1
|
Duran-Vian C, Gómez C, Navarro I, Reguero L, Alonso L, González-Vela MC, González-López MA. Acrokeratosis paraneoplastica (Bazex syndrome) with bullous lesions. Indian J Dermatol Venereol Leprol 2019; 86:335. [PMID: 31339109 DOI: 10.4103/ijdvl.ijdvl_288_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- C Duran-Vian
- Division of Dermatology, University Hospital of Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain
| | - C Gómez
- Division of Dermatology, University Hospital of Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain
| | - I Navarro
- Division of Dermatology, University Hospital of Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain
| | - L Reguero
- Division of Dermatology, University Hospital of Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain
| | - L Alonso
- Division of Oncology, University Hospital of Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain
| | - M C González-Vela
- Division of Pathology, University Hospital of Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain
| | - M A González-López
- Division of Dermatology, University Hospital of Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain
| |
Collapse
|
2
|
Vilanova I, Hernández JL, Mata C, Durán C, García-Unzueta MT, Portilla V, Fuentevilla P, Corrales A, González-Vela MC, González-Gay MA, Blanco R, González-López MA. Insulin resistance in hidradenitis suppurativa: a case-control study. J Eur Acad Dermatol Venereol 2018; 32:820-824. [PMID: 29485215 DOI: 10.1111/jdv.14894] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/24/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The association between chronic inflammatory diseases, such as rheumatoid arthritis and psoriasis, and insulin resistance (IR) has been well established. Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disease that affects the apocrine gland-bearing areas of the body. OBJECTIVE We aimed to determine the prevalence of IR in patients with HS. METHODS This cross-sectional, case-control study enrolled 137 subjects, 76 patients with HS and 61 age- and gender-matched controls. Demographic data, clinical examination of HS patients, anthropometric measures, cardiovascular risk factors and laboratory studies were recorded. The homeostasis model assessment of IR (HOMA-IR) was calculated in all participants by measuring fasting plasma glucose and insulin levels. RESULTS The median (IQR) HOMA-IR value in HS patients was significantly higher [2.0 (1.0-3.6)] than in controls [1.5 (0.9-2.3)] (P = 0.01). The prevalence of IR was significantly higher in cases (43.4%) compared with controls (16.4%) (P = 0.001). In the linear regression multivariable analysis after adjusting for age, sex and body mass index (BMI), HS remained as a significant factor for a higher HOMA-IR [2.51 (0.18) vs 1.92(0.21); P = 0.04]. The HOMA-IR value and the prevalence of IR did not differ significantly among HS patients grouped by severity of the disease. CONCLUSION Our results show an increased frequency of IR in HS. Thus, we suggest HS patients to be evaluated for IR and managed accordingly.
Collapse
Affiliation(s)
- I Vilanova
- Division of Dermatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - J L Hernández
- Division of Internal Medicine, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - C Mata
- Division of Rheumatology, Hospital Comarcal, Laredo, Cantabria, Spain
| | - C Durán
- Division of Dermatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - M T García-Unzueta
- Division of Medical Laboratory, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - V Portilla
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - P Fuentevilla
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - A Corrales
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - M C González-Vela
- Division of Pathology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - M A González-Gay
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - R Blanco
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| | - M A González-López
- Division of Dermatology, Hospital Universitario Marques de Valdecilla, IDIVAL, University of Cantabria, Santander, Cantabria, Spain
| |
Collapse
|
3
|
González-López MA, Hernández JL, Vilanova I, Mata C, López-Escobar M, González-Vela MC, López-Hoyos M, González-Gay MA, Blanco R. Thyroid autoimmunity in patients with hidradenitis suppurativa: a case-control study. Clin Exp Dermatol 2017; 42:642-644. [DOI: 10.1111/ced.13153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 11/27/2022]
Affiliation(s)
- M. A. González-López
- Division of Dermatology; Hospital Universitario Marqués de Valdecilla; IDIVAL; Universidad de Cantabria; Santander Cantabria Spain
| | - J. L. Hernández
- Division of Internal Medicine; Hospital Universitario Marqués de Valdecilla; IDIVAL; Universidad de Cantabria; Santander Cantabria Spain
| | - I. Vilanova
