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Artritis reumatoide: actitudes terapéuticas
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-05-01 DOI: 10.1016/j.med.2025.05.011
E. Fernández Fernández, E. Rabadán Rubio, A. Movasat Hajkhan, C. Corral Cuadrado, C. Bohórquez Heras
{"title":"Artritis reumatoide: actitudes terapéuticas","authors":"E. Fernández Fernández,&nbsp;E. Rabadán Rubio,&nbsp;A. Movasat Hajkhan,&nbsp;C. Corral Cuadrado,&nbsp;C. Bohórquez Heras","doi":"10.1016/j.med.2025.05.011","DOIUrl":"10.1016/j.med.2025.05.011","url":null,"abstract":"<div><div>Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes joint inflammation and progressive damage. The goal of RA treatment is to eliminate inflammation so as to avoid irreversible joint damage and the resulting disability. The key to achieving this is early initiation in the first weeks after diagnosis (“therapeutic window”) and the treat-to-target strategy, which focuses on continuously adjusting treatment to achieve specific goals: remission or low disease activity. Conventional disease-modifying drugs (DMARDs), such as methotrexate, continue to be the first line of treatment. However, the therapeutic arsenal has grown considerably in recent years, with a wide range of targeted biologic and synthetic DMARDs (JAK inhibitors) now available. This allows therapy to be personalized according to each patient's response and to achieve objectives more effectively.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 33","pages":"Pages 1985-1994"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166159","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 de profilaxis y manejo de las infecciones con los tratamientos biológicos inmunomoduladores y los inhibidores de JAK 使用免疫调节生物疗法和JAK抑制剂预防和控制感染的方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-05-01 DOI: 10.1016/j.med.2025.05.016
A. Abbasi Pérez , E. Rabadán Rubio , L. Antúnez Segura , P. Pretel Ruiz
{"title":"Protocolo de profilaxis y manejo de las infecciones con los tratamientos biológicos inmunomoduladores y los inhibidores de JAK","authors":"A. Abbasi Pérez ,&nbsp;E. Rabadán Rubio ,&nbsp;L. Antúnez Segura ,&nbsp;P. Pretel Ruiz","doi":"10.1016/j.med.2025.05.016","DOIUrl":"10.1016/j.med.2025.05.016","url":null,"abstract":"<div><div>This protocol addresses recommendations on infection prophylaxis and management for patients with inflammatory autoimmune diseases in treatment with biologic drugs and JAK inhibitors. The importance of an annual evaluation of vaccination status is notable, prioritizing administration in quiescent disease stages and before initiating immunosuppressive treatments. It includes considerations for non-live vaccines that are safe in immunocompromised patients and specific guidelines for live vaccines under controlled conditions. In addition, personalized strategies are suggested according to individual factors such as treatment, risk of infection, and local epidemiology.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 33","pages":"Pages 2026-2030"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166164","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
Varón de 28 años con fiebre, dolor e inflamación poliarticular 男性，28岁，发烧、疼痛和多关节炎症
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-05-01 DOI: 10.1016/j.med.2025.05.018
E. Rico Sánchez-Mateos, J. Muñoz Serrano, E. Fernández Fernández
{"title":"Varón de 28 años con fiebre, dolor e inflamación poliarticular","authors":"E. Rico Sánchez-Mateos,&nbsp;J. Muñoz Serrano,&nbsp;E. Fernández Fernández","doi":"10.1016/j.med.2025.05.018","DOIUrl":"10.1016/j.med.2025.05.018","url":null,"abstract":"","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 33","pages":"Pages 2035.e1-2035.e3"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166166","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 poliartritis crónica 慢性多关节炎诊断规程
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-05-01 DOI: 10.1016/j.med.2025.05.014
C. Corral Cuadrado, A. Movasat Hajkhan, P. Pretel Ruiz, A. Abbasi Pérez
{"title":"Protocolo diagnóstico de la poliartritis crónica","authors":"C. Corral Cuadrado,&nbsp;A. Movasat Hajkhan,&nbsp;P. Pretel Ruiz,&nbsp;A. Abbasi Pérez","doi":"10.1016/j.med.2025.05.014","DOIUrl":"10.1016/j.med.2025.05.014","url":null,"abstract":"<div><div>Polyarthritis is defined as the presence of synovitis in four or more joints for a period greater than six weeks. To diagnose it, a good case history and physical examination as well as conducting additional tests are essential. As part of this process, it is important to make a differential diagnosis between the different causes of polyarthritis such as inflammatory connective tissue diseases, microcrystalline arthritis, reactive or infectious arthritis, as well as some non-rheumatologic diseases such as paraneoplastic syndromes.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 33","pages":"Pages 2016-2020"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166162","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
