Correspondence to Professor Carolina Ramírez-Santana, Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad Del Rosario, Bogotá 111221, Colombia; ...heily.ramirez@urosario.edu.co Detection of antinuclear antibodies (ANAs) is of paramount importance for diagnosis and assessment of autoimmune diseases (ADs), but may vary depending on the method used. ...we aimed to compare three different line immunoassays (LIAs) for ANAs testing in order to simultaneously evaluate their concordance with the results obtained by a well known and widely used ELISA. IMTEC-ANA-LIA Maxx (Human diagnostics, Magdeburg Germany), ANA-Profile 23 (Euroimmune, Luebeck, Germany) and ImmcoStripe ANA Advanced LIA (Trinity Biotech, Bray, Co. Wicklow, Ireland). †The interassay agreement was assessed by the Cohen’s Kappa test implemented in Graph Pad calculator (https://www.graphpad.com/quickcalcs/kappa1.cfm). ‡Interpretation of the values was done as suggested by McHugh.7 dsDNA: double-strand DNA; RNP: ribonucleoprotein; Sm: Smith. Discordances have already been described when comparing other autoantibodies testing methodologies, such as ANAs screening by indirect immunofluorescence assay through different kits or among different laboratories1 2 ; ELISAS versus LIAs3 and LIAs from three different manufactures.4 5 In our study, the confirmation performed for anti-dsDNA antibodies by Crithidia luciliae indirect immunofluorescence test (CLIIFT) resulted disappointing, since the level of agreement between the four assays and the ‘gold standard’ technique did not surpass the ‘minimal’ level. ...out of 22 sera positive for anti-dsDNA by ELISA, only seven were positive by CLIIFT, confirming ELISA as highly sensitive but less specific than CLIIFT.6 As mentioned, different populations of anti-DNA antibodies due to affinities of the targeted antibodies for dsDNA and substrate differences account for such discrepancies.
El fenómeno de Raynaud (FR) es una respuesta vascular exagerada al frío o al estrés que se manifiesta por cambios de coloración de la piel; puede ser primario (RP) o secundario (RS).
El objetivo de ...esta revisión sistemática de la literatura (RSL) es describir y analizar las principales diferencias para la detección de cambios vasculares en FR entre la capilaroscopia (NC) y la termografía infrarroja (TRI).
RSL siguiendo guías Prisma en las siguientes fuentes de información: Medline, Cochrane, Pubmed, ClinicalKey y ScienceDirect. Criterios de inclusión: artículos publicados hasta septiembre del 2020, observacionales o analíticos, que incluyeran población con FR (primario o secundario), con evaluación diagnóstica concomitante utilizando NC (microscópica o videocapilaroscopia) y TRI. En la construcción de las ecuaciones de búsqueda se utilizaron términos MeSH («Thermography», «Microscopic angioscopy») y diferentes «Keywords» cruzadas a través de diferentes operadores booleanos. Se utilizó la herramienta «Joanna Briggs Institute Critical Appraisal Tools for Use in Systematic Reviews Checklist» para evaluar el riesgo de sesgo. Se siguió la guía SWiM para sintetizar y presentar los resultados.
Se identificaron 1.397 artículos, de los que luego de cribado y elegibilidad, se incluyeron cinco. Contemplaron poblaciones diferentes, evaluadas con equipos diferentes, dos artículos en niños y tres artículos en adultos. La población fue predominantemente caucásica y de género femenino, en total 403 individuos (79 menores de edad). Los dos estudios realizados en población pediátrica presentan resultados no concordantes y los estudios en población adulta presentan similitudes en sus resultados (NC técnica diagnóstica que mejor discrimina RP de RS), pero con patologías del tejido conectivo asociadas a RS diferentes.
A través de RSL se presentan hallazgos microvasculares de dos herramientas diagnósticas (NC y TRI) cuando se utilizan de manera concomitante en el FR. No se puede concluir a partir de los cinco artículos que existan diferencias claras o ventajas/desventajas en el uso preferente de una de las dos técnicas diagnósticas en el FR; el valor de la NC destaca para la diferencia entre RP y RS. Se requieren nuevos estudios para analizar diferencias entre las dos técnicas.