- Division of Dermatology; Hospital Universitario Marqués de Valdecilla; IDIVAL; Universidad de Cantabria; Santander Cantabria Spain
| | - C. Mata
- Division of Rheumatology; Hospital Universitario Marqués de Valdecilla; IDIVAL; Universidad de Cantabria; Santander Cantabria Spain
| | - M. López-Escobar
- Division of Dermatology; Hospital Universitario Marqués de Valdecilla; IDIVAL; Universidad de Cantabria; Santander Cantabria Spain
| | - M. C. González-Vela
- Division of Pathology; Hospital Universitario Marqués de Valdecilla; IDIVAL; Universidad de Cantabria; Santander Cantabria Spain
| | - M. López-Hoyos
- Division of Immunology; Hospital Universitario Marqués de Valdecilla; IDIVAL; Universidad de Cantabria; Santander Cantabria Spain
| | - M. A. González-Gay
- Division of Rheumatology; Hospital Universitario Marqués de Valdecilla; IDIVAL; Universidad de Cantabria; Santander Cantabria Spain
| | - R. Blanco
- Division of Rheumatology; Hospital Universitario Marqués de Valdecilla; IDIVAL; Universidad de Cantabria; Santander Cantabria Spain
| |
Collapse
|
4
|
Calvo-Río V, Santos-Gómez M, Calvo I, González-Fernández MI, López-Montesinos B, Mesquida M, Adán A, Hernández MV, Maíz O, Atanes A, Bravo B, Modesto C, Díaz-Cordovés G, Palmou-Fontana N, Loricera J, González-Vela MC, Demetrio-Pablo R, Hernández JL, González-Gay MA, Blanco R. Anti-Interleukin-6 Receptor Tocilizumab for Severe Juvenile Idiopathic Arthritis-Associated Uveitis Refractory to Anti-Tumor Necrosis Factor Therapy: A Multicenter Study of Twenty-Five Patients. Arthritis Rheumatol 2017; 69:668-675. [DOI: 10.1002/art.39940] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/20/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Vanesa Calvo-Río
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - Montserrat Santos-Gómez
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | | | | | | | | | | | | | - Olga Maíz
- Hospital Universitario Donostia; San Sebastian Spain
| | | | - Beatriz Bravo
- Hospitalario Universitario Virgen de las Nieves; Granada Spain
| | | | | | - Natalia Palmou-Fontana
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - Javier Loricera
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - M. C. González-Vela
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - Rosalía Demetrio-Pablo
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - J. L. Hernández
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - Miguel A. González-Gay
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| | - Ricardo Blanco
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), and University of Cantabria; Santander Spain
| |
Collapse
|
5
|
Calvo-Río V, Blanco R, Santos-Gómez M, Rubio-Romero E, Cordero-Coma M, Gallego-Flores A, Veroz R, Torre I, Hernández FF, Atanes A, Loricera J, González-Vela MC, Palmou N, Hernández JL, González-Gay MA. Golimumab in refractory uveitis related to spondyloarthritis. Multicenter study of 15 patients. Semin Arthritis Rheum 2016; 46:95-101. [PMID: 27060872 DOI: 10.1016/j.semarthrit.2016.03.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 12/02/2015] [Accepted: 03/04/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the efficacy of golimumab (GLM) in refractory uveitis associated to spondyloarthritis (SpA). METHODS Multicenter study of SpA-related uveitis refractory to at least 1 immunosuppressive drug. The main outcome variables were degree of anterior and posterior chamber inflammation, visual acuity, and macular thickness. RESULTS A total of 15 patients (13 men/2 women; 18 affected eyes; mean age 39 ± 6 years) were evaluated. The underlying SpA subtypes were ankylosing spondylitis (n = 8), psoriatic arthritis (n = 6) and non-radiographic axial SpA (n = 1). The ocular involvement patterns were recurrent anterior uveitis in 8 patients and chronic anterior uveitis in 7. Before GLM they have received methotrexate (n = 13), sulfasalazine (n = 6), pulses of methylprednisolone (n = 4), azathioprine (n = 3), leflunomide (n = 2), and cyclosporine (n = 1). Overall, 10 of them had also been treated with TNF-α blockers; etanercept (n = 7), adalimumab (n = 7), infliximab (n = 6), and certolizumab (n = 1). GLM was given at the standard dose (50mg/sc/monthly) as monotherapy (n = 7) or in combination with conventional immunosuppressive drugs (n = 8), mainly methotrexate. Most patients had rapid and progressive improvement of intraocular inflammation parameters. The median number of cells in the anterior chamber at 2 years [0 (0-0)] was significantly reduced compared to baseline findings [1 (0-3); p = 0.04]. The mean best corrected visual acuity value also improved (0.84 ± 0.3 at 2 years versus 0.62 ± 0.3 at baseline; p = 0.03). Only minor side effects were observed after a mean follow-up of 23 ± 7 months. CONCLUSIONS Our results indicate that GLM may be a useful therapeutic option in refractory SpA-related uveitis.
