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Protocolo de tratamiento de los antilinfocitos B en las enfermedades inmunomediadas
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.017
M. Retuerto Guerrero, C. Moriano Morales, I. González Fernández , I. González Fernández
{"title":"Protocolo de tratamiento de los antilinfocitos B en las enfermedades inmunomediadas","authors":"M. Retuerto Guerrero,&nbsp;C. Moriano Morales,&nbsp;I. González Fernández ,&nbsp;I. González Fernández","doi":"10.1016/j.med.2025.04.017","DOIUrl":"10.1016/j.med.2025.04.017","url":null,"abstract":"<div><div>B lymphocytes play a key role in the pathophysiology of systemic autoimmune diseases (SAD), as they not only transform into autoantibody-producing plasma cells, but also secrete proinflammatory cytokines that amplify the immune response. In addition, these lymphocytes act as antigen-presenting cells, which promotes the activation of T lymphocytes and perpetuates the autoimmune process. Aberrant B-cell activation contributes to the formation of immune complexes that, when deposited in different organs and tissues, cause tissue damage, as observed in diseases such as systemic lupus erythematosus, rheumatoid arthritis, and systemic sclerosis. Due to their central role in the pathogenesis of SAD, B-cells have become a key therapeutic target. Therapies targeting these lymphocytes, such as rituximab, have shown efficacy in improving clinical outcomes and reducing systemic inflammation. However, their use entails risks, such as an increase in serious infections due to its immunosuppressive effect and the possible induction of hypogammaglobulinemia, lymphopenia, and neutropenia, which compromises the patient's immune defense. Close monitoring of immunoglobulin levels and the administration of antimicrobial prophylaxis according to the patient's needs is essential.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 30","pages":"Pages 1842-1846"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mujer de 56 años con fiebre, síndrome general, desnutrición y agitación
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.018
C. Díez Morrondo, M. Retuerto Guerrero, C. Sieiro Santos, I. González Fernández
{"title":"Mujer de 56 años con fiebre, síndrome general, desnutrición y agitación","authors":"C. Díez Morrondo,&nbsp;M. Retuerto Guerrero,&nbsp;C. Sieiro Santos,&nbsp;I. González Fernández","doi":"10.1016/j.med.2025.04.018","DOIUrl":"10.1016/j.med.2025.04.018","url":null,"abstract":"","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 30","pages":"Pages 1847.e1-1847.e4"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico de la fiebre en las enfermedades reumáticas autoinmunes sistémicas
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.016
M. Retuerto Guerrero, C. Moriano Morales, I. González Fernández , I. González Fernández
{"title":"Protocolo diagnóstico de la fiebre en las enfermedades reumáticas autoinmunes sistémicas","authors":"M. Retuerto Guerrero,&nbsp;C. Moriano Morales,&nbsp;I. González Fernández ,&nbsp;I. González Fernández","doi":"10.1016/j.med.2025.04.016","DOIUrl":"10.1016/j.med.2025.04.016","url":null,"abstract":"<div><div>Fever is a common symptom in patients with systemic autoimmune rheumatic diseases (SARD) such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and vasculitis. Its emergence can be attributed to multiple causes, including the inflammatory activity of the underlying disease, opportunistic infections related to immunosuppression, and, in more infrequent cases, underlying neoplasms. It is crucial to consider that some infections, such as bacterial, viral, or fungal infections, can simulate a flare-up of immune-mediated disease, leading to diagnostic confusion and a potential delay in appropriate treatment. In addition, certain drugs used in the management of SARDs, such as immunosuppressants or biologics, may predispose to these infections, further complicating the differential diagnosis. A systematic approach that includes a detailed case history, thorough physical examination, and appropriate selection of laboratory and imaging tests is essential to identify the underlying cause. This protocol aims to optimize early diagnosis and treatment, reducing complications and improving patient prognosis.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 30","pages":"Pages 1839-1841"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Esclerosis sistémica
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.013
C. Sieiro Santos, M. Retuerto Guerrero, I. González Fernández, E. Díez Álvarez