Síndrome de Sjögren
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-05-01 DOI: 10.1016/j.med.2025.05.012
A. Movasat Hajkhan, L. Ruiz Gutiérrez, E. Rabadán Rubio, M. Ramírez Martín, P. Pretel Ruiz
{"title":"Síndrome de Sjögren","authors":"A. Movasat Hajkhan,&nbsp;L. Ruiz Gutiérrez,&nbsp;E. Rabadán Rubio,&nbsp;M. Ramírez Martín,&nbsp;P. Pretel Ruiz","doi":"10.1016/j.med.2025.05.012","DOIUrl":"10.1016/j.med.2025.05.012","url":null,"abstract":"<div><div>This article presents an updated review of Sjögren's syndrome (SS), a systemic autoimmune disease that primarily affects the salivary and lacrimal glands. It describes its epidemiology, with a predominance in women (9–10:1) and a prevalence of 0.1% – 0.6% in adults, and analyzes its pathogenic factors, including genetic, hormonal, immunological, and environmental aspects. The paper details the glandular (xerophthalmia, xerostomia) and extraglandular (musculoskeletal, neurological, dermatological, respiratory, digestive, renal, and hematological) clinical manifestations. The ACR/EULAR 2016 classification criteria are also presented and the therapeutic approach is described, which includes specific treatment for ocular and oral dryness as well as the management of systemic manifestations through immunosuppressants and biologic therapies.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 33","pages":"Pages 1995-2004"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166160","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
Artritis reumatoide
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-05-01 DOI: 10.1016/j.med.2025.05.010
E. Fernández Fernández, E. Rico Sánchez-Mateos, J. Campos Esteban, M. Ramírez Martín, L. Ruiz Gutiérrez
{"title":"Artritis reumatoide","authors":"E. Fernández Fernández,&nbsp;E. Rico Sánchez-Mateos,&nbsp;J. Campos Esteban,&nbsp;M. Ramírez Martín,&nbsp;L. Ruiz Gutiérrez","doi":"10.1016/j.med.2025.05.010","DOIUrl":"10.1016/j.med.2025.05.010","url":null,"abstract":"<div><div>Rheumatoid arthritis is a chronic, multisystem autoimmune disease. Its etiopathogenesis is complex; it has been linked to a breakdown of immune system tolerance favored by genetic and environmental factors. The disease course runs from predisposition through a situation of autoimmunity to the onset of non-visible joint symptoms and finally reaching clinical expression as persistent synovitis. Although the main manifestation is joint involvement in the form of symmetrical polyarthritis of the hands and feet, it can also affect other organs. Its most common extra-articular manifestation is rheumatoid nodules. Nonetheless, interstitial pulmonary involvement is of particular importance, as it the second leading cause of death after cardiovascular events. It is frequently associated with comorbidities such as cardiovascular risk, infections, cancer, and osteoporosis, whose evaluation and treatment must form part of these patients’ management. It is diagnosed through a combination of clinical features, characteristic laboratory findings such as the presence of rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies, and imaging tests. Although mortality is decreasing thanks to advances in recent decades, patients with rheumatoid arthritis continue to have a high disease burden and a significant decline in quality of life.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 33","pages":"Pages 1975-1984"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166158","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
Amiloidosis
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.021
F. Tornero-Romero , F. Lage-Estébanez , L. Cantero del Olmo , A. Albiñana-Pérez , A. Palacio-Tamarit y C. Arévalo-Cañas
{"title":"Amiloidosis","authors":"F. Tornero-Romero ,&nbsp;F. Lage-Estébanez ,&nbsp;L. Cantero del Olmo ,&nbsp;A. Albiñana-Pérez ,&nbsp;A. Palacio-Tamarit y C. Arévalo-Cañas","doi":"10.1016/j.med.2025.04.021","DOIUrl":"10.1016/j.med.2025.04.021","url":null,"abstract":"<div><div>Amyloidoses represent a group of complex diseases that occur as a consequence of extracellular amyloid deposition in different tissues. The three main types of amyloidoses are secondary amyloidosis (AA), as a consequence of chronic inflammation produced in infectious and inflammatory diseases, mainly affecting the kidney; light-chain amyloidosis (AL), secondary to the production of immunoglobulin chains in hematological diseases, mainly affecting the heart and kidney; and transthyretin amyloidosis (ATTR) in its hereditary or wild-type variant, predominantly affecting the heart and peripheral nervous system. The treatment of AA and AL is that of the underlying disease, while in ATTR, stabilizers, gene silencing drugs, and eliminating drugs are under investigation.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 31","pages":"Pages 1871-1882"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834654","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