Collapse
Affiliation(s)
- Vanesa Calvo-Río
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Avda. Valdecilla s/n, ES-39008 Santander, Spain
| | - Ricardo Blanco
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Avda. Valdecilla s/n, ES-39008 Santander, Spain
| | - Montserrat Santos-Gómez
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Avda. Valdecilla s/n, ES-39008 Santander, Spain
| | - Esteban Rubio-Romero
- Division of Rheumatology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Raúl Veroz
- Division of Rheumatology, Hospital de Mérida, Badajoz, Spain
| | - Ignacio Torre
- Division of Rheumatology, Hospital Basurto, Bilbao, Spain
| | | | - Antonio Atanes
- Division of Rheumatology, HUCA La Coruña, Asturias, Spain
| | - Javier Loricera
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Avda. Valdecilla s/n, ES-39008 Santander, Spain
| | - M C González-Vela
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Avda. Valdecilla s/n, ES-39008 Santander, Spain
| | - Natalia Palmou
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Avda. Valdecilla s/n, ES-39008 Santander, Spain
| | - José L Hernández
- Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria-IDIVAL, Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Santander, Spain
| | - Miguel A González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Avda. Valdecilla s/n, ES-39008 Santander, Spain.
| |
Collapse
|
6
|
Loricera J, Blanco R, Hernández JL, Carril JM, Martínez-Rodríguez I, Canga A, Peiró E, Alonso-Gutiérrez J, Calvo-Río V, Ortiz-Sanjuán F, Mata C, Pina T, González-Vela MC, Martínez-Amador N, González-Gay MA. Non-infectious aortitis: a report of 32 cases from a single tertiary centre in a 4-year period and literature review. Clin Exp Rheumatol 2015; 33:S-19-31. [PMID: 25437450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 07/25/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Non-infectious aortitis often presents with non-specific symptoms leading to inappropriate diagnostic delay. We intend to describe the clinical spectrum and outcome of patients with aortitis diagnosed at a single centre. METHODS We reviewed the clinical charts of patients diagnosed with non-infectious aortitis between January 2010 and December 2013 at the Rheumatology Division from a 1.000-bed tertiary teaching hospital from Northern Spain. The diagnosis of aortitis was usually based on FDG-PET-CT scan, and also occasionally on CT or MRI angiography or helical CT-scan. RESULTS During the period of assessment 32 patients (22 women and 10 men; mean age 68 years [range, 45-87]) were diagnosed with aortitis. The median interval from the onset of symptoms to the diagnosis was 21 months. FDG-PET CT scan was the most common tool used for the diagnosis of aortitis. The underlying conditions were the following: giant cell arteritis (n=13 cases); isolated polymyalgia rheumatica (PMR) (n=11); Sjögren's syndrome (n=2), Takayasu arteritis (n= 1); sarcoidosis (n=1), ulcerative colitis (n=1), psoriatic arthritis (n=1), and large-vessel vasculitis that also involved the aorta (n=2). The most common clinical manifestations at diagnosis were: PMR features, often with atypical clinical presentation (n=23 patients, 72%); diffuse lower limb pain (n=16 patients, 50%); constitutional symptoms (n=12 patients, 37%), inflammatory low back pain (n=9 patients, 28%) and fever (n=7 patients, 22%). Acute phase reactants were increased in most cases (median erythrocyte sedimentation rate 46 mm/1st hour, and a median serum C-reactive protein 1.5 mg/dL). CONCLUSIONS Aortitis is not an uncommon condition. The diagnosis is often delayed. Atypical PMR features, unexplained low back or limb pain, constitutional symptoms along with increased acute phase reactants should be considered 'red flags' to suspect the presence of aortitis.
