Primary hyperparathyroidism (HPT) and thyroid disease are both relatively common diseases, which can coexist in the same patient. However, mere coincidence does not seem to be a satisfactory explanation for this association. Some factors like prior exposure to radiation may play a role in the association. The aim of this study was to determine the frequency of thyroid disease associated with HPT in 54 consecutive patients who underwent parathyroidectomy in our center from January 1990 to December 1997. Twenty-eight (52%) patients had thyroid disease associated to HPT. The patients had a mean age of 61+/-13 yr; they were predominantly postmenopausal women. Thyroid disease was detected preoperatively in 20 (71%) patients and during the surgical procedure in 8 (29%). Two patients had previous radiation exposure; one of them with papillary carcinoma of the thyroid. Two patients had hypothyroidism. UItrasonography was performed in the majority of patients in their preoperative evaluation. A multinodular goiter was seen to be the most frequent finding (76%). In addition to parathyroidectomy, 23 (82%) patients were also thyroidectomized. In conclusion, patients with HPT showed a high prevalence of thyroid disease, especially in postmenopausal women. Unsuspected thyroid lesions were found with sufficient frequency to warrant careful preoperative and intraoperative evaluation of both glands, in order to obviate reoperation. In experienced hands, combined surgery can be safely performed. Cervical ultrasonography is useful in the preoperative detection of nodular thyroid disease in these patients.

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BackgroundDisease modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX), leflunomide (LFN) or antiTNFα have been implicated in development/exacerbation of Interstitial lung disease (ILD)of rheumatoid arthritis (RA). Several radiological patterns of ILD have been described: i) usual interstitial pneumonia (UIP), ii) nonspecific interstitial pneumonia (NSIP), iii) obliterating bronchitis (OB), and iv) Organized pneumonia (OP)ObjectivesTo assess the response to Abatacept (ABA) in these patterns of ILDMethodsMulticenter study of RA-ILD treated with ABA. ILD was diagnosed by high-resolution CT scan (HRCT) and classified in radiological patterns (Travis et al). We consider 3 subgroups: a) UIP, b) NSIP and c) “other” (OB, OP or mixed). ABA was used at iv or sc standard dose. We assessed: a) Dyspnea (Medical Research Council-modified scale; significant variations≥1); B) Respiratory function tests; significant changes≥10% in forced vital capacity (FVC) and DLCO≤10%, c) HRCT, d) DAS28. A comparative study was performed for the quantitative (U-Mann-Whitney) and qualitative variables (Fisher test) between the baseline and 3, 6 and 12 months.ResultsWe included 63 patients (27 women/36 men), mean age; 63.1±9.6 years. At ABA onset the RA had a median evolution of 6.8 [2–13.6] years and the ILD of 1 [0.3–3.03]. RA was seropositive in 85.7%. The diagnosis of ILD was confirmed by biopsy (n=18). The ILD was related to DMARDs: MTX (4), etanercept (3), adalimumab (3), certolizumab (2), Infliximab (1). ABA was used in monotherapy (26) or combined with other DMARDs (37); LFN (15), Cyclosporin (1), sulfasalazine (4), MTX (6), hydroxychloroquine (10), azathioprine (4), chloroquine (1). Table 1 shows the evolution in the available cases. A significant improvement in dyspnea and HRCT was observed in the NIU type. DLCO remained stable in most patients regardless of the radiological pattern. The activity of RA (DAS28) also improved.Table 1ConclusionsABA appears to be effective in ILD associated-RA, including the pattern of poor prognosis (UIP).References Travis WD et al. J Respir Crit Care Med 2013 188:733–748. Disclosure of InterestNone declared