Sarcoidosis 结节病
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.022
C. Arévalo-Cañas , G. Starita-Fajardo , L. Salmerón-Godoy , M. Andreo-Galera
{"title":"Sarcoidosis","authors":"C. Arévalo-Cañas ,&nbsp;G. Starita-Fajardo ,&nbsp;L. Salmerón-Godoy ,&nbsp;M. Andreo-Galera","doi":"10.1016/j.med.2025.04.022","DOIUrl":"10.1016/j.med.2025.04.022","url":null,"abstract":"<div><div>Sarcoidosis is a systemic inflammatory disease characterized by the formation of non-caseating granulomas that can affect any organ, with the lung being the most characteristic. Demonstrating non-necrotizing granulomas in a biopsy is essential in order to establish a diagnosis in practically all cases. Other additional tests, such as blood and urine tests, imaging and respiratory function tests, and bronchoalveolar lavage are useful in the diagnosis. The mainstay of treatment is corticosteroids, although immunosuppressive and biologic drugs may be useful.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 31","pages":"Pages 1883-1894"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834650","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 de evaluación de la afectación cardíaca en las enfermedades autoinmunes y autoinflamatorias 自体免疫和自体炎症性疾病的心脏损伤评估议定书
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.04.024
C. Arévalo-Cañas , I. Calatayud-Marín , F. Tornero-Romero , J. Ballano-Rodríguez-Solís
{"title":"Protocolo de evaluación de la afectación cardíaca en las enfermedades autoinmunes y autoinflamatorias","authors":"C. Arévalo-Cañas ,&nbsp;I. Calatayud-Marín ,&nbsp;F. Tornero-Romero ,&nbsp;J. Ballano-Rodríguez-Solís","doi":"10.1016/j.med.2025.04.024","DOIUrl":"10.1016/j.med.2025.04.024","url":null,"abstract":"<div><div>Cardiac involvement in systemic autoimmune diseases (SADs) and autoinflammatory diseases (AIDs) is underdiagnosed and can occur at different levels. This protocol provides a generic diagnostic approach to pericardial, myocardial, and endocardial involvement in SADs and AIDs, with the aim of improving their identification and promoting early diagnosis. Echocardiography, and especially cardiac magnetic resonance imaging, are useful in the diagnosis.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 31","pages":"Pages 1900-1903"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834651","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
Artritis idiopática juvenil 少年特发性关节炎
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.05.004
A. Abbasi Pérez , L. Antúnez Segura , E. Rabadán Rubio , P. Pretel Ruiz , C. Bohórquez Heras
{"title":"Artritis idiopática juvenil","authors":"A. Abbasi Pérez ,&nbsp;L. Antúnez Segura ,&nbsp;E. Rabadán Rubio ,&nbsp;P. Pretel Ruiz ,&nbsp;C. Bohórquez Heras","doi":"10.1016/j.med.2025.05.004","DOIUrl":"10.1016/j.med.2025.05.004","url":null,"abstract":"<div><div>Juvenile idiopathic arthritis (JIA) is a condition affecting children under 16 years of age characterized by arthritis of unknown origin that lasts at least six weeks. It is classified into several subtypes, such as systemic, oligoarticular, and polyarticular JIA, each with specific diagnostic criteria. JIA is the most common chronic rheumatic disease in pediatrics. The etiopathogenesis involves genetic factors, especially in the HLA region, and an abnormal activation of the immune system has been identified. The clinical manifestations within the systemic subtype are diverse; typical complications are uveitis and temporomandibular joint involvement. The diagnosis is based on the medical record, a physical examination, and laboratory tests. Treatment is aimed at remission and may include non-steroidal anti-inflammatory drugs, corticosteroids, synthetic disease-modifying drugs, TNF-α inhibitors, IL-1 and IL-6 inhibitors, and small molecules. The assessment of disease activity is performed using scales that combine clinical and analytical parameters.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 32","pages":"Pages 1942-1951"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083614","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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