Rheumatoid Arthritis: Mexico

Damián-Abrego GN, Cabiedes J, Cabral AR. · Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. · Lupus. · Pubmed #18413411 No free full text.

Abstract: The objective was to study the association of antibodies against cyclic citrullinated peptides (anti-CCP) in patients with lupus articular damage. We studied 34 systemic lupus erythematosus patients (30 women) with (n = 14) or without (n = 20) deforming arthropathy. Anti-DNA and arthritis were mandatory inclusion criteria for both groups. As controls, 34 patients with rheumatoid arthritis and nine patients with rheumatoid arthritis and systemic lupus erythematosus (rhupus) were included. Anti-CCP and rheumatoid factor were determined by ELISA and nephelometry respectively. All patients had recent x-ray films of the hands that were evaluated according to Sharp's method. Systemic lupus erythematosus patients had a mean 6.50 +/- 0.86 (SD, range 5-8) American College of Rheumatology (ACR) criteria, rheumatoid arthritis patients met 5.38 +/- 0.60 (range 4-6) ACR criteria for rheumatoid arthritis and rhupus patients had 5.78 +/- 0.44 (range 5-6) criteria for rheumatoid arthritis and 5.11 +/- 0.78 (range 4-6) for systemic lupus erythematosus. Systemic lupus erythematosus patients, with or without deforming arthropathy, had normal serum anti-CCP concentrations. In contrast, rheumatoid arthritis and rhupus patients had 30- and 23-fold higher than normal amounts of anti-CCP (p < 0.001, both comparisons). Rheumatoid arthritis (97%) and rhupus (100%) patients were more frequently positive for anti-CCP than SLE patients with (7%) or without (5%) deforming arthropathy (p < 0.001, both comparisons). Patients with lupus deforming arthropathy were more frequently positive for rheumatoid factor (65%) than patients with non-deforming arthritis (15%) (p = 0.005). Patients with lupus deforming arthropathy had similar frequency of erosions and mean Sharp's score than rhupus patients. Anti-CCP antibodies do not associate with lupus arthropathy, whether deforming, non-deforming or erosive.

Ramos HL, Valencia-Pacheco G, Alcocer-Varela J. · Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico. · Scand J Rheumatol. · Pubmed #18189193 No free full text.

Abstract: OBJECTIVE: Signal transducers and activators of transcription (STATs) are crucial mediators of cytokine signalling. Constitutive activation of STATs, especially STAT3, has been reported in several diseases. Primary Sjögren's syndrome (pSS) is associated with overproduction of cytokines such as interleukin-10 (IL-10), although the mechanism by which this occurs is unknown. As STAT3 is a potent inducer of IL-10, this study focused on determining the pattern of STAT3 activation in peripheral lymphocytes from patients with pSS. METHODS: Twelve pSS patients and 12 healthy age-matched control subjects were studied. Peripheral blood mononuclear cells (PBMCs) were isolated by gradient centrifugation. Phosphorylated STAT3 (pSTAT3) and also STAT3 expression were determined by flow cytometry in gated CD3(+ )and CD19(+) lymphocytes. Similarly, pJak1 and pTyk2 were also determined in gated CD3(+) lymphocytes. RESULTS: Although the protein expression of STAT3 was similar among controls and pSS patients, we found that STAT3 was constitutively activated in CD3(+) lymphocytes from pSS patients. Neither Jak1 nor Tyk2 (the upstream activators of STAT3) was activated in pSS CD3(+) lymphocytes, suggesting that the constitutive activation of STAT3 observed in pSS patients might not depend on cytokine stimulation but instead might be the result of an abnormal inactivation of pSTAT3. CONCLUSIONS: These data provide evidence of abnormal STAT3 signalling in T cells from pSS patients.

Duarte-Salazar C, Guzmán-Vázquez S, Soto-Molina H, Cháidez-Rosales P, Ilizaliturri-Sánchez V, Nieves-Silva J, Valero-González F, Aguilera-Zepeda JM. · Department of Rheumatology, Instituto Nacional de Rehabilitación, Mexico City. caro20@ prodigy.net.mx · Clin Exp Rheumatol. · Pubmed #18173931 No free full text.