Collapse
Affiliation(s)
- J Loricera
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - R Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - J L Hernández
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - J M Carril
- Department of Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - I Martínez-Rodríguez
- Department of Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - A Canga
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - E Peiró
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - J Alonso-Gutiérrez
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - V Calvo-Río
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - F Ortiz-Sanjuán
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - C Mata
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - T Pina
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - M C González-Vela
- Department of Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - N Martínez-Amador
- Department of Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - M A González-Gay
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain, and University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
7
|
Loricera J, Blanco R, Hernández JL, Calvo-Río V, Ortiz-Sanjuán F, Mata C, Rueda-Gotor J, Álvarez L, González-Vela MC, González-López MA, Armesto S, Pina T, González-Gay MA. Cutaneous vasculitis associated with severe bacterial infections. A study of 27 patients from a series of 766 cutaneous vasculitis. Clin Exp Rheumatol 2015; 33:S-36-43. [PMID: 26016750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the clinical spectrum of severe bacterial infections presenting as cutaneous vasculitis (CV) in a defined population. METHODS Unselected series of 766 patients with CV diagnosed at a single university referral center. RESULTS An underlying severe bacterial infection was diagnosed in 27 (22 men/5 women; mean age ± standard deviation [SD]: 53 ± 18 years) of 766 cases presenting with CV (3.5%). These infections were: pneumonia (n=8), endocarditis (n=6), meningitis (n=4), intra-abdominal infections (n=3), septic arthritis (n=2), septicaemia (n=2), septic bursitis (n=1), and urinary tract infection (n=1). All the patients were admitted for suspected CV. The median delay from admission to the diagnosis of infection was 4 days. A typical palpable purpura without relevant visceral vasculitic involvement was the main clinical manifestation. Patients with severe bacterial infections were older, with male predominance, had more frequently fever, constitutional symptoms, focal infectious features, and leukocytosis with left shift and anaemia than the remaining patients with CV. Although antibiotics were prescribed in all the patients, seven also required the use of low-dose corticosteroids to achieve complete resolution of the cutaneous lesions. Most patients experienced full recovery but two of them underwent prosthetic cardiac valve replacement, and another two died due to infection-related complications. CONCLUSIONS CV may be the presenting manifestation of a severe underlying bacterial infection. Physicians should keep in mind this fact to make an early diagnosis of infection and, consequently, prevent life-threatening complications.
Collapse
Affiliation(s)
- J Loricera
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - R Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - J L Hernández
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - V Calvo-Río
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - F Ortiz-Sanjuán
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - C Mata
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - J Rueda-Gotor
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - L Álvarez
- Department of Paediatrics, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - M C González-Vela
- Department of Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - M A González-López
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - S Armesto
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - T Pina
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - M A González-Gay
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| |
Collapse
|
8
|
Riancho-Zarrabeitia L, Delgado-Alvarado M, Riancho J, Oterino A, Sedano MJ, Rueda-Gotor J, Pérez-Martín I, González-Vela MC, Berciano J, González-Gay MA, Blanco R. Anti-TNF-α therapy in the management of severe neurosarcoidosis: a report of five cases from a single centre and literature review. Clin Exp Rheumatol 2014; 32:275-284. [PMID: 24321604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 11/08/2013] [Indexed: 06/03/2023]
Abstract
Neurologic manifestations are found in 5-15 % of patients with sarcoidosis. This granulomatous disease may affect any part of the peripheral or the central nervous system, being potentially severe and difficult to treat. Corticosteroids are the cornerstone of therapy in sarcoidosis. However, some patients become resistant or experience side effects to corticosteroids. In these patients, second line therapies including immunosuppressive drugs such as methotrexate, azathioprine, mycophenolate, cyclophosphamide and leflunomide have been used. Anti-TNF-α drugs have been proposed as a therapeutic option for those who are refractory to immunosuppressive drugs or initially in cases of severe sarcoidosis. We report on 5 patients with neurosarcoidosis treated with anti-TNF-α drugs in our center. A literature review of patients with neurosarcoidosis treated with anti-TNF-α drugs was conducted. In our series successful response to anti-TNF-α therapy was achieved. However, the high frequency of relapses following anti-TNF-α discontinuation makes necessary a close follow-up of these patients when the biologic agent is stopped.