{"title":"Esclerosis sistémica","authors":"C. Sieiro Santos,&nbsp;M. Retuerto Guerrero,&nbsp;I. González Fernández,&nbsp;E. Díez Álvarez","doi":"10.1016/j.med.2025.04.013","DOIUrl":"10.1016/j.med.2025.04.013","url":null,"abstract":"<div><div>Systemic sclerosis (SSc) is a complex systemic autoimmune disease characterized by progressive fibrosis of the skin and internal organs. Its etiology remains unknown, although its pathogenesis involves a multifactorial interaction between genetic predisposition, environmental factors, and three key processes: vascular damage, immune dysfunction, and fibrosis. It is more common in women, especially in middle age, and is classified into two main subtypes according to the extent of cutaneous involvement: limited and diffuse. It is a remarkably heterogeneous disease, with a clinical spectrum ranging from mild, stable forms to severe presentations with rapid progression. Among its most characteristic manifestations are Raynaud's phenomenon, gastrointestinal involvement (especially esophageal), pulmonary arterial hypertension (PAH), interstitial lung disease (ILD), musculoskeletal abnormalities, and cardiac complications.</div><div>This review will delve into the main clinical manifestations of SSc, current diagnostic criteria, and recent advances in its therapeutic management.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 30","pages":"Pages 1816-1829"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Miopatías inflamatorias
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.019
L. Salmerón-Godoy , C. Arévalo-Cañas , M. Díaz-Santiáñez , C. Sánchez-Díaz , A. Muñoz-Blanco
{"title":"Miopatías inflamatorias","authors":"L. Salmerón-Godoy ,&nbsp;C. Arévalo-Cañas ,&nbsp;M. Díaz-Santiáñez ,&nbsp;C. Sánchez-Díaz ,&nbsp;A. Muñoz-Blanco","doi":"10.1016/j.med.2025.04.019","DOIUrl":"10.1016/j.med.2025.04.019","url":null,"abstract":"<div><div>Inflammatory myopathies (IM) are a heterogeneous group of acquired diseases of an autoimmune pathogenesis. They are classified into dermatomyositis (DM), polymyositis (PM), antisynthetase syndrome (ASS), immune-mediated necrotizing myopathy (IMNM), inclusion body myopathy (IBM), and myopathies associated with other systemic autoimmune diseases (SAD). They are multisystemic diseases with cutaneous, muscular, pulmonary, gastrointestinal, and cardiac involvement, among others. They may be associated with other SADs and neoplasms. Treatment is based on corticosteroids associated with immunosuppressants. The prognosis depends on treatment response and clinical compromise.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 31","pages":"Pages 1849-1860"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lupus eritematoso sistémico (I)
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.010
I. González Fernández , C. Moriano Morales, I. González Fernández , M. Retuerto Guerrero
{"title":"Lupus eritematoso sistémico (I)","authors":"I. González Fernández ,&nbsp;C. Moriano Morales,&nbsp;I. González Fernández ,&nbsp;M. Retuerto Guerrero","doi":"10.1016/j.med.2025.04.010","DOIUrl":"10.1016/j.med.2025.04.010","url":null,"abstract":"<div><div>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of multifactorial etiology characterized by aberrant activation of T and B lymphocytes, production of autoantibodies, and immune complex formation, with multisystemic tissue damage. Its prevalence and incidence are higher in women of childbearing age, with a female:male ratio of 9:1. Genetic factors, such as HLA-DR3 and DR15 alleles, and environmental factors, such as ultraviolet radiation and viral infections, contribute to its pathogenesis.</div><div>Clinically, SLE presents a heterogeneous spectrum of manifestations including constitutional symptoms, arthritis, nephritis, and hematologic and neuropsychiatric involvement. Renal and cardiovascular complications are the main causes of morbidity and mortality. Its diagnosis is based on a detailed clinical assessment supported by immunological studies. The various classification criteria developed for SLE over the years are useful tools for structuring the clinical assessment and selecting homogeneous populations in research, which can also be used to guide the diagnosis.</div><div>An early and accurate diagnosis is crucial, considering that serological abnormalities may precede clinical manifestations by years. The integration of clinical, analytical, and imaging tools together with a multidisciplinary approach allows for optimizing the management and prognosis of SLE.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 30","pages":"Pages 1783-1798"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lupus eritematoso sistémico (II). Estrategias terapéuticas
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.011
C. Moriano Morales, I. González Fernández , M. Retuerto Guerrero, E. Díez Álvarez
{"title":"Lupus eritematoso sistémico (II). Estrategias terapéuticas","authors":"C. Moriano Morales,&nbsp;I. González Fernández ,&nbsp;M. Retuerto Guerrero,&nbsp;E. Díez Álvarez","doi":"10.1016/j.med.2025.04.011","DOIUrl":"10.1016/j.med.2025.04.011","url":null,"abstract":"<div><div>Systemic lupus erythematosus (SLE) is a complex, multisystem autoimmune disease with variable symptoms that hinder its diagnosis and treatment. Its management seeks to control inflammation, prevent organ damage, improve prognosis, and ensure a better quality of life for people with SLE. This requires an approach that is personalized, adapted to the needs of each patient, and multidisciplinary, with the aim of optimizing disease control. General measures include solar protection, regular exercise, a balanced diet, vitamin D supplementation, and not smoking. In regard to pharmacological treatment, hydroxychloroquine is essential as first-line therapy, while glucocorticoids have a role as a “bridge therapy,” and their use should be minimized. The latest EULAR 2023 recommendations promote the early use of immunosuppressants and biologics according to severity and clinical manifestations. Biologic therapies, such as belimumab and anifrolumab, are important advances in the therapeutic strategy for SLE. The approach to a patient with SLE should be comprehensive and include prevention of complications and management of associated comorbidities.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 30","pages":"Pages 1799-1807"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico de la afectación neurológica inmunomediada autoinmune y paraneoplásica
