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Lupus eritematoso sistémico (II). Estrategias terapéuticas 系统性红斑狼疮(II)。治疗策略
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 免疫介导的自身免疫和副肿瘤神经病变诊断方案
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
Artritis psoriásica
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.05.002
L. Ruiz Gutiérrez, A. Abbasi Pérez, P. Pretel Ruiz, J. Campos Esteban, A. Movasat Hajkhan
{"title":"Artritis psoriásica","authors":"L. Ruiz Gutiérrez,&nbsp;A. Abbasi Pérez,&nbsp;P. Pretel Ruiz,&nbsp;J. Campos Esteban,&nbsp;A. Movasat Hajkhan","doi":"10.1016/j.med.2025.05.002","DOIUrl":"10.1016/j.med.2025.05.002","url":null,"abstract":"<div><div>Psoriatic arthritis (PsA) is a chronic inflammatory disease that can affect joints, tendons, entheses, and the axial skeleton. It usually occurs in patients with psoriasis. It is a complex, multifactorial disease favored by genetic, environmental, and immunological factors, among which TNF-alpha, IL-23, and IL-17 are the most important. There are no validated diagnostic criteria for PsA, but the CASPAR <em>(ClASsification criteria for Psoriatic Arthritis</em>) criteria can serve as a guide in clinical practice. In addition to joint manifestations, patients may present with extramusculoskeletal manifestations and comorbidities that must be taken into account in the management of the disease. Conventional, biological, or synthetic disease-modifying antirheumatic drugs (DMARDs) are available for its treatment.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 32","pages":"Pages 1923-1931"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083765","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 荨麻疹血管性水肿
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
Diferenciación, activación y clasificación de los linfocitos B B淋巴细胞的分化、活化和分类
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
Protocolo diagnóstico y terapéutico de los síndromes paraneoplásicos del cáncer de pulmón 肺癌副肿瘤综合征的诊断和治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.006
G. González, S. Roa, M. García-Pardo, Y. Lage, A. Barril, J.C. Calvo, M.E. Olmedo, V. Alía, P. Garrido, J. Chamorro
{"title":"Protocolo diagnóstico y terapéutico de los síndromes paraneoplásicos del cáncer de pulmón","authors":"G. González,&nbsp;S. Roa,&nbsp;M. García-Pardo,&nbsp;Y. Lage,&nbsp;A. Barril,&nbsp;J.C. Calvo,&nbsp;M.E. Olmedo,&nbsp;V. Alía,&nbsp;P. Garrido,&nbsp;J. Chamorro","doi":"10.1016/j.med.2025.03.006","DOIUrl":"10.1016/j.med.2025.03.006","url":null,"abstract":"<div><div>Paraneoplastic syndromes are a set of signs and symptoms that appear in sites distant from the primary tumor or its metastases in relation to the secretion of substances produced by the neoplasm itself or by antibodies targeted against tumor antigens that generate a cross-reaction with other tissues. Lung cancer is one of the neoplasms in which this type of syndrome most frequently develops.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 27","pages":"Pages 1614-1617"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591722","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
Tráfico leucocitario: mecanismos e impacto clínico 白细胞贩运：机制和临床影响
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.014
D. De León-Oliva , D. Liviu Boaru , P. De Castro-Martínez , R. Díaz-Pedrero , L. López-González , M. Álvarez-Mon , M.A. Ortega
{"title":"Tráfico leucocitario: mecanismos e impacto clínico","authors":"D. De León-Oliva ,&nbsp;D. Liviu Boaru ,&nbsp;P. De Castro-Martínez ,&nbsp;R. Díaz-Pedrero ,&nbsp;L. López-González ,&nbsp;M. Álvarez-Mon ,&nbsp;M.A. Ortega","doi":"10.1016/j.med.2025.03.014","DOIUrl":"10.1016/j.med.2025.03.014","url":null,"abstract":"<div><div>Leukocyte trafficking is the highly regulated process by which immune cells migrate between the vascular system and tissues. They perform immune surveillance functions under conditions of homeostasis and facilitate inflammatory responses in the event of injury or infection, promoting the elimination of harmful agents and contributing to tissue repair. The regulation of this traffic depends on local signals that induce changes in the capillary system, facilitating leukocyte adhesion and extravasation through the leukocyte adhesion cascade, which is mediated by adhesion molecules on the cell surface of leukocytes and vascular cells. This update will review the set of chemotactic signals that attract leukocytes to the site of injury and the pathological implications of leukocyte trafficking dysregulation as well as provide an update regarding their relationship to aging and the pharmacological treatments that regulate it.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 28","pages":"Pages 1688-1697"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739992","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