Collapse
Affiliation(s)
- L Riancho-Zarrabeitia
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IFIMAV), University of Cantabria and Centro de Investigacion Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Calvo-Río V, Loricera J, Martín L, Ortiz-Sanjuán F, Alvarez L, González-Vela MC, González-Lamuño D, Mata C, Gortázar P, Rueda-Gotor J, Arias M, Martínez-Taboada V, González-Gay MA, Blanco R. SAT0157 Nephropathy in Henoch-SchÖNlein Purpura: Study of 142 Patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
10
|
Loricera J, Calvo-Río V, Ortiz-Sanjuán F, Fernández-Llaca H, González-López MA, Álvarez L, González-Vela MC, González-Lamuño D, Mata C, Rueda-Gotor J, Martínez-Taboada VM, Á. González-Gay M, Blanco R. SAT0147 Clinical Associations of Cutaneous Vasculitis: Study of 817 Patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
11
|
Loricera J, Calvo-Río V, Ortiz-Sanjuán F, Fernández-Llaca H, González-López MA, González-Vela MC, Mata C, Rueda-Gotor J, Álvarez L, González-Lamuño D, Martínez-Taboada VM, González-Gay M, Blanco R. AB0463 Cutanoeous vasculitis associated to severe infection: study of 27 patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
12
|
Calvo-Río V, Loricera J, Martín L, Ortiz-Sanjuán F, Alvarez L, González-Vela MC, González-Lamuño D, Mata C, Gortázar P, Rueda-Gotor J, Arias M, Peiró E, Martínez-Taboada VM, González-Gay MA, Blanco R. Henoch-Schönlein purpura nephritis and IgA nephropathy: a comparative clinical study. Clin Exp Rheumatol 2013; 31:S45-S51. [PMID: 23663681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/15/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Henoch-Schönlein purpura nephritis (HSPN) and IgA nephropathy (IgAN) are related syndromes. In the present study we aimed to compare the clinical characteristics and outcome of a large and unselected series of patients diagnosed as having HSPN and IgAN. METHODS Comparative study of a wide and unselected population of HSPN (142 patient) and IgAN (61 patients) from a teaching hospital of Northern Spain. RESULTS All of the following comparisons were expressed between HSPN vs. IgAN, respectively. HSPN patients were younger (30.6±26.4 vs. 37.1±16.5 years, p<0.001). Precipitating events, usually an upper respiratory tract infection and/or drug intake, were more frequently observed in HSPN (38% vs. 23%, p=0.03). Extra-renal manifestations were also more common in HSPN than in IgAN; skin lesions (100% vs. 1.8%; p<0.001), gastrointestinal (62% vs. 7.4%; p<0.001), and joint involvement (61.3% vs. 3.6%; p<0.001). However, nephritis was less severe in HSPN, renal insufficiency (25% in HSPN vs. 63.4% in IgAN; p<0.001), nephrotic syndrome (12.5%, vs. 43.7%; p<0.001), and nephritic syndrome (6.8% vs. 10.7%; NS). Leukocytosis was more frequent in HSPN (22.5% vs. 8.2%; p=0.015) and anaemia in IgAN (12.7% in HSPN vs. 36% in IgAN, p<0.001). The frequency of corticosteroid (79.6% vs. 69%; NS) and cytotoxic drug (19% vs. 16.5%, NS) use was similar. The frequency of relapses was similar (38.6% in HSPN vs. 36.3% in IgAN). After a median follow-up of 120.8 (IQR; 110-132) months in HSPN and 138.6 (IQR; 117-156) in IgAN, requirement for dialysis (2.9% vs. 43.5%; p<0.001), renal transplant (0% vs. 36%, p<0.001) and residual chronic renal insufficiency (4.9% vs. 63.8%; p<0.001) was more frequently observed in patients with in IgAN. CONCLUSIONS HSPN and IgAN represent different syndromes. IgAN has more severe renal involvement while HSPN is associated with more extra-renal manifestations.
