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Giménez-Arnau AM, Manzanares N, Podder I. Recent updates in urticaria. Med Clin (Barc) 2023; 161:435-444. [PMID: 37537021 DOI: 10.1016/j.medcli.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 08/05/2023]
Abstract
Urticaria is a skin-condition characterized by sudden-onset pruritic wheals with/without angioedema. Urticaria can be acute or chronic. Chronic urticaria may be spontaneous or inducible, based on absence/presence of specific triggers. Chronic spontaneous urticaria is most frequent (∼80%). Urticaria is primarily a mast-cell mediated histaminergic-disorder. Recently, other inflammatory cells and pro-inflammatory cytokines have been implicated. Deeper understanding has unmasked two endotypes - IgE-mediated type I autoimmunity/autoallergy and IgG-mediated type IIb autoimmunity. Current treatment recommendation involving second-generation H1-antihistamines, omalizumab and cyclosporine is effective in 60-80% patients. So, newer treatment options are being explored based on emerging targets. Despite being non-lethal, urticaria considerably impairs patient's quality-of-life and may be associated with extra-cutaneous comorbidities. Several "patient reported outcome measures" have been proposed to evaluate disease-activity, impact and control, for effective treatment modulation till complete disease control. This review discusses the current understanding about urticaria and its future directions, to facilitate optimum evidenced-based care.
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Affiliation(s)
- Ana M Giménez-Arnau
- Department of Dermatology, Hospital del Mar-IMIM, Universitat Pompeu Fabra de Barcelona, Spain.
| | - Nerea Manzanares
- Department of Dermatology, Hospital del Mar-IMIM, Universitat Pompeu Fabra de Barcelona, Spain
| | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata 700058, West Bengal, India
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Castrillo A, Mendoza A, Caballero L, Cerdán D, Rodríguez MF, Guerrero P, Tabernero C, Ferrero M, Benito I, Marín L, Duarte J. Effectiveness of anti-CGRP monoclonal antibodies in the preventive treatment of migraine: A prospective study of 63 patients. Med Clin (Barc) 2023; 160:341-346. [PMID: 36623986 DOI: 10.1016/j.medcli.2022.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Calcitonine Gen-Related Peptide (CGRP) established a revolution in migraine pathophysiology knowledge and has led to the development of new drugs specifically targeting this disease. METHODS We present a prospective study in which 63 episodic and chronic migraine patients have been treated with anti-CGRP monoclonal antibodies describing their efficacy, security and relapses after their interruption. Response predictors have been analyzed such they can help us to create a better treatment plan. RESULTS Average age was 48.3 ± 11.81 years old, 84.1% of them being women. The average was of 15.59 migraine days per month (MDM). 63.5% of all patients suffered chronic migraine. The initial dose of Erenumab in all patient was 70 mg subcutaneous. This was increased to 140 mg in 47.6% of the patients. An MDM reduction between 49.85% and 59.53% was obtained within three to twelve months from the start of treatment. Constipation was present in 17.5% of the patients and 4.8% suffered injection site reaction. The treatment was changed to Galcanezumab in 17.9% of the patients. After interrupting the treatment, 23 patients relapsed with a good response on reintroduction of the treatment. It was not possible to establish a clear response predictor, however a statistically significant increase in the number of days of improvement was observed with more MDM at baseline level (p = 0.002). CONCLUSIONS Anti-CGRP monoclonal antibodies are effective, safe, and well tolerated drugs. We have observed that their discontinuation, in some cases can lead to frequent and early relapses so we strongly recommend to extend the treatment in those patients with a higher MDM.
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Affiliation(s)
- Ana Castrillo
- Sección de Neurología. Complejo Asistencial de Segovia.