Abstract: OBJECTIVE: Our aim was to determine the disability impact on quality of life (QOL) in Mexican adults with juvenile idiopathic arthritis polyarticular course (JIAPA) and juvenile ankylosing spondylitis (JAS). METHODS: A cross-sectional study was performed on 32 adult patients with juvenile idiopathic arthritis. Functional outcome was evaluated using Global Functional Status (GFS) according to American College of Rheumatology (ACR) and Spanish Health Assessment Questionnaire-Disability Index (HAQ-DI) arthritis-specific measurements for functional disability in patients with polyarticular course and Bath Ankylosing Spondylitis Functional Index (BASFI) for those who developed JAS. Quality of life (QOL) was assessed using SF-36 and EuroQol 5D (EQ-5D). Descriptive statistics and associations among clinical, functional, and QOL measurements were examined using Spearman's correlation test. Multiple regression analysis was used to estimate predictor factors for impaired QOL. Differences between groups were evaluated by Fisher exact and Mann-Whitney U tests, and p values of <0.05 were considered statistically significant. RESULTS: JIAPA and JAS had GFS III/IV in 65 and 50%, respectively. A HAQ-DI score of > 1.5 was found in 35% of JIAPA, and a BASFI score of > 5 in 92% of JAS. Patients with JIAPA and JAS reported lower scores for all physical domains and for mental domains (physical role, social functioning, and emotional role) compared with Mexican population scores (p < 0.005). Health status between both groups studied does not show significant differences (p > 0.05). EQ-5D showed impairment in all five dimensions for both groups studied. Multiple regression analysis showed that GFS was the only variable that affects QOL assessed by SF36. CONCLUSIONS: In our study population, JIAPA and JAS exhibited a great disability impact on QOL and poor functional outcome during the patients' adult life. GFS has a significant impact on quality of life.

Araiza MT, Aguilar León DE, Retana VN, Martínez-Cordero E. · National Institute of Respiratory Diseases (INER), Mexico City, Mexico. · J Clin Lab Anal. · Pubmed #17847114 No free full text.

Abstract: The association of rheumatoid factor (RF) and lung disease in several immunologically mediated conditions has suggested that it may be physiopathologically relevant. Since previous reports in hypersensitivity pneumonitis (HP) have dealt mainly with the immunoglobulin M (IgM) RF measurement, we studied such antibody activity in other immunoglobulins, to determine the IgG and IgA RF levels in pigeon-HP, and in asymptomatic breeders (AB) and rheumatoid arthritis (RA) as controls. RFs were measured in 35 HP patients, 41 AB, 31 RA controls, and 55 healthy donors by enzyme-linked immunosorbent assay (ELISA) using human or rabbit immunoglobulin G (IgG), anti-IgM, F(ab')2 of IgG, and IgA F(ab')2 conjugates. An affinity chromatography, fragment crystallizable (Fc) preparations of IgG, pepsin digestion, and Western blots were used to confirm RF specificity. We also evaluated anti-avian antibodies (AA) and cross-reacting antibodies. The HP group revealed positive IgM (51.4%), IgG (31.4%), and immunoglobulin A (IgA) (34.2%) RF tests, and these antibody values exceeded the AB reference levels (P<0.02). HP and RA showed a similar frequency and distribution of RFs. Possible immunoassay interferences were excluded. As in other immunologically mediated diseases, IgG and IgA RFs may play a pathogenic role in HP, amplifying the inflammatory reaction, immune-complex formation, and complement activation. IgM-RF producing cells that have been implicated in the presentation of self and foreign antigens, and T-cell activation might induce the isotype switching of RFs.

Montaño-Loza AJ, Crispín-Acuña JC, Remes-Troche JM, Uribe M. · Department of Gastroenterology and Hepatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. · Ann Hepatol. · Pubmed #17786140 No free full text.

Abstract: BACKGROUND/AIMS: Patients with primary Sjögren's syndrome may present liver involvement. Our goals were to establish the prevalence of abnormal hepatic biochemistries and clinical liver disease in patients with primary Sjögren's syndrome and correlate their presence with other clinical and laboratory features. METHODS: Ninety-five patients with diagnosis of primary Sjögren's syndrome were studied. Data on gender, age, clinical features, liver biochemistries, tests of inflammation and autoimmunity, and concomitant diseases were collected. RESULTS: Forty-two patients (44%) had abnormal hepatic biochemistries, and of these 19 patients (20%) had clinical liver disease. Patients with abnormal hepatic biochemistries had higher frequency of autoimmune hypotiroidism, arthritis, vasculitis, Raynaud's phenomenon, higher sedimentation rate,and higher frequency of antinuclear and antimitochondrial antibodies than patients with normal liver biochemistries (P < 0.05 for each). Patients with clinical liver disease had higher frequency of arthritis, vasculitis, and higher frequency of antimitochondrial antibodies than patients without clinical liver disease (P < 0.05 for each). Twenty-one patients had diagnosis of a specific liver disease, such as hepatitis C virus infection (n = 11), autoimmune hepatitis (n = 2), primary biliary cirrhosis (n =5),nonalcoholic fatty liver disease (n = 2), and hepatitis B virus infection (n = 1). In half of patients with liver involvement a definitive cause could not be identified. CONCLUSION: Liver involvement is frequently found in patients with primary Sjögren's syndrome, and its presence is associated with clinical features of systemic disease, and markers of autoimmunity and inflammation. There may be a subgroup of patients with liver involvement secondary to primary Sjögren's syndrome.