Collapse
Affiliation(s)
- V Calvo-Río
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
González-López MA, Martínez-Taboada VM, González-Vela MC, Blanco R, Fernández-Llaca H, Rodríguez-Valverde V, Val-Bernal JF. Recall injection-site reactions associated with etanercept therapy: report of two new cases with immunohistochemical analysis. Clin Exp Dermatol 2007; 32:672-4. [DOI: 10.1111/j.1365-2230.2007.02478.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
González-Vela MC, Val-Bernal JF, Arce FP, Gómez-Roman J, González-López MA, Fernández-Llaca JH. Presence of human herpesvirus-8 in inflammatory myofibroblastic tumor of the skin. J Eur Acad Dermatol Venereol 2007; 21:399-401. [PMID: 17309471 DOI: 10.1111/j.1468-3083.2006.01876.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
15
|
González-López MA, Salesa R, González-Vela MC, Fernández-Llaca H, Val-Bernal JF, Cano J. Subcutaneous phaeohyphomycosis caused by Exophiala oligosperma in a renal transplant recipient. Br J Dermatol 2007; 156:762-4. [PMID: 17263805 DOI: 10.1111/j.1365-2133.2006.07732.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
González-Vela MC, Val-Bernal JF, Martino M, González-López MA, García-Alberdi E, Hermana S. Sclerotic fibroma-like dermatofibroma: an uncommon distinctive variant of dermatofibroma. Histol Histopathol 2005; 20:801-6. [PMID: 15944929 DOI: 10.14670/hh-20.801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dermatofibroma (DF) is a common benign cutaneous tumor with many variants based on alterations in the morphology and composition of its diverse elements. One very infrequent type is sclerotic fibroma-like DF (SF-DF). We report 7 new cases of SF-DF. In addition, their main clinicopathological and immunohistochemical features were compared with 14 unselected common DFs and with 3 sclerotic fibromas (SFs). Microscopically, the 7 cases of SF-DFs showed an unencapsulated, well-circumscribed, hypocellular central nodule with thick collagen bundles arranged in a storiform pattern with prominent clefts. The overlying epidermis was attenuated. The periphery of this nodule was more cellular with histopathologic features of common DF. The 7 SF-DFs patients were 4 women and 3 men with a mean (+/-SD) age of 44.8 (+/-15.5) years. These 7 patients were younger than those suffering from SFs [71.0 (+/-17.3) years; (p=0.04)] and older than those presenting common DFs [30.5 (+/-12.3) years; (p=0.03)]. Immunohistochemically, spindle cells in all 7 SF-DFs were negative for CD34 and CD99. On the contrary, the 3 cases of SF were positive for CD34 and CD99. All of the common DFs were negative for CD34 and only 4 (28.6%) of them were positive for CD99. In conclusion, SF-DF is an uncommon variant of DF with similar clinicopathological and immunohistochemical features. SF-DF shares certain histopathologic features with SF but they are immunophenotypically different. Therefore, both entities should be differentiated.
Collapse
Affiliation(s)
- M C González-Vela
- Department of Anatomical Pathology, Marques de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Avda. Valdecilla 1, Santander, Spain
| | | | | | | | | | | |
Collapse
|
17
|
González-Vela MC, Garijo MF, Fernández F, Val-Bernal JF. MIB1 proliferation index in breast infiltrating carcinoma: comparison with other proliferative markers and association with new biological prognostic factors. Histol Histopathol 2001; 16:399-406. [PMID: 11332695 DOI: 10.14670/hh-16.399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS In breast invasive carcinoma our objectives were I) to compare cellular proliferation determined by MIB1 index with S-phase fraction (SPF) assessed by flow cytometry and with mitotic index, and II) to examine the association of MIB1 index with classical and with new biological prognostic factors [bcl-2, p53, c-erbB-2 and cathepsin D (CD)]. METHODS AND RESULTS From 102 cases of breast invasive carcinoma, 5-microm thick serial sections were cut from formalin-fixed, paraffin-embedded tissue blocks, and processed for detection of CD, c-erbB-2, p53, bcl-2, Ki-67 antigen MIB-1 and estrogen receptors (ER) and progesterone receptors (PR). SPF was measured by flow cytometry in fresh-frozen tissue samples taken from the carcinoma in each patient. MIB1 index was correlated with SPF (rho=0.45, p<0.0001) and with mitotic index (rho=0.42, p<0.0001). The MIB-1 index was positively associated with the histological grade (p=0.001), tumor size (p=0.04) and the presence of metastases in axillary lymph nodes (p=0.01). MIB1 was associated directly with p53 (p=0.045) and inversely with bcl-2 (p=0.0002). The MIB-1 index was not statistically associated with c-erbB-2. There was a weak association between MIBI index and stromal cell CD. The median MIB1 index was higher in tumors with moderate to strong CD staining of stromal cell, but the difference did not reach statistical significance (p=0.09). CONCLUSIONS MIB1 index correlates with well established methods for assessing tumor proliferation and with parameters of an aggressive phenotype of tumor. MIB1 index is an effective and readily accessible method for assessing tumor proliferation in breast carcinoma.