ResumenObjetivo: Análisis del coste de las alternativas terapéuticas recogidas en el protocolo de la Comisión Autonómica Central de Farmacia y Terapéutica para el tratamiento de la Artritis Reumatoide. Material y métodos: Estudio observacional descriptivo transversal (Abril 2012) de los pacientes a tratamiento con los siguientes medicamentos biológicos: infliximab, abatacept, tocilizumab, rituximab, etanercept, adalimumab, certolizumab y golimumab. Se registró medicamento actual y pauta, tratamiento previo con metotrexato y coste anual del tratamiento. Se elabora una comparativa con la hipótesis de cambio de tratamiento, en el caso de los pacientes con medicamentos de administración intrahospitalaria, a los medicamentos de dispensación a pacientes externos incluidos en el protocolo. Resultados: 558 pacientes: 229 a tratamiento con infliximab: 30 (13,1%) con dosis de 3 mg/kg, 173 (75,5%) con 5 mg/kg y 26 (11,4%) con 7 mg/ kg; 27 con abatacept: 5 (18,5%) con dosis de 500 mg, 19 (70,4%) con 750 mg y 3 (11,1%) con 1000 mg; 12 con tocilizumab: 100% con 8 mg/kg; 66 con rituximab 1000 mg; 14 con golimumab 50 mg; 5 con certolizumab 200 mg; 116 con etanercept 50 mg y 101 con adalimumab 40 mg. Un 95,78% (546) habían recibido metotrexato previamente. El coste medio anual se calculó por paciente considerando peso superior a 70 kg y compartiendo viales en el caso de los medicamentos que se preparan en cabina de flujo laminar: infliximab 14.665€, abatacept 14.695€, tocilizumab 14.140€, rituximab 2400€/dosis, etanercept 11.879€, adalimumab 12.895€, certolizumab 11.888€ y golimumab 10.316€/año. Siguiendo la hipótesis de cambio de tratamientos administrados en Hospital de Día a tratamientos de dispensación ambulatoria los ahorros estimados estarían comprendidos entre 1.245 y 4.379 €/paciente. Conclusiones: A la espera de algún estudio que demuestre superioridad de alguno de estos medicamentos frente a otro en eficacia y seguridad, debería hacerse una adecuada selección del medicamento que permita ahorrar recursos tanto en gasto farmacéutico como de personal. Es importante considerar determinados factores como la frecuencia de administración, posibilidad de alargamiento del intervalo de administración, determinaciones de anticuerpos frente a los fármacos y valoraciones diagnósticas para mejorar la eficacia/eficiencia de los tratamientos, para así evitar un posible "agotamiento terapéutico".Palabras clave: Artritis Reumatoide. Coste. Terapias biológicas. AbstractObjective: Cost analysis of alternative biological therapies included in the Galician Central Autonomous Committee of Pharmacy and Therapeutics protocol for Rheumatoid Arthritis treatment. Material and methods: Descriptive study (April 2012) of rheumatoid arthritis patients being treated with biologics: infliximab, abatacept, tocilizumab, rituximab, etanercept, adalimumab, certolizumab and golimumab. Current medication regimen and annual treatment costs were determined. Cost savings are described assuming changes in treatment, from hospital-administered drugs to the ambula...

Introduction: Hyperphosphataemia aggravates both parathyroid hyperplasia and PTH secretion in patients with chronic kidney disease (CKD). Hyperplasia is associated with decreases in calcium receptor expression (CaSR), vitamin D (VDR) and α-Klotho, inducing resistance of the parathyroid gland to respond both to treatment and to increases in FGF23. This study examined the possible epigenetic contributions of raised phosphorus to aggravate secondary hyperparathyroidism (SHPT) in patients with (CRD). Material and methods: The degree of methylation was compared by pyrosequencing of bisulfite in CpGrich sequences of the promoters in the CaSR, VDR, PTH and α-Klotho genes in parathyroid gland DNA from uremic rats fed a normal and high phosphorus diet. Results: The diet rich in phosphorus increased PTH expression and caused a marked reduction in the degree of methylation in the promoter of the PTH gene. In contrast, the promoter regions of the CaSR, VDR and α-Klotho genes did not show significant differences in the percentage of methylation between the two groups of rats. Thus, it was not the determining mechanism for the decrease of the expression of these genes observed in the SHPT. Conclusions: The epigenetic alterations induced by the phosphorus rich diet in SHPT, particularly the PTH gene hypomethylation, could contribute to the increases that occur in the synthesis and secretion of this hormone. The identification of the mechanisms involved would allow better treatments for SHPT to be designed in the early stages of CKD.