| | | | | | - Débora Cerdán
- Sección de Neurología. Complejo Asistencial de Segovia
| | | | | | | | - Marta Ferrero
- Sección de Neurología. Complejo Asistencial de Segovia
| | - Inés Benito
- Sección de Neurología. Complejo Asistencial de Segovia
| | - Laura Marín
- Servicio de Farmacia. Complejo Asistencial de Segovia
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Segura-Charry JS, Parada-Martinez MA, Segura-Puello HR, Muñoz-Forero DM, Nieto-Mosquera DL, Villamil-Ballesteros AC, Cortés-Muñoz AJ. Musculoskeletal disorders due to chikungunya virus: A real experience in a rheumatology department in Neiva, Huila. ACTA ACUST UNITED AC 2021; 17:456-460. [PMID: 34625148 DOI: 10.1016/j.reumae.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/02/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chikungunya (CHIKV), is an endemic RNA virus in some regions of Asia and Africa. In Colombia in 2014, its spread started explosively and quickly. The presentation of CHIKV is a febrile condition, with musculoskeletal symptoms, which can progress to erosive arthropathy and polyarticular deformity. The purpose of this study is to evaluate symptomatic and serological behaviour in patients suffering from CHIKV infection in Neiva, Huila who attend the Rheumatology clinic, and to describe the comorbidities associated with the chronic phase of the disease. METHODS An observational, longitudinal and retrospective analysis of data collected in 410 patients afflicted with the CHIKV virus, with symptoms lasting more than 3 months, who persisted with musculoskeletal and joint symptoms. The patients were classified according to their commitment in post-viral arthralgias, polyarthritis post viral, Rheumatoid Arthritis (RA) post CHIKV, Spondyloarthritis postCHIKV, and soft tissue rheumatism. The statistical analysis was performed using SPSS software (version 24). A descriptive analysis was carried out to evaluate quantitative variables such as the mean (standard deviation), and categorical variables such as frequency (%). The categorical variables were compared using the Chi-square equation. As a statistical significance, a p less than .05 was considered. RESULTS Of the 410 patients, 89.23% were women, with polyarticular involvement in 92.26% of the cases. Of the patients, 49.83% had osteoarthritis. At the time of the evaluation in the Rheumatology clinic, 46.3% of the cases presented persistent non-inflammatory arthralgias, and 53.7% of the patients underwent arthritis on physical examination, of which, remarkably, 20.3% met the criteria for rheumatoid arthritis postCHIKV. CONCLUSIONS The development of musculoskeletal symptoms after CHIKV infection is a very serious public health problem, with persistent complications and long-term morbidity risk in real life. The presence of net postviral arthritis is noteworthy, however the development of postCHIKV rheumatoid arthritis usually requires more advanced pharmacological measures, including, in some cases, transition to biological therapy. The presence of symptoms of venous insufficiency in the lower limbs that developed with CHIKV infection was an incidental finding that requires a more precise study.
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Affiliation(s)
- Juan Sebastián Segura-Charry
- Servicio de Reumatología, Clinica Medilaser, Neiva, Huila, Colombia; Universidad Manuela Beltrán, Laboratorio de Investigación Humana (LIH), Bogotá, Colombia.
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Segura-Charry JS, Parada-Martinez MA, Segura-Puello HR, Muñoz-Forero DM, Nieto-Mosquera DL, Villamil-Ballesteros AC, Cortés-Muñoz AJ. Musculoskeletal Disorders due to Chikungunya Virus: A Real Experience in a Rheumatology Department in Neiva, Huila. Reumatol Clin (Engl Ed) 2020; 17:S1699-258X(20)30073-5. [PMID: 32576537 DOI: 10.1016/j.reuma.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/13/2020] [Accepted: 04/02/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chikungunya (CHIKV), is an endemic RNA virus in some regions of Asia and Africa. In Colombia in 2014, its spread starts explosively and quickly. The presentation of CHIKV is a febrile condition, with musculoskeletal symptoms, which can progress to erosive arthropathy and polyarticular deformity. The purpose of this study is to evaluate in patients suffering from CHIKV infection in Neiva, Huila who attend the Rheumatology clinic, the symptomatic and serological behavior, and to describe comorbidities associated to the chronic phase of the disease. METHODS An observational, longitudinal and retrospective analysis of data collected in 410 patients afflicted with the CHIKV virus, with symptoms lasting more than 3 months, who persisted with musculoskeletal and joint symptoms. The patients were classified according to their commitment in post-viral arthralgias, polyarthritis post viral, Rheumatoid Arthritis (RA) post CHIKV, Spondyloarthritis postCHIKV, and soft tissue rheumatism. The statistical analysis was performed using SPSS software (version 24). A descriptive analysis was carried out to evaluate quantitative variables such as the mean (standard deviation), and categorical variables such as frequency (%). The categorical variables were compared using the Chi-square equation. As a statistical significance, a p less than .05 was considered. RESULTS Of the 410 patients, 89.23% were women, with polyarticular involvement in 92.26% of the cases. Of the patients, 49.83% had osteoarthritis. At the time of the evaluation in the Rheumatology clinic, 46.3% of the cases presented persistent non-inflammatory arthralgias, and 53.7% of the patients underwent arthritis on physical examination, of which, remarkably, 20.3% met the criteria for rheumatoid arthritis postCHIKV. CONCLUSIONS The development of musculoskeletal symptoms after CHIKV infection is a very serious public health problem, with persistent complications and long-term morbidity risk in real life. The presence of net postviral arthritis is noteworthy, however the development of postCHIKV rheumatoid arthritis usually requires more advanced pharmacological measures, including, in some cases, transition to biological therapy. The presence of symptoms of venous insufficiency in the lower limbs that developed with CHIKV infection was an incidental finding that requires a more precise study.