Collapse
Affiliation(s)
- M C González-Vela
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
| | | | | | | |
Collapse
|
18
|
González-Vela MC, Garijo MF, Fernández FA, Buelta L, Val-Bernal JF. Predictors of axillary lymph node metastases in patients with invasive breast carcinoma by a combination of classical and biological prognostic factors. Pathol Res Pract 1999; 195:611-8. [PMID: 10507081 DOI: 10.1016/s0344-0338(99)80126-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The presence of axillary lymph node metastases (ALNMs) is the most important prognostic factor in breast carcinoma. If ALNMs were predictable without performing axillary lymph node dissection (ALND), this procedure would not be necessary in selected patients. Using a combination of some of the new biological markers with the classical ones, our objective was I) to identify the best set of predictors of ALNMs, and II) to define predictive models with either high or low probability of ALNMs. We studied 102 patients with invasive breast carcinoma. All patients underwent ALND, and at least 10 axillary lymph nodes per case were obtained. In the primary tumour we evaluated size, histological subtype and grade, lymphatic/vascular invasion and margin. Hormone receptor status, MIB1 index, microvessel density, c-erbB-2 and cathepsin D expression were assessed by immunohistochemistry, and DNA ploidy and S-phase by flow cytometry. Risk factors for ALNMs were estimated by nonlinear logistic regression analysis. The best predictors of ALNMs were: tumour size > 2 cm [OR 6.45, 95% confidence interval (CI) 21.74 to 1.91], presence of lymphatic/vascular invasion [OR 4.95, CI (14.50 to 1.69)], infiltrative margin [OR 9.87 CI (37.44 to 2.60)] and high MIB-1 index [OR 8.39, CI (33.47 to 2.10)]. Two subsets had a very high risk of ALNMs: I) tumour size > 2 cm, with lymphatic/vascular invasion and infiltrative margin; 26 (89.66%) of 29 patients of this subgroup had ALNMs, and (II) tumour size > 2 cm, with lymphatic/vascular and high MIB1 index.; eight of the nine (89%) patients of this subgroup had ALNMs. We could also identify a two-variable model with a very low risk of ALNMs constituted by tumour with circumscribed margin and low MIB-1 index. Of the 19 patients showing these features, only 1 (5.26%) had ALNMs. Therefore, pathological features of the primary tumour can help to assess the risk for ALNM in invasive breast carcinoma. Such risk assessment might avoid regional surgical overtreatment.
Collapse
Affiliation(s)
- M C González-Vela
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
| | | | | | | | | |
Collapse
|
19
|
González-Vela MC, Garijo MF, Fernández F, Buelta L, Val-Bernal JF. Cathepsin D in host stromal cells is associated with more highly vascular and aggressive invasive breast carcinoma. Histopathology 1999; 34:35-42. [PMID: 9934582 DOI: 10.1046/j.1365-2559.1999.00548.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To determinate the relationship between tumoral angiogenesis and cathepsin D (CD) expression in tumour and host stromal cells of invasive breast carcinoma, and to examine its association with classical prognostic factors such as lymph node status, histological grade, tumour size, mitotic rate, peritumoral lymphovascular invasion and oestrogen receptor (ER) status. METHODS AND RESULTS Sections from 102 invasive breast carcinoma were cut from the archival formalin-fixed, paraffin-embedded tissue blocks and stained using immunohistochemistry for the endothelial cell adhesion molecule (CD31) and CD. Microvessel density was assessed by counting vessels in the three most vascular areas at x400 field. The counts were expressed as the highest counts within any x400 field. The evaluation of immunostaining for CD was performed separately in both the parenchymal and stromal cells. Microvessel density was correlated positively with histological grade and peritumoral lymphovascular invasion, and correlated inversely with ER status. Positive CD staining of tumour cells was more frequent in positive ER tumours and was not significantly associated with the other classical prognostic factors. However, moderate to strong staining of host cells was correlated with higher histological grade, higher mitotic index and lack of ER protein. There was a statistically significant association between CD expression of host stromal cells and higher vessel count. CONCLUSIONS CD in host stromal cells is associated with more aggressive tumours and with a higher intratumoral microvessel density. Evaluation of CD in combination with angiogenic activity may be of some help in more accurately predicting the biological behaviour of breast carcinoma.