Sáez-de-Ocariz M, Granados J, Yamamoto-Furusho JK, López-Martínez A, Vega-Memije ME. · Department of Dermatology, Hospital Dr Manuel Gea González, Mexico City, Mexico. · Skinmed. · Pubmed #17786108 links to  free full text

This publication has no abstract.

Ramos-Remus C, Sierra-Jimenez G, Skeith K, Aceves-Avila FJ, Russell AS, Offer R, Olguin-Redes JE, Homik J, Sanchez L, Sanchez-Ortiz A, Navarro-Cano G. · Department of Rheumatology, Hospital de Especialidades del Centro Medico Nacional de Occidente, IMSS, Guadalajara, Mexico. · Clin Rheumatol. · Pubmed #17646901 No free full text.

Abstract: The mean age of rheumatoid arthritis (RA) onset is around 50 years as reported in several clinical trials involving Caucasian patients. However, clinical observations suggest that Mexican RA patients' disease is initiated at a younger age. The objective of the study was to assess whether the age of onset of RA is different in Mexican and in Canadian RA patients. Certified rheumatologists from Canada and Mexico directly interviewed consecutive RA patients attending their clinics regarding the date patients first noticed a swollen joint. None of the participant rheumatologists were aware of the primary aim of this exploratory study at the time of the interviews. Data was gathered from 161 Mexican (91% women) and 130 Canadian (77% women) RA patients collected by three rheumatologists in each country. Duration since disease onset was not different within countries (mean 95% confidence interval [CI] for differences -10 to 16 years, p = 0.12 for Canadians, and -6 to 10 years, p = 0.26, for Mexicans). However, there was a significant difference between the two countries. Mexicans patients on average developed RA almost 12 years younger than Canadians (95% CI for difference 9 to 15 years, p < 0.001). Frequency distribution showed that 35.5% of Canadians but only 4% of Mexicans had the onset of the disease after the age of 55 (all p < 0.001). It appears that RA begins at a much younger age in Mexican than Canadian patients. If this were confirmed after controlling for different confounders and biases, it would have important societal, economic, and therapeutic implications.

Daza L, Martin-Jimenez R, De la Torre PX, Hernández E, Murillo B. · Rheumatology and Clinical Research Unit, Unidad Medica de Alta Especialidad T1, Instituto Mexicano del Seguro Social, Av. A. López Mateos e Insurgentes S/N, Col. Los Paraísos CP 37480 León, Guanajuato Mexico. · Eur J Endocrinol. · Pubmed #17609401 links to  free full text

Abstract: OBJECTIVE: The hypothalamic-pituitary-adrenal (HPA) axis evaluation has been conflicting in rheumatoid arthritis (RA) patients. Our aim was to evaluate the HPA axis response to the insulin tolerance test (ITT) in premenopausal female patients with RA before and after anti-tumor necrosis factor therapy (anti-TNF therapy). DESIGN: A comparative cross-sectional analysis. SUBJECTS AND METHODS: Ten females with RA and without previous anti-TNF therapy were included. Five healthy females were included as controls. An ITT was performed before first dose of anti-TNF therapy and then after week 12. Anti-TNF therapy was applied every 14 days for 12 weeks. Cortisol and ACTH levels were measured at 0, 30, 45, and 65 min. Prolactin was measured at 0, 30, 45, 90, 120, and 150 min. RESULTS: The ACTH basal plasma levels at weeks 0 and 12 did not show statistical differences, at 1.26 (0.41-2.12) vs 1.54 (0.60-2.49) respectively (P = 0.68). The controls demonstrated a higher ACTH response than in the RA patients at week 0 before the anti-TNF therapy (349.12 area under curve (AUC)), (P = 0.004) and a similar ACTH response to ITT to those of RA patients at week 12 after the use of the anti-TNF therapy (1087.42 AUC). Serum cortisol levels did not show significant changes when the ITT was performed before and after the anti-TNF therapy. CONCLUSIONS: Our findings support a role for the TNF on the pituitary gland in premenopausal female patients with RA. An adequate control of RA in early stages of the disease diminishing TNF levels improves ACTH response to stress situations.

Furuzawa-Carballeda J, Vargas-Rojas MI, Cabral AR. · Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15 Tlalpan, Mexico City 14000, Mexico. · Autoimmun Rev. · Pubmed #17289553 No free full text.

