacientes con LES. Los ANAS se presentaron en el 100% los pacientes con trastorno vascular de la retina. Los pacientes con epiescleritis presentaron la mayor proporción de positivización de anticuerpos anti-DNA. La EAI que más presentó epiescleritis fue LES con 4 pacientes (12,5%) El 22% de paciente con anticuerpos anti-RNP presentaron escleritis y 32,1% de los pacientes con uveítis presentaron HLA-B27 positivo. Las manifestaciones oftalmológicas precedieron a las sistémicas entre un 11,1% y un 33,3% de los pacientes. Conclusión: Las enfermedades oculares se presentan con frecuencia en los pacientes colombianos con EAI (38.65%), siendo la AR la enfermedad con mayor compromiso ocular (62,2%) y la QCS la enfermedad ocular con mayor prevalencia en todas las EAI (63,5%). La uveítis se presentó en 28 pacientes (12,6%). Las manifestaciones oftalmológicas pueden preceder a las sistémicas. El examen oftalmológico debe ser incluido en los pacientes con EAI, por ser la enfermedad ocular una comorbilidad frecuente. Adicionalmente, los efectos oftalmológicos de las medicaciones sistémicas utilizadas en EAI deben ser estrechamente monitorizados, durante el curso del tratamiento. Objectives: To estimate the prevalence of various ocular diseases occuring in the context of an autoimmune disease in patients from a rheumatology clinic referral center in Colombia, according to clinical features and socio-demographic factors from 2000 to 2015. Methods: We conducted an observational, descriptive prevalence study. Randomized stratified sampling with proportional assignment was carried out using Epidat 3.4. Data analysis was fulfilled through SPSS v22.0. Categorical variables were subjected to univariate analysis. Measures of central tendency were performed for cuantitative variables. Results: Ocular involvement was present in 634 patients (38,65%). Excluding patients with Sjögren´s syndrome (SS) and dry eye, which account for 100% (by definition, dry eye is present in all patients with SS), ocular involvement was present in 222 patients (13,53%). 83,3% subjects were women. Rheumatoid arthritis (RA) posed the greatest eye disease prevalence (62,2%), sarcoidosis the lesser (10%). Keratoconjunctivitis sicca (KCS) was the most common ophthalmic manifestation (63,5%) in all autoimmune diseases except the spondyloarthropaties. Out of 414 patients with SS and KCS, additional eye disease was present on 8 individuals, the most common being uveitis (10,6%). The highest prevalence of corticosteroid drug usage (88,8%) was present in patients with cataract (4.1% of the total population). 28 of 222 (12,6%) patients had uveitis. 16 (7,2%) of the total patients (and 18,75% of the total patients with Systemic lupus erythematosus –SLE- ) had ocular toxicity due to antimalarial drugs. Antinuclear antibodies were present in the whole vascular retinal disease group. The highest anti-DNA antibody serum positivity was present in patients with episcleritis; accordingly, SLE rendered the highest episcleritis prevalence (12,5%). 22% of anti-RNP positive patients presented scleritis. 32,1% of uveitis patients were HLA-B27 positive. Eye manifestations preceded systemic involvement in 11,1 to 33,3% of patients. Conclusions: Eye disease is present with relative frequency in Colombian patients with autoimmune disease (38,65%), RA being the condition with the highest prevalence (62,2%) and KCS being the most prevalent ocular manifestation (63,5%). 12,6% of patients had uveitis. On occasion, eye disease can precede systemic compromise. Eye examination should be included as part of these patient population assessment because it is a frequent co-morbidity. In addition, rheumatic drug ocular adverse effects should be monitored during the course of treatment. |
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application/pdf |
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spa |
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Facultad de medicina |
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info:eu-repo/semantics/embargoedAccess |
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| Palavras-Chave | #Enfermedades autoimunes -- investigación #WW 475 #Oftalmopatías -- estudio de casos -- Colombia, 200-2015 #Artritis reumatoide -- consecuencias #autoimmune disease, rheumatoid arthritis, eye involvement, prevalence, uveitis, keratoconjunctivitis sicca. #Autoimmune disease #Rheumatoid arthritis #eye involvement #Prevalence #Uveitis #Keratoconjunctivitis #Sicca |
| Tipo |
info:eu-repo/semantics/bachelorThesis info:eu-repo/semantics/acceptedVersion |
