Value of clinical factors in selecting postmenopausal women with rheumatoid arthritis for bone densitometry.

Criteria to decide which patients with rheumatoid arthritis (RA) should be examined by dual energy x ray absorptiometry (DXA) are currently not available. The rheumatologists from Amsterdam have proposed preliminary criteria based on clinical risk factors (age, disease activity, and functional status). These criteria are preliminary and not widely accepted but might be helpful in practice. The value of the proposal in a group of Spanish postmenopausal women with RA is analysed. METHODS DXA (lumbar spine and femoral neck) was performed in 128 patients recruited from a clinical setting, and the proposed criteria were applied. T and Z scores were established for a Spanish reference population. RESULTS The mean (SD) age of the patients was 61.3 (10.7) and mean duration of the postmenopausal period 14.5 (10.1) years. Mean duration of RA was 13.7 (7.7) years. Mean C reactive protein was 22 (21) mg/l; mean erythrocyte sedimentation rate 26 (18) mm/1st h; and mean Health Assessment Questionnaire score 1.25 (0.79). Ninety (70%) patients fulfilled the proposed criteria. Their sensitivity for the diagnosis of osteoporosis (T score ¿¿2.5 SD) was 86% and their specificity, 43%. Positive predictive value was 54% and negative predictive value, 79%. CONCLUSIONS The proposed criteria seem a good screening method for the selection of those patients with RA whose bone mineral density should be assessed as the sensitivity and negative predictive value are acceptable.

Blood lymphocyte subsets in rats with adjuvant arthritis

To determine the phenotype of peripheral blood lymphocytes during the time-course of adjuvant arthritis (AA) to detect alterations that could be involved in the pathogenesis of the arthritic process. METHODS--Phenotype analysis was performed on days 7, 14, 21, 28, 42, 56 and 70 after arthritis induction using monoclonal antibodies to CD5, CD4 and CD8 subsets, and flow cytometry. The proportion of activated lymphocytes and lymphocytes was also assessed with monoclonal antibodies to IL-2R (CD25), to Ia antigen and by polyclonal antibodies to rat Ig. RESULTS--Adjuvant arthritis produced leukocytosis with neutrophilia. Rats with AA showed a marked increase in the number of both CD4+ and CD8+ cells. The ratio CD4/CD8 decreased because the rise in CD8+ cells was more pronounced than the increase in CD4+ cells. Changes in lymphocyte counts showed two well-defined periods: the first, from day 14 to day 28, during which the inflammation of the joints reached a maximum and changes in lymphocyte subsets were more pronounced, that is, there was a threefold increase in CD8+ lymphocytes over normal counts, and the second, from day 42 to day 70, in which modified parameters improved considerably but remained different from controls. CONCLUSION--Alterations were detected in the phenotype of peripheral blood lymphocytes in AA, which provides an additional marker of disease activity.

HLA class II antigens (DR, DQ LOCI) and peripheral arthritis in ankylosing spondylitis.

Fifty one patients with ankylosing spondylitis (AS) were typed for HLA-A, B, C, DR, and DQ antigens. The antigen frequencies were compared with those of a normal population and with a B27 positive control group. All but one of the patients with AS were HLA-B27 positive. A positive linkage disequilibrium between Cw1, Cw2, DR1, and the B27 antigen was observed. Patients with AS showed a significant increase in DQw2 antigen compared with the B27 positive control group. No differences in antigenic frequencies were observed in patients having peripheral arthritis and patients with only axial involvement. Seven out of nine patients (78%) with an erosive peripheral arthritis were DR7 positive, suggesting that DR7 or genes closely linked could be related with a more aggressive peripheral joint involvement in patients with AS.

Tratamiento farmacológico de las enfermedades reumáticas

El tratamiento de las enfermedades reumáticas está condicionado por el hecho que, en su mayoría, son procesos de carácter crónico, y que salvo en contadas excepciones, como por ejemplo las artritis infecciosas, no existen tratamientos curativos. Por ello, el objetivo lógico de curar se debe de sustituir por aliviar y conservar.