Abstract: Recent studies demonstrated an IL-17-producer CD4+ T cell subpopulation, termed Th17, distinct from Th1 and Th2. It represents a different pro-inflammatory Th-cell lineage. This notion is supported by gene-targeted mice studies. Mice lacking IL-23 (p19-/-) do not develop experimental autoimmune encephalomyelitis (EAE) or collagen-induced arthritis (CIA), while knockout mice for the Th1 cytokine IL-12 (p35-/-) strongly develop both autoimmune diseases. Disease resistance by IL-23 knockout mice correlates well with the absence of IL-17-producing CD4(+) T lymphocytes in target organs despite normal presence of antigen-specific-IFN-gamma-producing Th1 cells. This finding may thus explain previous contradictory reports showing that anti-IFN-gamma-treated mice, IFN-gamma- or IFNR-deficient mice develop CIA or EAE. TGF-beta, IL-6 and IL-1 are the differentiation factors of Th17 cells. IL-23 is dispensable for this function, but necessary for Th17 expansion and survival. The master regulator that directs the differentiation program of Th17 cells is the orphan nuclear receptor RORgammat. IL-27, a member of the IL-12/IL-23 family, potently inhibits Th17 development. Evidence suggesting rheumatoid arthritis and multiple sclerosis as primarily IL-17 autoimmune inflammatory-mediated diseases is rapidly accumulating. The IL-17/23 axis of inflammation and related molecules may rise as therapeutic targets for treating these and perhaps other autoimmune diseases.

Furuzawa-Carballeda J, Fenutria-Ausmequet R, Gil-Espinosa V, Lozano-Soto F, Teliz-Meneses MA, Romero-Trejo C, Alcocer-Varela J. · Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. · Clin Exp Rheumatol. · Pubmed #17181919 No free full text.

Abstract: OBJECTIVE: To determine the efficacy, tolerance and safety of intramuscular injections of porcine type I collagen-PVP in patients with RA in a long term-therapy. METHODS: The study was a double blind placebo-controlled and included 30 patients with active RA (ACR). Patients were treated with intramuscular injections of 2 ml of collagen-PVP (3.4 mg of collagen) or 2 ml of placebo during 6 months. The follow up was done during the next 6 months. The primary endpoints included the Ritchie index (RI), swollen joint count, disease activity score (DAS), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The secondary endpoints included morning stiffness, pain intensity on a visual analogue scale (VAS), and Spanish-health assessment questionnaire (HAQ-DI). Improvement was determined using American College of Rheumatology response criteria (ACR20, 50 and 70). RESULTS: Collagen-PVP was safe and well tolerated. There were no adverse events. Patients had a statistically significant improvement (p < 0.05) in collagen-PVP-treated vs. placebo at 6 months of treatment in: swollen joint count (7.1 +/- 0.8 vs. 16.0 +/- 1.6), RI (8.1 +/- 0.8 vs. 15.2 +/- 1.5), morning stiffness (9.2 +/- 3.1 vs. 29.1 +/- 5.9 min), HAQ-DI (50.0 +/- 10.8 vs. 22.9 +/- 10.3), DAS (3.0 +/- 0.2 vs. 4.9 +/- 0.3), ACR20 (78.6 vs. 71.4%), ACR50 (57.1 vs. 0%) and ACR70 (7.1 vs. 0%) and CRP (1.1 +/- 0.4 vs. 2.5 +/- 0.7). Patients treated with collagen-PVP required lower doses of methotrexate vs. placebo (12.6 +/- 0.6 vs. 14.2 +/- 0.7 at 6 months and 12.3 +/- 0.8 vs. 15.4 +/- 0.6 at 12 months; p < 0.05). Serological or haematological parameters remained unchanged. CONCLUSION: Collagen-PVP has been shown to be a safe and well-tolerated drug for the long-term treatment of RA. Combination of collagen-PVP plus methotrexate was more efficacious than methotrexate alone. This biodrug can be useful in the treatment of RA.

Amezcua-Guerra LM, Springall R, Marquez-Velasco R, Gómez-García L, Vargas A, Bojalil R. · Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan 14080, Mexico City, Mexico. · Arthritis Res Ther. · Pubmed #16934155 links to  free full text

Abstract: 'Rhupus' is a rare condition sharing features of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). If rhupus is a distinctive entity, an overlap between RA and SLE or a subset of SLE is currently debated. This study was performed to explore the prevalence of antibodies against cyclic citrullinated peptides (anti-CCP antibodies) in rhupus. Patients meeting American College of Rheumatology criteria for RA, SLE, or both were included. Clinical and radiographic features were recorded and sera were searched for anti-CCP antibodies, rheumatoid factor, antinuclear antibodies, anti-extractable nuclear antigens, and antibodies against double-stranded DNA (anti-dsDNA antibodies). Seven patients for each group were included. Clinical and serological features for RA or SLE were similar between rhupus and RA patients, and between rhupus and SLE patients, respectively. Values for anti-CCP antibodies obtained were significantly (p < 0.05) higher in RA (6/7) and rhupus (4/7) than in SLE patients (0/7) and healthy subjects (0/7). Our data support the possibility that rhupus is an overlap between RA and SLE, because highly specific autoantibodies for RA (anti-CCP) and for SLE (anti-dsDNA and anti-Sm) are detected in coexistence.