Mesotelioma pleural maligno
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.003
V. Alía, M.E. Olmedo, G. González, Y. Lage, M. García-Pardo, S. Roa, J.C. Calvo, A. Barrill, P. Garrido, J. Chamorro
{"title":"Mesotelioma pleural maligno","authors":"V. Alía,&nbsp;M.E. Olmedo,&nbsp;G. González,&nbsp;Y. Lage,&nbsp;M. García-Pardo,&nbsp;S. Roa,&nbsp;J.C. Calvo,&nbsp;A. Barrill,&nbsp;P. Garrido,&nbsp;J. Chamorro","doi":"10.1016/j.med.2025.03.003","DOIUrl":"10.1016/j.med.2025.03.003","url":null,"abstract":"<div><div>Malignant pleural mesothelioma is an aggressive and rare neoplasm associated with asbestos exposure. Its incidence is increasing in developing countries. It has a poor prognosis, with a median survival time of about one year. The treatments currently available offer limited benefits. Based on the available evidence, the role of radical surgery is controversial because of the high perioperative morbidity and mortality and the tendency for disease recurrence. Platinum- and pemetrexed-based chemotherapy was the cornerstone of the treatment of unresectable disease in patients with good functional reserve. Immunotherapy with nivolumab and ipilimumab has recently emerged as a new standard option, improving survival figures and with manageable toxicity, especially in the non-epithelioid histologic subtype. Pleural effusion and trapped lung are common complications in this disease, so techniques aimed at controlling symptoms are fundamental. It is necessary to conduct new clinical trials and translational research in order to improve survival and quality of life expectations for patients with pleural mesothelioma.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 27","pages":"Pages 1595-1602"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591725","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
Indicaciones e interpretación de las pruebas alérgicas cutáneas y serológicas 皮肤和血清学过敏检测的适应症和解释
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.04.005
C. Vidal Pan , I. Roibás Veiga , P. Méndez Brea , T. González Vidal
{"title":"Indicaciones e interpretación de las pruebas alérgicas cutáneas y serológicas","authors":"C. Vidal Pan ,&nbsp;I. Roibás Veiga ,&nbsp;P. Méndez Brea ,&nbsp;T. González Vidal","doi":"10.1016/j.med.2025.04.005","DOIUrl":"10.1016/j.med.2025.04.005","url":null,"abstract":"<div><div>Protocols for in vivo and in vitro tests used in the study of allergic reactions are presented with special emphasis on the former. In vivo tests include the identification of specific IgE by intraepidermal and intradermal immediate hypersensitivity testing as well as the identification of sensitised T-lymphocytes in delayed hypersensitivity skin tests. Among the in vitro tests, the methods used for the quantification of allergen-specific IgE are described.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 29","pages":"Pages 1757-1762"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143817560","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
Inmunidad innata y adaptativa 先天和适应性免疫
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-03-01 DOI: 10.1016/j.med.2025.03.015
A. Prieto Martín, D. Díaz Martín, L. Muñoz Zamarrón y J. Monserrat Sanz
{"title":"Inmunidad innata y adaptativa","authors":"A. Prieto Martín,&nbsp;D. Díaz Martín,&nbsp;L. Muñoz Zamarrón y J. Monserrat Sanz","doi":"10.1016/j.med.2025.03.015","DOIUrl":"10.1016/j.med.2025.03.015","url":null,"abstract":"<div><div>Immune responses are divided into innate and adaptive. Innate immunity is rapid and non-specific, acting against a broad spectrum of pathogens using receptors that recognize pathogen-associated molecular patterns (PAMPs) or damage-associated molecular patterns (DAMPs). Adaptive immunity recognizes specific antigens through a diverse repertoire of antigen-specific T and B lymphocytes. This system requires time for antigen-specific cells to activate and proliferate. This response generates effector and memory T cell clones that enable a potent, effective, rapid, and specific response in future exposures to the same pathogen. The interaction between both systems is essential for the efficient defense of the organism. The antigen-presenting cells of the innate system inform the adaptive cells about the nature of the pathogens detected and polarize the adaptive response so that it is more effective against the type of pathogen being confronted. Innate immunity can generate a trained memory that enhances its response to subsequent exposures.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 28","pages":"Pages 1698-1711"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739993","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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