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Affiliation(s)
- Juan Sebastián Segura-Charry
- Servicio de Reumatología, Clinica Medilaser, Neiva, Huila, Colombia; Universidad Manuela Beltrán, Laboratorio de Investigación Humana (LIH), Bogotá, Colombia.
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Encarnación-Guevara S. The dawn and the first twenty-five years of proteomics in Mexico: a personal chronicle. Bol Med Hosp Infant Mex 2018; 74:208-211. [PMID: 29382488 DOI: 10.1016/j.bmhimx.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 03/23/2017] [Indexed: 11/16/2022] Open
Abstract
This review does not aim to be an up-to-date of proteomics in Mexico; it simply tries to trace its development, exposing the story of the researchers, laboratories and some institutions that have contributed to the establishment and development of this science in Mexico.
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Rivas Felice J, González Herranz P, Mejía Casado A, Pérez Navarro R, Hernández Díaz R. Chronic recurrent osteomyelitis: A diagnostic and therapeutic challenge. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 61:35-42. [PMID: 27514713 DOI: 10.1016/j.recot.2016.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/03/2016] [Accepted: 07/06/2016] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Chronic recurrent osteomyelitis (CRO) is a rare disease characterised by unifocal or multifocal aseptic inflammatory bony lesions. OBJECTIVE To evaluate clinical features and response to treatment with non-steroidal anti-inflammatory drugs in patients with CRO. MATERIALS AND METHODS A retrospective assessment was conducted on 5 children with OCR over a period of 8 years. They had been diagnosed based on clinical, laboratory findings, histological study of injuries, and imaging test. RESULTS Multifocal disease was observed in 40% of cases, and unifocal in 60%. The large majority (80%) were male, with a mean age at diagnosis of 13 years (range: 11-15 years). The bones most frequently affected were the clavicle and tibia, representing 18.2%. The most common presenting symptom was pain in all patients, with fever being present in 20% of cases. Imaging studies such as CT and MRI were effective in 100%, and in all cases the biopsy reported a lymphoplasmacytic infiltrate. After a mean follow-up of 5.9 years, there was a good treatment response in 100%, with a mean recurrence at 5.25 months being observed. CONCLUSIONS The anodyne results of most clinical studies to assess CRO, and the similarity in clinical presentation of this with many infectious or tumour diseases makes its diagnosis a real challenge. On the other hand treatment with NSAIDs can be considered a good initial therapeutic option.
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Affiliation(s)
- J Rivas Felice
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General de La Palma, Breña Alta, España.
| | | | - A Mejía Casado
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Royo Villanova, Zaragoza, España
| | - R Pérez Navarro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General de La Palma, Breña Alta, España
| | - R Hernández Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General de La Palma, Breña Alta, España
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Ángel-Pereira D, Rocha-Cabrera P, Cordovés-Dorta L, Losada Castillo MJ, Blasco Alberto A, Abreu Reyes JA. Spironolactone, a therapeutic alternative in the treatment of diffuse retinal pigment epitheliopathy. ACTA ACUST UNITED AC 2016; 91:599-603. [PMID: 27017536 DOI: 10.1016/j.oftal.2016.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/08/2016] [Accepted: 02/11/2016] [Indexed: 11/29/2022]
Abstract
CASE REPORT Two cases are presented of patients with chronic diffuse epitheliopathy (CDE) that showed a favourable response when treated with spironolactone. The first patient had regions of neurosensory detachment (DNS) and the second, multiple DNS, secondary intra-retinal cysts and retinal pigment epithelium detachment. DISCUSSION After treatment with spironolactone, both patients showed a visual acuity improvement and structural changes (reduced neurosensory retinal detachment and cystoid degeneration). Aldosterone receptor agonists (ARA) used for persistent forms of chronic central serous chorioretinopathy show encouraging results and could represent a therapeutic alternative for CDE.
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Affiliation(s)
- D Ángel-Pereira
- Servicio de Oftalmología, Hospital Universitario de Canarias, La Laguna, Tenerife, España.
| | - P Rocha-Cabrera
- Servicio de Oftalmología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - L Cordovés-Dorta
- Servicio de Oftalmología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - M J Losada Castillo
- Servicio de Oftalmología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - A Blasco Alberto
- Servicio de Oftalmología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - J A Abreu Reyes
- Servicio de Oftalmología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
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