Ortiz-Mendoza CM. · Servicio de Clínica de Mama-Oncología, Hospital General Tacuba, ISSSTE, México. · Cir Cir. · Pubmed #16887087 No free full text.

Abstract: A 71-year-old female with rheumatoid arthritis and chronic use of corticosteroids presented to the emergency room with 2 weeks of urinary symptoms, abdominal pain and a mass located in hypo-mesogastrium and both flanks. An X-ray film of the abdomen showed that bowels were displaced by the mass. Laboratory studies showed thrombocytosis (549,000/mm(3)) and leukocytosis (41,800/mm(3)). Several hours after her arrival the patient developed acute abdomen and surgery was indicated. A urinary catheter drained 2100 ml of urine and the abdominal mass was reduced in size but did not disappear. Surgery demonstrated that the urinary bladder covered the fundus and the anterior face of the uterus, where extensive necrosis and a 3-cm perforation were found; 400 ml of foul-smelling pus was drained from the uterine cavity. Due to necrosis, a hysterectomy was performed. The histopathological report indicated necrosis, atrophic cervicitis and endometritis; pus culture developed Escherichia coli and Proteus vulgaris. Despite administration of broad-spectrum antibiotics, the patient developed severe sepsis and died 11 days postoperatively. During a literature review, only one similar case was found. Acute abdomen due to uterine perforation secondary to pyometra and associated with chronic use of corticosteroids is a rare complication.

Daza L, Aguirre M, Jimenez M, Herrera R, Bollain JJ. · Unidad de Investigación Clínica, Unidad Médica de Alta Especialidad Bajío, Instituto Mexicano del Seguro Social, Av. A. López Mateos e Insurgentes S/N, Col. Los Paraísos, CP 37480, León Guanajuato, Mexico. · Clin Rheumatol. · Pubmed #16758372 No free full text.

Abstract: High atherosclerosis prevalence was found in rheumatoid arthritis (RA), and the von Willebrand factor (vWF) was shown to be a marker for endothelial damage. The aim of this study was to evaluate the association of intima-media thickness of the left common carotid artery with vWF serum levels in rheumatoid arthritis patients without cardiovascular risk factors. We included 55 RA female patients, each with at least 5 years of duration of the disease, and 20 healthy female subjects as members of the control group. The vWF, cholesterol, triglycerides, and the immune variables-rheumatoid factor and reactive C protein-were evaluated. The media thickness and intima-media thickness (IMT) in patients and in the control subjects were assessed by Doppler ultrasound of the left common carotid artery. Although the ages for RA patients and healthy female controls were not different, the IMT of the left common carotid artery (IMT CCA) in rheumatoid arthritis patients was increased in comparison with healthy control measurements, the mean being 0.67 mm (SD 0.18) vs 0.58 mm (SD 0.10) with a p value 0.01. The vWF serum levels showed differences in RA patients from those in control patients, 145.6 (SD 30.08) vs 121.8 (SD 37.17), respectively, with p=0.007. A correlation was also found between vWF with IMT CCA in the RA patients: r=0.390 and p<0.05. We concluded that the measurements of the left common carotid artery intima-media thickness together with the von Willebrand factor serum levels could give valuable information about the artery status and the atherosclerosis process in early stages in patients with rheumatoid arthritis without cardiovascular risk factors.

Cardiel MH, Anonymous00194, Anonymous00195. · Unidad de Investigación Clínica, Hospital General Dr Miguel Silva, Morelia, Mich, México. · Rheumatology (Oxford). · Pubmed #16709584 links to  free full text