Collapse
Affiliation(s)
- M C González-Vela
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
| | | | | | | | | |
Collapse
|
20
|
Yáñez S, Val-Bernal JF, Mira C, Echevarría MA, González-Vela MC, Arce F. Spindle cell hemangioendotheliomas associated with multiple skeletal enchondromas: a variant of Maffucci's syndrome. Gen Diagn Pathol 1998; 143:331-5. [PMID: 9653917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
An unusual case of Maffucci's syndrome confined to an extremity with an additional superficial lymphangioma in the same limb is described. The patient, a 47-year-old woman, presented with several painful subcutaneous spindle cell hemangioendotheliomas (SCHs) and multiple lytic bone lesions, some calcified, in the left leg. She has been followed for two years and continues to do well. The combination of SCHs and multiple enchondromas (ENCHs) should be searched in any patient who presents with SCHs or multiple ENCHs, because there is a significant risk of malignant transformation.
Collapse
Affiliation(s)
- S Yáñez
- Department of Dermatology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
| | | | | | | | | | | |
Collapse
|
21
|
Blanco R, Martínez-Taboada VM, González-Gay MA, Armona J, Fernández-Sueiro JL, González-Vela MC, Rodríguez-Valverde V. Acute febrile toxic reaction in patients with refractory rheumatoid arthritis who are receiving combined therapy with methotrexate and azathioprine. Arthritis Rheum 1996; 39:1016-20. [PMID: 8651964 DOI: 10.1002/art.1780390619] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess the frequency and clinical features of an acute febrile toxic reaction (AFTR) in patients with refractory rheumatoid arthritis (RA) receiving combined therapy with methotrexate (MTX) and azathioprine (AZA). METHODS A cohort of 43 RA patients being treated with MTX/AZA combination therapy were studied. In all of them, RA had been refractory to single-therapy disease-modifying antirheumatic drugs. We analyzed the frequency and clinical features of AFTR, which consisted mainly of the development of fever, leukocytosis, and cutaneous leukocytoclastic vasculitis when AZA was added to the MTX regimen. RESULTS Four of the 43 patients (9.3%) who had been receiving long-term, well-tolerated treatment with MTX (mean +/- SD 375.5 +/- 159.5 days, range 227-561 days) developed AFTR shortly (mean +/- SD 25.7 +/- 13.6 days, range 17-46 days) after the addition of AZA to the regimen. The AFTR resolved rapidly (3 +/- 1.4 days) after discontinuation of AZA and MTX. In 2 cases, rechallenge with AZA and MTX was linked to a new flare of AFTR. CONCLUSION The knowledge of this side effect is particularly important because it mimics a severe infectious complication related to immunosuppressive therapy, and because rechallenge can produce severe toxicity. Most of the new combined therapies for RA do not seem to be more toxic than single-drug treatment. Nevertheless, clinicians should be aware of a possible increase in side effects due to drug interactions or some other unidentified mechanism.
Collapse
Affiliation(s)
- R Blanco
- Hospital Universitario M. Valdecilla, Universidad de Cantabria, Santander, Spain
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
A case of acute gangrenous appendicitis with perforation caused by metastatic small cell carcinoma of the lung in a 65 year old man is reported. The manifestation of appendicitis occurred more than 4 years after the diagnosis of the bronchogenic carcinoma. With longer survival of patients with disseminated tumors it is probable that new manifestations of those malignancies will be discovered. Acute appendicitis due to metastasis from a distant neoplasm should be considered in the differential diagnosis of right lower abdominal pain in the oncology patient.
Collapse
Affiliation(s)
- M C González-Vela
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Faculty of Medicine, University of Cantabria, Santander, Spain
| | | | | | | |
Collapse
|