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.014
M. Retuerto Guerrero, I. González Fernández , E. Díez Álvarez, C. Díez Morrondo
{"title":"Protocolo diagnóstico de la afectación neurológica inmunomediada autoinmune y paraneoplásica","authors":"M. Retuerto Guerrero,&nbsp;I. González Fernández ,&nbsp;E. Díez Álvarez,&nbsp;C. Díez Morrondo","doi":"10.1016/j.med.2025.04.014","DOIUrl":"10.1016/j.med.2025.04.014","url":null,"abstract":"<div><div>Immune-mediated neurological involvement refers to a group of disorders in which the immune system attacks cells of the nervous system. It is common in autoimmune diseases such as systemic lupus erythematosus, multiple sclerosis, and myasthenia gravis. Symptoms include weakness, sensory disturbances, and cognitive problems, usually due to the presence of specific antibodies that damage neurons or myelin. The diagnosis is based on the identification of these antibodies and on imaging evidence of neuronal inflammation. On the other hand, paraneoplastic neurological involvement occurs as a result of an immune response against the cancer rather than direct autoimmune dysfunction. It is associated with neurological syndromes such as limbic encephalitis or peripheral neuropathy and may occur in the context of occult malignant tumors. Unlike the former, biomarkers such as specific paraneoplastic antibodies help to differentiate it, along with identification of the presence of underlying neoplasms.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 30","pages":"Pages 1830-1833"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diferenciación, activación y clasificación de los linfocitos B
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.012
R. Sánchez Martín , A. Miranda , J. Monserrat Sanz , M. Álvarez-Mon
{"title":"Diferenciación, activación y clasificación de los linfocitos B","authors":"R. Sánchez Martín ,&nbsp;A. Miranda ,&nbsp;J. Monserrat Sanz ,&nbsp;M. Álvarez-Mon","doi":"10.1016/j.med.2025.03.012","DOIUrl":"10.1016/j.med.2025.03.012","url":null,"abstract":"<div><div>B lymphocytes are fundamental to adaptive immunity. They play a key role in antibody production and immune memory formation. Their development begins in primary lymphoid organs, where processes such as somatic recombination of genes to form the B cell receptor take place. In secondary lymphoid organs, B lymphocytes respond to the antigen in a thymus-dependent or thymus-independent manner. Abnormalities in B lymphocytes contribute to autoimmune diseases, hypersensitivities, and lymphomas. Innovative therapies, such as monoclonal antibodies and cellular approaches, offer new options for treating hematologic cancers and autoimmune diseases.</div><div>This article aims to review and update in a simple manner the fundamentals of the differentiation, functions, and classes of B lymphocytes as well as to explore therapeutic advances in the treatment of diseases in which B lymphocytes are involved.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 28","pages":"Pages 1660-1672"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Urticaria y angioedema
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.04.004
C. Vidal Pan , T. González-Vidal , P. Méndez Brea , I. Roibás Veiga
{"title":"Urticaria y angioedema","authors":"C. Vidal Pan ,&nbsp;T. González-Vidal ,&nbsp;P. Méndez Brea ,&nbsp;I. Roibás Veiga","doi":"10.1016/j.med.2025.04.004","DOIUrl":"10.1016/j.med.2025.04.004","url":null,"abstract":"<div><div>The term urticaria refers to the presence of raised, red lesions that represent vasodilatation and edema located in the most superficial layers of the skin. Angioedema refers to a similar lesion but one that is located in the deeper layers. Although it may appear to be an easily diagnosed disease, the lesions can be confused with different diseases and it is necessary to make a differential diagnosis. It is a mast cell disease. Chronic urticaria/angioedema lasts more than six weeks and requires a study to attempt to identify the cause and underlying pathophysiology, as the prognosis and treatment response may vary depending on these parameters. The existence of a physical trigger can point to the diagnosis of inducible urticaria, but in the absence of such a trigger, it will be classified as spontaneous chronic urticaria.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 29","pages":"Pages 1746-1756"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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