Abstract: BACKGROUND: Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that involves synovial joints, resulting in severe dysfunction or burden for individual patients, families and society. Latin American Rheumatology Associations have acknowledged its relevance and recognized multiple limitations for its diagnosis and treatment in Latin America and the Caribbean. This document underscores issues regarding the impact and relevance of this disease in these countries. OBJECTIVES: To develop a consensus document that may unify and guide the pharmacological management of RA in Latin America and the Caribbean. METHODS: An Executive Committee appointed by the Epidemiology, Rheumatoid Arthritis and Radiology Committees of Pan-American League of Association for Rheumatology (PANLAR), held a meeting at Lisbon in May 2003. The goal was to establish a task force for the development of a Latin American consensus on the management of RA. Efforts focused on the problems encountered in the region regarding the availability of appropriate treatment for RA and the development of treatment guidelines for clinical practice. A secondary objective was the diffusion of the consensus conclusions and recommendations in participating countries. RESULTS: Six major issues were identified for discussion by six working groups. All Latin American Rheumatology Associations registered in PANLAR were invited to participate in the consensus. PANLAR members were well-represented in each group. Coordinators identified essential literature to be reviewed, analysed, and electronically discussed before the consensus meeting. CONCLUSIONS: The consensus' results and recommendations of this effort to delineate RA management in Latin America are contained in this article, which has been reviewed by participant societies and authors during 2004/2005 and endorsed by PANLAR.

Sánchez-Guerrero J, Pérez-Dosal MR, Celis-Aguilar E, Cárdenas-Velázquez F, Soto-Rojas AE, Avila-Casado C. · Department of Immunology and Rheumatology, Instituto Nacional de Ciencas Medicas y Nutricion Salvador Zubiirdan, UNAM, Mexico, DF Mexico. · J Rheumatol. · Pubmed #16541477 No free full text.

Abstract: OBJECTIVE: To determine the validity of screening tests for Sjogren's syndrome (SS) in ambulatory patients with chronic diseases. METHODS: Three hundred randomly selected patients from the rheumatology and internal medicine clinics of a tertiary care center were assessed for SS according to the American-European Consensus Group criteria. During the screening phase, an interview, the European questionnaire for sicca symptoms, Schirmer-I test, and the wafer test were carried out in all patients. Patients with positive screening had confirmatory tests including fluorescein staining test, nonstimulated whole salivary flow, and autoantibody testing. Confirmatory tests were also done in 13 patients with negative screening. During the last phase, lip biopsy was proposed to patients who met preestablished criteria. RESULTS: Women made up 79% of the study population. Mean age of subjects was 42.8+/-15.7 years. Two hundred twenty patients (73%) had positive screening. The distribution of positive test results was: xerophthalmia 118 (39%), xerostomia 103 (34%), Schirmer-I test 101 (34%), and wafer test 187 (62%) patients. Forty (13%) patients met criteria for SS. All screening tests were useful for identifying patients with SS; however, the model composed of at least one positive response to the European questionnaire (EQ1), Schirmer-I test, and wafer test showed the best performance. CONCLUSION: Use of the European questionnaire, Schirmer-I test, and wafer test in parallel was useful for identifying patients with SS among ambulatory patients with chronic diseases.

Prokhorov EF, Prokhorova TE, González-Hernández J, Kovalenko YA, Llamas F, Moctezuma S, Romero H. · Centro de Investigación y de Estudios Avanzados del IPN, Unidad Querétaro, Libramiento Norponiente # 2000, Fracc. Real de Juriquilla, Juriquilla, Qro, Mexico. · Complement Ther Med. · Pubmed #16473751 No free full text.

Abstract: OBJECTIVES: The aim of this work was to compare in vivo measurements of direct current (dc) and alternating current (ac) obtained from acupuncture points in Ukrainian and Mexican residents. METHODS: Measurements were made using the method of Voll. The participants were 43 healthy Ukrainian and 71 healthy Mexican residents aged between 20 and 30 years, as well as 24 Mexican patients with a clinical diagnosis of rheumatoid arthritis and 14 patients with a clinical diagnosis of allergy. RESULTS: The results showed that dc measurements are not directly applicable to different populations. Thus, the dc resistance of the acupuncture points in the Mexican participants was 4-5 times larger than in the Ukrainians. In contrast, the capacitance of the two groups did not differ by more than 25%. CONCLUSIONS: Impedance measurements from acupuncture points can be used as an efficient and prompt non-invasive method for diagnostic purposes.

Crispín JC, Martínez-Baños D, Alcocer-Varela J. · Department of Immunology and Rheumatology, Mexico City, Mexico. · Medicine (Baltimore). · Pubmed #16267408 No free full text.

