Patients with loss of density present worse FVC and DLCO values. Prospective studies are warranted to determine whether NVC is useful for studying pulmonary function in SSc.
Background:Polymyalgia rheumatica (PMR) is characterized by pain in the shoulders and hips, elevation of acute phase reactants and a rapid response to treatment with corticosteroids. Currently, there is no specific test for its diagnosis, and it presents a wide differential diagnosis. Positron Emission Tomography - Computed tomography (PET-CT) is a non-invasive technique, capable of measuring metabolic activity by locating and quantifying glucose consumption. The use of PET-CT in the study of neoplastic, infectious or inflammatory processes suggests that it may be a suitable technique for the study of the differential diagnosis of patients with PMR. It is unknown if there are differences in the result of the technique in patients with debut PMR vs. patients with cortico-resistant PMR.Objectives:To describe the findings of PET-CT in patients with PMR.To analyze if there are significant differences between the results of patients with onset PMR and those of cortico-resistant PMR patients.Methods:This is a cross-sectional prospective study performed in a cohort of patients with PMR. Out of all patients with PMR who do follow up treatment in our centre, the patients selected for this study included those who underwent a PET scan at the time of diagnosis and those who presented corticosteroid resistance (patients who did not respond to conventional therapy with corticosteroids or with a relapse with doses <7.5mg/day of prednisone or equivalent). Demographic, epidemiological data of the disease, treatment, as well as analytical parameters (CRP, ESR, Hematological and Biochemical) were collected from all the patients at the time the PET-CT was performed.For the categorical variables, the chi-square test or Fisher’s exact test were used, as appropriate. In the case of quantitative variables, we used the comparison of the mean values, by means of a ”t” test. The level of statistical significance was established for those values of p <0.05.Results:103 patients with a PMR diagnosis who had undergone a PET-TC were included, out of the total number of patients that we visited in our service. 52 (50.4%) patients had an onset PMR and 51 (49.9%) had PMR refractory to treatment. The demographic, clinical and serological characteristics of the patients at the time of PET-CT are shown in Table 1.The PET-CT showed a distribution of uptake compatible with the diagnosis of PMR in 73 (70.9%) patients, vasculitis of large vessels in 16 (15%) and contributed in the diagnosis of neoplastic processes in 5 (4.8%). Table 2 shows the final diagnoses.When analyzing the results of PET in patients with onset PMR vs. those who are corticosteroids resistant, no significant differences were observed in the final diagnoses (p = 0.078).Table 1 Patient’s featuresWomen, n (%)73 (70.9%)Disease duration (months), mean ± SD24 ± 41.92Shoulder pain, n (%)100 (97.1%)Hip pain, n (%)89 (86.4%)Amaurosis, n (%) 5 (4.9%)Temporal artery tenderness, n (%)2 (1.9%)ESR (mm/s), mean ± SD55.92 ± 31.09Table 2 DiagnosesTOTAL Onset PMR Cortico- resistant PMRPMR, n (%)73 (70...
Systemic sclerosis is a disease where microcirculation damage is critical in their beginning and vascular complications have similar pathogenic findings. Digital ulcers are a frequent complication in systemic sclerosis patients and pulmonary hypertension is one of the leading causes of death. The use of bosentan has been shown to be useful for the treatment of pulmonary arterial hypertension and to prevent new digital ulcers. However, is unknown if bosentan can prevent pulmonary hypertension. Our objective was to determine if bosentan is useful to prevent pulmonary hypertension in SSc patients. A retrospective study in 237 systemic sclerosis patients with digital ulcers history treated or not with bosentan to prevent it was made. We analyzed the occurrence of pulmonary hypertension defined by an echocardiogram pulmonary arterial pressure > 40 mmHg in the entire cohort. Demographic, clinical, and treatment variables were recorded for all patients. Statistical significance was denoted by p values < 0.05. Fifty-nine patients were treated with bosentan a median of 34 months. 13.8% of treated patients had pulmonary hypertension vs 23.7% of untreated patients (p 0.13) during the follow up. In multivariate analysis patients not treated with bosentan had 3.9fold-increased risk of pulmonary hypertension compared with patients under bosentan treatment (p < 0.02). Moreover the percentage carbon monoxide diffusing capacity (DLCO) in bosentan treated patients did not decrease from baseline to the end of follow-up (61.8±14% vs 57±20.1%, p = 0.89). We concluded that Systemic sclerosis patients with digital ulcers treated with bosentan seems to have less risk to develop pulmonary hypertension and to stabilize DLCO
Objectives To determine the relation between different pathological capillaroscopic findings and pulmonary function tests in patients with scleroderma. Methods Retrospective observational study of a cohort of patients with systemic sclerosis (SSc) or early SSc (eSSc) followed in Rheumatology Unit of a University Hospital from 1975 to 2011. Patients who had a nailfold videocapillaroscopy with 120x magnification were selected. The following pathological findings were considered: presence of megacapillaries and/or angiogenesis and loss of capillary density. Capillaroscopic findings were compared with the following values of lung function tests performed in the same year of the capillaroscopy: % predicted forced vital capacity (FVC), DLCO and the FVC/DLCO ratio. The following variables were also included: sex, type of SSc, presence of digital ulcers, interstitial lung disease (ILD), scleroderma renal crisis (SRC) and pulmonary hypertension determined by echocardiogram. Statistical analysis was performed by T Test to compare the capillaroscopic findings and pulmonary function test. Values of p<0.05 were considered statistical significance. Results Of all patients (n=136), 84 had at least one videocapillaroscopy. We observed that 92,9% were female, 67% (57/84) had limited SSc, 25,3% (21/84) ILD, 29,8% (25/84) DU and 17,9% (15/84) of patients had PH. We analyzed the capillaroscopics findings with the lung function parameters. We found that patients with loss of capillary density had worse FVC (87% ± 19,58 vs 101,12% ± 16,06, p <0.01) and DLCO (71,24% ± 21,37 vs. 85,9% ± 19,81, p <0.01). We did not find a relation between alteration in respiratory function tests and the presence of megacapillaries and angiogenesis. Conclusions Patients with significant loss of capillary density in the nail-fold capillaroscopy showed worst values of FVC and DLCO. Prospective studies are needed to determine if the nail-fold capillaroscopy may be useful to study lung involvement in patients with systemic sclerosis. Disclosure of Interest None Declared
Mónica Sarmiento es pintora y escultora, se doctoró en Bellas Artes por la Universidad Complutense de Madrid (España). Tiene una maestría en Literatura y arte hispánica por la Universidad de St. John’s en New York, Estados Unidos, donde actualmente es profesora. Otra maestría en Estudios avanzados en investigación artística por la Universidad Miguel Hernández de Alicante, España. Es directora de biCoa: Base Iberoamericana / Comunidad de dos Américas en Nueva York. biCoa promueve la cultura iberoamericana y la interrelación con otras culturas mediante el proyecto internacional “Connecting Cultures”.
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