Raynaud's phenomenon (RP) is an exaggerated vascular response to cold or stress that is manifested by changes in skin colour. It can be primary (PR) or secondary (SR).
The objective of this systematic review of the literature (SLR) is to describe and analyse the main differences for the detection of vascular changes in RP between capillaroscopy (NC) and infrared thermography (IRT).
An SLR following PRISMA guidelines in the following information sources: Medline, Cochrane, Pubmed, ClinicalKey and ScienceDirect. Inclusion criteria: observational or analytical articles published until September 2020, that included a population with RP (primary or secondary), with concomitant diagnostic evaluation using NC (microscopic or videocapillaroscopy) and IRT. In the construction of the search equations, MeSH terms («Thermography», «Microscopic Angioscopy») and different keywords crossed with different Boolean operators were used. The Joanna Briggs Institute Critical Appraisal tools for use in Systematic Reviews Checklist was used to assess the risk of bias. The SWiM guideline was followed to synthesize and present the results.
1,397 articles were identified, of which, after screening and eligibility, five were included. They included different populations, evaluated with different equipment; two articles in children and three in adults. Predominantly Caucasian and female population, total of 403 individuals (79 minors). The two studies carried out in the paediatric population showed non-concordant results and the studies in the adult population showed similarities in their results (NC better discriminates PR from SR), but with different connective tissue pathologies associated with SR.
Microvascular findings from two diagnostic tools (NC and IRT) are presented through the SLR when used concomitantly in RP. Through the 5 articles, it is not possible to conclude that there are clear differences or advantages / disadvantages in the preferential use of one of the two diagnostic techniques in RP, highlighting the value of NC for differentiating between PR and SR. Further studies are required to analyse differences between the two techniques.
ABSTRACT Introduction: Several studies have documented the statistical association between leptin and osteoarthritis (OA) especially in joints that support weight, such as hips and knees, ...demonstrating high concentrations of plasma leptin and synovial fluid. Few studies address the possible relationship between leptin and obesity/overweight with OA hand. Objectives: To determine the relationship between serum leptin levels and the severity of OA in hands. Establish the association between obesity/overweight with the severity of OA, using radiographic scales. Methods: Measurement of leptin levels by ELISA technique to 44 patients with primary OA of hand and 30 healthy controls. Analysis of hand radiographs using the classification system of Kellgren and Lawrence, and anthropometric measurements for the calculation of body mass index. Results: Serum leptin levels in the group of patients with primary hand OA were higher compared to healthy controls (P = 0.046). No significant associations were found between the different degrees of severity of the disease measured by radiological scale of de Kellgren and Lawrence with the average leptin levels (P = 0.94) as well as the obesity/overweight categorization according to the body mass index (P = 0.88). Conclusions: Serum leptin levels in the group of patients with primary hand OA in this study were higher compared to healthy controls, with a significant statistical difference. This difference was not maintained in relation to gender, as well as in the subgroup of patients with obesity or overweight.
BACKGROUNDDermatomyositis (DM) and polymyositis (PM) are forms of idiopathic inflammatory myopathies (IIMs), which are associated with the production of autoantibodies that are useful in the ...diagnosis and prognosis of the disease.
OBJECTIVEThe aim of this study was to determine the frequency of antinuclear autoantibodies (ANAs), myositis-specific autoantibodies (MSAs), and myositis-associated autoantibodies (MAAs) in 6 Latin American countries.
METHODSTwo hundred ten patients with IIM were included in this cross-sectional study from 2014 to 2017112 from Mexico, 46 from Colombia, 20 from Peru, 16 from the Dominican Republic, 10 from Argentina, and 6 from Guatemala. Antinuclear autoantibodies were detected by indirect immunofluorescence on HEp-2 cells. MSAs and MAAs were tested by a line immunoassay method. Mann-Whitney U and χ tests were used for statistical analysis.