Abstract: We conducted the current study to evaluate the cases of fever of unknown origin (FUO) admitted in our institution during the 10 years between 1991 and 2001 and to compare the patients diagnosed as having adult-onset Still disease (AOSD) with the patients with FUO due to other diagnoses. We performed a case-control study and analyzed 26 patients with AOSD and 135 patients with FUO due to other diseases. Controls were classified into 1 of 4 groups: 1. Infectious diseases; 2. Malignant conditions; 3. Autoimmune diseases; 4. No diagnosis. Differences between groups were evaluated by analysis of variance (ANOVA). Odds ratios (OR) were calculated by multiple logistic regression analyses.Patients with AOSD were younger than controls. Arthritis (OR, 8.6; 95% confidence interval [CI], 1.5-49.1; p = 0.014), pharyngitis (OR, 6.9; 95% CI, 1.5-30.2; p = 0.010), splenomegaly (OR, 5.4; 95% CI, 1.1-26.7; p = 0.039), and neutrophilic leukocytosis (OR, 18.1; 95% CI, 3.5-93.6; p = 0.001) were significantly more common in patients with AOSD than in the control groups. A clinical scale that identifies patients with AOSD was designed. It proved to be highly specific ( approximately 98%), with predictive values greater than 90%.AOSD is a defined clinical entity. In most cases, it is clinically distinguishable from other causes of FUO. We propose a clinical scale as a tool to identify patients whose disease can be diagnosed based on clinical grounds without the need of long, costly diagnostic procedures.

González Guevara MB, Torres Tejero MA, Martínez Mata G. · Centro de Diagnóstico de Histopatología Bucal, Universidad Autónoma, Metropolitana-Xochimilco. · Rev Med Inst Mex Seguro Soc. · Pubmed #16138452 No free full text.

Abstract: We carried out a retrospective study on non-neoplastic enlargement of the salivary glands at the Oral Histopathology Diagnostic Center of the Autonomous Metropolitan University at Xochimilco (UAM-Xochimilco) in Mexico during a period of 24 years (1979-2003). From 5,625 biopsies received and analyzed, a total of 461 (8.2%) were non-neoplastic enlargement of the salivary glands; for each case, we registered demographic data as well as clinic characteristics. These lesions were characterized as a heterogeneous group of pathologic entities among which we included local, obstructive, infectious, and immunopathologic lesions. The most frequent lesion was the extravasation cyst in 341 (74%) cases, followed by chronic sialoadenitis and Sjögren's syndrome with 54 (11.7%) and 41 (8.8%) cases, respectively, and at a lesser percentage mucous retention cyst, sialosis, benign lymphoepithelial lesions and those related with sialolytes. Females were affected more frequently; mean age was second to third life decades. These lesions were most frequently localized on inferior labial mucosa.

Rodríguez-Reyna TS, Alarcón-Segovia D. · Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. · Autoimmunity. · Pubmed #16126510 No free full text.

Abstract: The presence of autoimmune rheumatic diseases in several members of the same family, the concurrence of autoimmune rheumatic with non-rheumatic diseases in relatives of patients, the presence of autoantibodies in sera from healthy relatives of autoimmune-disease patients, the development of two or more autoimmune rheumatic diseases in one patient and the interplay of genetic and environmental factors leading to the presence of several autoimmune disease and/or their autoantibodies in families, is being termed "shared autoimmunity". Herein we analyzed autoimmune rheumatic overlap syndromes in this context. We performed a retrospective analysis of the clinical, serological and radiological characteristics of patients with overlap syndromes from the Clinic of Rheumatic Diseases at the Department of Immunology and Rheumatology of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. We found 23 patients with overlap syndromes; 13 patients with rhupus, 5 with sclerodermatomyositis, 3 with scleroderma and SLE, one with sclerodermatomyositis and SLE and one with scleroderma and MPA. Rhupus tends to develop sequentially while sclerodermatomyositis tends to appear simultaneously. The other overlap syndromes are less common and their clinical course is rather aggressive, although clinical manifestations respond to standard treatment. The second and/or third disease appears while the first one is still active, even with adequate treatment. The coexistence of autoimmune rheumatic diseases may be partially explained by the interplay of environmental factors with genes that predispose to autoimmunity in general and to manifestations of specific diseases. This is part of the concept of Shared Autoimmunity.

Alarcón-Segovia D. · Department of Medicine and Immunology, Universidad Nacional Autónoma de México, Mexico, 14000 D.F, Mexico. · Autoimmunity. · Pubmed #16126507 No free full text.

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Téllez-Zenteno JF, Cardenas G, Estañol B, Garcia-Ramos G, Weder-Cisneros N. · Department of Neurology, Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Delegacion Tlalpan, Mexico. · Eur J Neurol. · Pubmed #15525299 No free full text.