Aplicación de la genética en la identificación de enfermedades infecciosas bucodentales

La genética ha supuesto una gran revolución en la identificación de seres vivos a través de análisis de ADN. Actualmente se investiga la pos1bilidad de aplicarla en el estudio de nuestros antepasados, desde el hombre prehistórico. En el ámbito de la odontologfa se vislumbran nuevas perspectivas en el estudio de la patologfa infecciosa, gracias a estos avances en biologfia molecular. El presente trabajo pretende repasar cuál ha sido esta patología infecciosa en el hombre del pasado y cuáles son Jos métodos de análisis genético que penniten estudiarla. Fundamentalmente, las infecciones bucodentales del hombre prehistórico se resumen en caries y patología periodontal. La RCP (reacción en cadena de la polimerasa) es la técnica que ha revolucionadola ingeniería genética, pues permite obtener copias del ADN para poder ser analizado y, con ello, ofrece un diagnóstico específico de la etiología de las enfermedades infecciosas, lográndose una identificación más precisa que con el cultivo o con la inmunohistoquímica de las bacterias, hongos y virus que conviven en el medio oral.

PFKFB3 (6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3)

The human PFKFB3 is composed of 19 exons spanning genomic region about 90,6 Kb (GenBank). Alternative splicing variants have been reported. The main variants corresponding to mRNAs of 4453 bp and 4224 bp for the variant 1 u-PFK2 (NM_004566.3) and variant 2 i-PFK2 (NM_001145443.1), respectively...

Diagnostic and prognostic value of antibodies against chimeric fibrin/filaggrin citrullinated synthetic peptides in rheumatoid arthritis

Introduction: Evidence suggests that citrullinated fibrin(ogen) may be a potential in vivo target of anticitrullinated protein/peptide antibodies (ACPA) in rheumatoid arthritis (RA). We compared the diagnostic yield of three enzyme-linked immunosorbent assay (ELISA) tests by using chimeric fibrin/filaggrin citrullinated synthetic peptides (CFFCP1, CFFCP2, CFFCP3) with a commercial CCP2-based test in RA and analyzed their prognostic values in early RA. Methods: Samples from 307 blood donors and patients with RA (322), psoriatic arthritis (133), systemic lupus erythematosus (119), and hepatitis C infection (84) were assayed by using CFFCP- and CCP2-based tests. Autoantibodies also were analyzed at baseline and during a 2-year follow-up in 98 early RA patients to determine their prognostic value. Results: With cutoffs giving 98% specificity for RA versus blood donors, the sensitivity was 72.1% for CFFCP1, 78.0% for CFFCP2, 71.4% for CFFCP3, and 73.9% for CCP2, with positive predictive values greater than 97% in all cases. CFFCP sensitivity in RA increased to 80.4% without losing specificity when positivity was considered as any positive anti-CFFCP status. Specificity of the three CFFCP tests versus other rheumatic populations was high (> 90%) and similar to those for the CCP2. In early RA, CFFCP1 best identified patients with a poor radiographic outcome. Radiographic progression was faster in the small subgroup of CCP2-negative and CFFCP1-positive patients than in those negative for both autoantibodies. CFFCP antibodies decreased after 1 year, but without any correlation with changes in disease activity. Conclusions: CFFCP-based assays are highly sensitive and specific for RA. Early RA patients with anti-CFFCP1 antibodies, including CCP2-negative patients, show greater radiographic progression.

Fármacos que inhiben el factor de necrosis tumoral α y embarazo

Pregunta: ?Es segura la administración de los fármacos que inhiben el factor de necrosis tumoral a (TNF-a) durante el embarazo? Respuesta: En los últimos años se han desarrollado medicamentos que inhiben el TNF-a, porque esta citocina tiene un efecto inflamatorio que condiciona el proceso patológico de diversas enfermedades autoinmunitarias sistémicas, como artritis reumatoide, psoriasis, enfermedades inflamatorias intestinales y otras. Actualmente existen en el mercado farmacéutico 5 fármacos que...

