G. Starita Fajardo , D. Lucena López , C. Arévalo-Cañas , A. González García
{"title":"Enfermedad relacionada con IgG4","authors":"G. Starita Fajardo , D. Lucena López , C. Arévalo-Cañas , A. González García","doi":"10.1016/j.med.2025.04.020","DOIUrl":"10.1016/j.med.2025.04.020","url":null,"abstract":"<div><div>IgG4-related disease (IgG4-RD) is an immune-mediated disorder of a fibroinflammatory nature that can affect practically any organ. Some of the most common manifestations are glandular involvement, orbital pseudotumor, pancreatic involvement, and retroperitoneal fibrosis. The 2019 ACR/EULAR classification criteria for IgG4-RD, based on clinical and histologic findings, may be useful for diagnosis. Corticosteroids are the mainstay of treatment, although different immunosuppressive drugs are under investigation with mixed results.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 31","pages":"Pages 1861-1870"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834653","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}
{"title":"Protocolo terapéutico de las enfermedades autoinflamatorias","authors":"J. Ballano-Rodríguez-Solís , C. Arévalo-Cañas","doi":"10.1016/j.med.2025.04.026","DOIUrl":"10.1016/j.med.2025.04.026","url":null,"abstract":"<div><div>The repeated episodes of inflammation that characterize autoinflammatory diseases trigger organ damage and occupational disability. Treatment is aimed at reducing the number and intensity of outbreaks as well as avoiding the development of secondary amyloidosis, which is most associated with inflammasomopathies. The most commonly used therapeutic agents include: NSAIDs, corticosteroids, colchicine, and biologic drugs (mainly anti-IL-1 and TNF inhibitors).</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 31","pages":"Pages 1909-1912"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833110","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}
M. Retuerto Guerrero, E. Díez Álvarez, C. Sieiro Santos, I. González Fernández
{"title":"Protocolo diagnóstico diferencial del dolor abdominal en pacientes con enfermedades inmunomediadas autoinmunes sistémicas","authors":"M. Retuerto Guerrero, E. Díez Álvarez, C. Sieiro Santos, I. González Fernández","doi":"10.1016/j.med.2025.04.015","DOIUrl":"10.1016/j.med.2025.04.015","url":null,"abstract":"<div><div>Autoimmune rheumatic diseases are often accompanied by pain and other gastrointestinal symptoms that may affect different areas of the digestive tract. Its differential diagnosis is complex due to the nonspecific and episodic nature of the clinical manifestations. It is essential to perform a comprehensive differential diagnosis that considers specific organ damage and vascular complications associated with the disease, infections, adverse drug effects, and occult neoplasms. The case history should be detailed, including the onset, location, duration, and characteristics of the pain as well as triggering factors, associated symptoms, and treatments received. The physical examination plays a key role in identifying signs of acute abdomen that require surgical intervention as well as oriented clinicians toward a precise etiology. Laboratory studies, in addition to imaging tests according to clinical suspicion, are indispensable. This comprehensive approach makes it possible to distinguish between surgical, inflammatory, metabolic, and infectious causes, ensuring adequate and timely management.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 30","pages":"Pages 1834-1838"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834468","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}
I. Calatayud Marín , N. Abdilla Bonías , M. Calabuig Ballester , C. Arévalo-Cañas
{"title":"Protocolo diagnóstico de las miositis","authors":"I. Calatayud Marín , N. Abdilla Bonías , M. Calabuig Ballester , C. Arévalo-Cañas","doi":"10.1016/j.med.2025.04.023","DOIUrl":"10.1016/j.med.2025.04.023","url":null,"abstract":"<div><div>Idiopathic inflammatory myopathies (IIM) are systemic autoimmune diseases characterized by progressive muscle weakness and variable extramuscular involvement. This diagnostic protocol offers a structured approach that includes a detailed clinical assessment, identification of specific autoantibodies, imaging studies, and muscle biopsy. The integration of these tools improves diagnostic accuracy, facilitates disease classification, and optimizes clinical management.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 31","pages":"Pages 1895-1899"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835344","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}
J. Campos Esteban, M. Ramírez Martín, E. Rico Sánchez-Mateos
{"title":"Varón de 28 años con dolor lumbar crónico","authors":"J. Campos Esteban, M. Ramírez Martín, E. Rico Sánchez-Mateos","doi":"10.1016/j.med.2025.05.009","DOIUrl":"10.1016/j.med.2025.05.009","url":null,"abstract":"","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 32","pages":"Pages 1973.e1-1973.e3"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083763","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}
J. Campos Esteban, E. Rabadán Rubio, E. Fernández Fernández, A. Abbasi Pérez, A. Movasat Hajkhan