RESULTSOf the 210 IIM patients, 139 (66.2%) had DM, 59 (28%) PM, and 12 (5.7%) juvenile DM. The mean age was 43.5 (6–79 years); 158 (75.2%) were female, and 52 (24.8%) were male. The overall frequency of ANA was 60%. The most frequent patterns were fine speckled (AC-4) (78.3%) and cytoplasmic (AC-19) (6.45%). The most frequent MSA were anti–Mi-2 (38.5%) and anti–Jo-1 (11.9%). Anti–Mi-2 was more frequent in patients from Colombia (40.1%). The MAA more frequent were anti–Ro-52/TRIM21 (17.6%) and anti–PM-Scl75 (7.5%).
CONCLUSIONSThis is the first study of ANA, MSA, and MAA in patients from 6 countries from the Panamerican League against Rheumatism myositis study group. We observed a general prevalence of 60% of ANA. In relation to MSA and MAA, anti–Mi-2 was the more frequent (38.5%).
ABSTRACT Introduction: Post-chikungunya virus (CHIKV) chronic arthritis is a common complication of the acute infection caused by this virus, with high risk of progression to functional and quality ...of life sequelae. Objective: To identify the clinical and immunological characteristics, functional disabilities, and quality of life decline in a sample of Colombian patients with chronic arthropathy associated with chikungunya virus (CHIKV). Methods: A group of 94 patients was evaluated in a City in Colombia during the CHIKV epidemics from 2014 to 2015. Results: The mean age of the 94 patients was 57 years; 76% were women, and 100% came from low socioeconomic groups. Typically, the joint disease was symmetrical, with joint swelling present in 30% of the cases, mostly involving the small and large joints of the upper limbs. Rheumatoid factor was positive in 1.06% and anti-citrulline antibodies in 0%. There were detectable levels of IL6 in 64.9%, and IL 17 in 7.45% of the patients. The severity of disease activity was determined using the DAS28 score, identifying 55.3% with moderate activity, 40.4% with mild activity, and 4.2% with high activity. The HAQ-DI identified a moderate functional limitation in 45.7% of the cases, with a mean score of 1.02. The quality of life measured with the SF-36 scale showed that all of the domains evaluated were affected but pain and the physical and emotional domains were significantly more affected. Conclusions: Patients with post-chikungunya chronic arthritis, presented in most cases arthralgia, arthritis, functional impairment, and poor quality of life. It is then necessary to adopt comprehensive therapeutic measures for a sound intervention of this pathology.
La artropatía por virus de chikungunya (CHIKV) es una complicación frecuente secundaria a la infección inicial por este virus con un alto riesgo de progresión a secuelas funcionales y de calidad de ...vida.
Identificar las características clínicas, inmunológicas, de discapacidad funcional y de deterioro de la calidad de vida en una muestra de pacientes colombianos con artropatía crónica por CHIKV.
Se evaluó un grupo de 94 pacientes en una ciudad colombiana durante la epidemia por CHIKV en el periodo 2014-2015.
En los 94 pacientes la edad media fue de 57 años, siendo el 76% mujeres y el 100% de la población afectada perteneció a estratos socioeconómicos bajos. El cuadro articular característicamente fue simétrico con inflamación articular en el 30%, mayor compromiso de articulaciones grandes y pequeñas de miembros superiores. Se identificó positividad para factor reumatoide en el 1,06%, anticuerpos anticitrulina en el 0%, niveles detectables de IL-6 en el 64,9% y de IL-17 en el 7,45% de los pacientes. La severidad de la actividad articular se exploró con la escala DAS28, identificando un 55,3% con actividad moderada, un 40,4% actividad leve y un 4,2% con actividad alta. El HAQ-DI identificó un compromiso funcional moderado en el 45,7%, con puntaje medio de 1,02. La calidad de vida medida con la escala SF-36 mostró que todos los dominios evaluados fueron afectados con mayor compromiso de los dominios dolor, rol físico y rol emocional.