PFKFB3 (6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3)

The human PFKFB3 is composed of 19 exons spanning genomic region about 90,6 Kb (GenBank). Alternative splicing variants have been reported. The main variants corresponding to mRNAs of 4453 bp and 4224 bp for the variant 1 u-PFK2 (NM_004566.3) and variant 2 i-PFK2 (NM_001145443.1), respectively...

La reaparición de una olvidada enfermedad en la cavidad oral: la sífilis

La sífilis es una enfermedad de transmisión sexual (ETS) producida por el Treponema pallidum, que infecta principalmente a seres humanos y que es capaz de invadir casi cualquier órgano del cuerpo. Su infección facilita la transmisión de otras ETS. Desde finales de la última década hasta la actualidad, han ido apareciendo sucesivos brotes de sífilis en la mayor parte de países de la Europa Occidental. La sífilis, junto con otras ETS, es una enfermedad de declaración obligatoria en los países de la Unión Europea. Concretamente en España, la infonnación epidemiológica a nivel estatal se obtiene a través del Sistema de Enfemledades de Declaración Obligatoria (EDO) y del Sistema de Información Microbiológica (SIM), que recopila infonnación de una red de 46 laboratorios centinela situados en 12 Comunidades Autónomas. Las ETS sometidas a vigilancia epidemiológica son la infección gonocócica, la sífilis y la sífilis congénita, todas ellas de declaración numérica semanal. Con esta información se ha podido apreciar en los últimos años un incremento en los casos de sífilis y gonococia notificados en España (las tasas de sífilis por 100.000 habitantes en el año 1999 fueron de 1,69 y en el 2007 de 4,38 notificadas al sistema EDO). En este artículo revisamos el resurgimiento y la evolución de esta enfermedad infecciosa en ocho países europeos, a la vez que pretendemos llamar la atención a los dentistas acerca del papel que deben desempeñar en el diagnóstico de la enfennedad y en la derivación a centros de control de infecciones de transmisión sexual

Diagnostic and prognostic value of antibodies against chimeric fibrin/filaggrin citrullinated synthetic peptides in rheumatoid arthritis

Introduction: Evidence suggests that citrullinated fibrin(ogen) may be a potential in vivo target of anticitrullinated protein/peptide antibodies (ACPA) in rheumatoid arthritis (RA). We compared the diagnostic yield of three enzyme-linked immunosorbent assay (ELISA) tests by using chimeric fibrin/filaggrin citrullinated synthetic peptides (CFFCP1, CFFCP2, CFFCP3) with a commercial CCP2-based test in RA and analyzed their prognostic values in early RA. Methods: Samples from 307 blood donors and patients with RA (322), psoriatic arthritis (133), systemic lupus erythematosus (119), and hepatitis C infection (84) were assayed by using CFFCP- and CCP2-based tests. Autoantibodies also were analyzed at baseline and during a 2-year follow-up in 98 early RA patients to determine their prognostic value. Results: With cutoffs giving 98% specificity for RA versus blood donors, the sensitivity was 72.1% for CFFCP1, 78.0% for CFFCP2, 71.4% for CFFCP3, and 73.9% for CCP2, with positive predictive values greater than 97% in all cases. CFFCP sensitivity in RA increased to 80.4% without losing specificity when positivity was considered as any positive anti-CFFCP status. Specificity of the three CFFCP tests versus other rheumatic populations was high (> 90%) and similar to those for the CCP2. In early RA, CFFCP1 best identified patients with a poor radiographic outcome. Radiographic progression was faster in the small subgroup of CCP2-negative and CFFCP1-positive patients than in those negative for both autoantibodies. CFFCP antibodies decreased after 1 year, but without any correlation with changes in disease activity. Conclusions: CFFCP-based assays are highly sensitive and specific for RA. Early RA patients with anti-CFFCP1 antibodies, including CCP2-negative patients, show greater radiographic progression.