{"title":"Espondiloartritis, espondilitis anquilopoyética y síndrome SAPHO","authors":"J. Campos Esteban, E. Rabadán Rubio, E. Fernández Fernández, A. Abbasi Pérez, A. Movasat Hajkhan","doi":"10.1016/j.med.2025.05.001","DOIUrl":"10.1016/j.med.2025.05.001","url":null,"abstract":"<div><div>Spondyloarthritis is a heterogeneous group of chronic rheumatic diseases characterized by autoimmune/autoinflammatory involvement of different structures of the axial skeleton; entheses; peripheral joints; and extra-articular tissues such as the eyes, skin, and intestine. These conditions share a genetic basis, with HLA-B27 as a predisposing factor, in addition to immunological and environmental factors that contribute to their development. The clinical manifestations, which usually occur in flares, include inflammatory lumbar pain, peripheral arthritis, enthesitis, and extra-articular symptoms (uveitis, psoriasis, and inflammatory bowel disease). Its natural progression leads to the onset of tissue damage and characteristic osteogenesis. The diagnosis is based on a detailed clinical assessment supported by laboratory tests and imaging studies, notable among which is the use of magnetic resonance imaging for early detection, mainly in axial forms. Therapeutic strategies seek to reduce inflammation, alleviate symptoms, and prevent progression of structural damage, combining pharmacological treatments (NSAIDs, DMARDs, and biologics) with non-pharmacological interventions, including regular exercise. Delayed diagnosis and insufficient management represent significant challenges, underscoring the need for a multidisciplinary approach in the event of the onset of extra-musculoskeletal manifestations in order to improve patient health outcomes.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 32","pages":"Pages 1915-1922"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083764","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}
E. Rabadán Rubio, E. Rico Sánchez-Mateos, P. Pretel Ruiz, C. Bohórquez Heras, L. Ruiz Gutiérrez
{"title":"Artritis reactiva","authors":"E. Rabadán Rubio, E. Rico Sánchez-Mateos, P. Pretel Ruiz, C. Bohórquez Heras, L. Ruiz Gutiérrez","doi":"10.1016/j.med.2025.05.003","DOIUrl":"10.1016/j.med.2025.05.003","url":null,"abstract":"<div><div>Reactive arthritis (RA) is a form of aseptic arthritis that usually occurs one to six weeks after a primary infection that did not initially affect the joints. The microorganisms usually involved in its onset tend to have a genitourinary or enteric origin. It usually appears in young patients, with a peak incidence in individuals between 30 and 40 years of age. The natural history of this disease classifies the clinical manifestations according to chronology in an acute phase, in which the symptoms of the primary infection manifest and followed a few days later by joint manifestations, and a chronic phase of disease, if the symptoms persist for more than six months. Symptoms include musculoskeletal manifestations (peripheral and axial arthritis, dactylitis, and enthesitis) and extra-articular manifestations, including mucocutaneous manifestations such as balanitis circinata and keratoderma blennorrhagicum, and ocular manifestations, with conjunctivitis being the most common. The diagnosis should be made by attempting to identify the causative bacteria via culture when possible, serology, or molecular tests such as RCP. Antibiotic therapy should be used to treat the active infection. For joint manifestations, NSAIDs and corticosteroids are the first line of treatment, followed by disease-modifying drugs and anti-TNF-alpha for refractory or chronic cases.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 32","pages":"Pages 1932-1941"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083766","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}
C. Corral Cuadrado, J. Muñoz Serrano, M. Ramírez Martín, E. Fernández Fernández
{"title":"Protocolo diagnóstico de las uveítis anteriores","authors":"C. Corral Cuadrado, J. Muñoz Serrano, M. Ramírez Martín, E. Fernández Fernández","doi":"10.1016/j.med.2025.05.006","DOIUrl":"10.1016/j.med.2025.05.006","url":null,"abstract":"<div><div>Uveitis is characterized by inflammation of the ocular vascular layer between the sclera and the retina. It is divided into anterior, intermediate, and posterior uveitis according to the anatomical location of the inflammation. Most cases of anterior uveitis are idiopathic, but it is essential to make a differential diagnosis, especially with autoimmune diseases, infections, or ocular causes. To do so, a good case history and physical examination as well as conducting additional tests are important.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 32","pages":"Pages 1958-1962"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083768","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}
C. Bohórquez Heras, A. Movasat Hajkhan, A. Abbasi Pérez, M. Ramírez Martín
{"title":"Protocolo diagnóstico de las entesitis","authors":"C. Bohórquez Heras, A. Movasat Hajkhan, A. Abbasi Pérez, M. Ramírez Martín","doi":"10.1016/j.med.2025.05.008","DOIUrl":"10.1016/j.med.2025.05.008","url":null,"abstract":"<div><div>Enthesitis is one of the key manifestations in spondyloarthritis, both in its axial and peripheral manifestations. An adequate diagnostic approach is essential to recognize involvement of the entheses, which is often difficult to detect by physical examination alone. Different clinical indexes that can be used in clinical practice have been developed to aid in the systematic screening of the most important enthesitis. From an imaging point of view, ultrasound is currently considered the gold standard test for the evaluation and diagnosis of enthesitis. The MASEI is the most commonly used index for assessment. Both a plain x-ray and magnetic resonance imaging are tests that can help in making a proper diagnosis in the entheseal involvement of these diseases.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 32","pages":"Pages 1968-1972"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083762","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}