En los pacientes afectados por artropatía crónica por CHIKV se observó artralgias, artritis, deterioro funcional y de la calidad de vida en la mayoría de la población estudiada, por lo que es necesario adoptar medidas terapéuticas en todos estos niveles para una intervención adecuada en esta patología.
Post-chikungunya chronic arthritis is a common complication of the acute infection caused by this virus, with high risk of functional and quality of life sequelae.
To identify the clinical, immunological, functional disability, and quality of life sequelae in a sample of Colombian patients with chronic arthropathy due to chikungunya virus (CHIKV).
A group of 94 patients was evaluated in a Colombian city during the CHIKV epidemic in the period 2014-2015
The mean age of the patients was 57 years, with 76% women, and 100% were from a low socioeconomic level. The joint disease was symmetric, with arthritis in 30%, and mostly in small and large joints of the upper limbs. Rheumatoid factor was positive in 1.06% and anti-citrulline antibodies in 0%. There were detectable levels of IL6 in 64.9%, and IL 17 in 7.45% of patients The severity of disease activity was determined using the DAS28 score, identifying 55.3% with moderate activity, 40.4% mild activity, and 4.2% with high activity. The HAQ-DI identified a moderate functional limitation in 45.7%, with a mean score of 1.02. The quality of life measured with the SF-36 scale showed that each domain evaluated were affected with greater compromise in pain, physical, and emotional role domains.
In patients with post-chikungunya chronic arthritis, joint disease, functional, and quality of life sequelae were observed in the majority of the studied group. Treatment in the physical, mental, and functional spheres is necessary to achieve an adequate intervention in this disease.
BACKGROUND:Procalcitonin (PCT), the precursor of the calcitonin, is synthesized in the parafollicular C-cells of the thyroid. It has been used to detect and to differentiate systemic bacterial ...infections from flares of systemic lupus erythematosus (SLE). PCT in serum increases in severe bacterial and fungal infections, but not, or only slightly in viral infections.
OBJECTIVE:To measure PCT levels in patients with active SLE and to compare them with patients without lupus activity and to determine the possible association between activity and elevation of the PCT.
DESIGN:Prospective case control study.
PATIENT AND METHODS:Measurements were made of PCT (METHODEssay immunoluminometric - and ultrasensitive - BRAHMS Diagnostika, Berlin, Germany), C-reactive protein, erythrocyte sedimentation rate, and blood and urine cultures. The index of activity of SLE was determined by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score of a serial group of patients seen by our rheumatology service. Samples from 53 patients were analyzed. The patients were divided in 2 groupsgroup I (n = 21) with little or no activity for SLE; group II (n = 32) with activity for SLE (SLEDAI >5). None of the patients had severe bacterial infection, sepsis, or systemic multiorgan failure.
RESULTS:Group I had a SLEDAI score of 1.8 95% confidence interval (CI) 1.09–2.51 with mean levels of PCT 0. 08 ng/mL (Negative smaller than 0. 5 ng/mL). Group II SLEDAI score was 14.6 (95% CI 11.95–17.23) with mean levels of PCT 0.418 ng/mL with standard deviation 1.0021 (95% CI 0.0628–0.773). The measure of association calculated by Fisher method was not significant (1.927) (P = 0. 282). In the group II, 3 patients had frankly positive PCT (3.18, 3.42, and 3.95 ng/mL) and high activity indices (14, 13, and 24). None presented with severe infection, sepsis, or systemic multiorgan failure. They had pneumonia, renal failure (PCT 3.42 ng/mL) and urinary tract infection without systemic symptoms (3.95 ng/mL). Infection was not detected in the other patient (3.18 ng/mL) that was interpreted as a false positive.
CONCLUSIONS:This study demonstrates that there is no association between the activity of SLE and PCT levels. The utility of the PCT resides is in raising suspicion of a concurrent bacterial or mycotic infection in the evaluation of patients with active autoimmune diseases.
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