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Protocolo de tratamiento de los antilinfocitos B en las enfermedades inmunomediadas 免疫介导疾病中的B型抗淋巴细胞治疗方案
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
Protocolo diagnóstico de la oligoartritis
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.05.005
J. Muñoz Serrano, M. Ramírez Martín, C. Corral Cuadrado, J. Campos Esteban
{"title":"Protocolo diagnóstico de la oligoartritis","authors":"J. Muñoz Serrano,&nbsp;M. Ramírez Martín,&nbsp;C. Corral Cuadrado,&nbsp;J. Campos Esteban","doi":"10.1016/j.med.2025.05.005","DOIUrl":"10.1016/j.med.2025.05.005","url":null,"abstract":"<div><div>Oligoarthritis is defined as inflammation that affects between two and four joints. Its etiology can be of any nature and it may progress to polyarthritis, suggesting common pathogenic mechanisms of the different clinical forms. For the etiological diagnosis, a detailed clinical assessment is required that includes a case history and physical examination as well as additional tests to differentiate it from other conditions. Synovial fluid analysis is key to identifying inflammation or infection and, in many cases, further analysis and radiological studies are also required to confirm the diagnosis.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 32","pages":"Pages 1952-1957"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083767","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 患有发热、一般综合症、营养不良和躁动的56岁妇女
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 全身性自身免疫性风湿病发热诊断方案
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
Protocolo diagnóstico de la sacroilitis y la discitis 骶骨炎和椎间盘炎的诊断方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-04-01 DOI: 10.1016/j.med.2025.05.007
M. Ramírez Martín, C. Corral Cuadrado, E. Rico Sánchez-Mateos, J. Muñoz Serrano
{"title":"Protocolo diagnóstico de la sacroilitis y la discitis","authors":"M. Ramírez Martín,&nbsp;C. Corral Cuadrado,&nbsp;E. Rico Sánchez-Mateos,&nbsp;J. Muñoz Serrano","doi":"10.1016/j.med.2025.05.007","DOIUrl":"10.1016/j.med.2025.05.007","url":null,"abstract":"<div><div>Sacroiliitis is characterized by lower back pain with an inflammatory rhythm. It is usually in the gluteal area and can be unilateral or bilateral. It sometimes radiates to the pelvic area or lower limbs through the posterior face and can be confused with radicular pain. It is difficult to diagnose, as its presentation is similar to many other causes of back pain; therefore, its diagnosis is by exclusion. It is important to establish the cause of the symptoms, including infectious, degenerative, or idiopathic inflammatory causes (usually in the context of spondyloarthritis), among others. Laboratory and imaging tests such as sacroiliac joint radiography and magnetic resonance imaging (MRI) are used for diagnosis, the latter being very useful in the differential diagnosis.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 32","pages":"Pages 1963-1967"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083769","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 炎症性Miopatías
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
Esclerosis sistémica 硬皮病
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
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
Lupus eritematoso sistémico (I) 系统红斑狼疮(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
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