Abstract: To compare the response of thymectomy in patients with associated conditions (PWAC) and without associated conditions (PWOAC). Comparative, retrospective. 198 patients with the established diagnosis of myasthenia gravis who had a thymectomy between 1987 and 2000, and who were folowed up for at least 3 years. We formed two groups, one with associated conditions and the second without associated conditions. The patients were divided into four groups: (i) patients in remission, (ii) patients with improvement, (iii) patients without changes, and (iv) patients whose condition worsened. Associated conditions (AC) were found in 49 patients (26%). The main associated conditions were hyperthyroidism in 16 patients (33%) hypothyroidism in seven (14%), rheumatoid arthritis in five (10%) and hypothyroidism and Sjogren syndrome in three (6%). Concerning the response of thymectomy, 13 patients WAC showed remission (27%), vs. 54 patients WOAC (39%). Twenty patients WAC showed improvement (41%) vs. 46 WOAC (33%). Thirteen patients WAC had no changes (27%) vs. 37 WOAC (26%). Finally, in three patients WAC their condition worsened (6%) vs. three WOAC (2%). The response to thymectomy was high (69%) in both groups. We did not identify significant differences.

Sánchez-Guerrero J, Pérez-Dosal MR, Cárdenas-Velázquez F, Pérez-Reguera A, Celis-Aguilar E, Soto-Rojas AE, Avila-Casado C. · Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14000 México, D.F. Mexico. · Rheumatology (Oxford). · Pubmed #15509625 links to  free full text

Abstract: OBJECTIVE: To estimate the prevalence of Sjögren's syndrome (SS) in ambulatory patients attending a tertiary care centre, according to the American-European Consensus Group criteria, using a structured approach. METHODS: Three hundred patients from rheumatology and internal medicine clinics were randomly chosen. During the screening phase, a face-to-face interview, a screening questionnaire, a Schirmer-I test and a wafer test were carried out in all patients. During the second phase, patients with positive screening had confirmatory tests including fluorescein staining test, non-stimulated whole salivary flow and autoantibody testing. Confirmatory tests were also done in 13 patients with negative screening. In the last phase, lip biopsy was proposed to those patients who met pre-established criteria. RESULTS: Females constituted 79% of the study population. The mean age of the subjects was 42.8+/-15.7 yr. Two hundred and twenty patients (73%) had positive screening. Fifty-five (27%) out of 204 patients evaluated showed keratoconjunctivitis sicca and 28 (13%) out of 215 patients xerostomia. One hundred and sixty-eight patients met criteria for lip biopsy and it was performed in 80 subjects who accepted the procedure. Focal sialoadenitis was demonstrated in 39 patients (49%), but only 28 of them met criteria for SS. In total, 40 patients were classified as SS. The minimum prevalence of SS in the population studied was 13.3% (95% CI 9.5-17.1%). The structured approach used in this study allowed 24 (60%) undiagnosed cases of SS to be identified. CONCLUSION: SS is common among ambulatory patients attending a tertiary care centre and in most of them it is undiagnosed.

Ferro-Flores G, Hernández-Oviedo O, Arteaga de Murphy C, Tendilla JI, Monroy-Guzmán F, Pedraza-López M, Aldama-Alvarado K. · Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Km. 36.5 Carretera Mexico-Toluca, Ocoyoacac, Estado de Mexico, CP 52045, Mexico. · Appl Radiat Isot. · Pubmed #15388114 No free full text.

Abstract: Radiation synovectomy is an effective treatment in patients suffering from inflammatory-rheumatoid and degenerative joint diseases. The aim of this work was to examine the feasibility of preparing dysprosium-166 (166Dy)/holmium-166(166Ho) hydroxide macroaggregates ([166Dy]Dy/166Ho-HM) as an in vivo generator for radiation synovectomy evaluating whether the stability of 166Dy-HM and 166Ho-HM complexes is maintained when the daughter 166Ho is formed. The Monte Carlo (MCNP4B) theoretical depth dose profile for the in vivo [166Dy]Dy/166Ho generator system in a joint model was calculated and compared with that produced by 90Y, 153Sm and 166Ho. 166Dy was obtained by neutron irradiation of enriched 164Dy2O3 in a Triga Mark III reactor. Macroaggregates were prepared by reaction of [166Dy]DyCl3 with 0.5 M NaOH in an ultrasonic bath. [166Dy]Dy/166Ho-HM was obtained with radiochemical purity >99.5% and with the majority of particles in the 2-5 microm range. In vitro studies demonstrated that the radio-macroaggregates are stable in saline solution and human serum without a significant change in the particle size over 14 d, suggesting that no translocation of the daughter nucleus occurs subsequent to beta- decay of 166Dy. Biological studies in normal rats demonstrated high retention in the knee joint even 7 d after [166Dy]Dy/166Ho-HM administration. The Monte Carlo (MCNP4B) theoretical depth dose profiles in a joint model, showed that the in vivo [166Dy]Dy/166Ho generator system would produce 25% and 50% less radiation dose to the articular cartilage and bone surface, respectively, than that produced by 90Y or pure 166Ho in a treatment with the same therapeutic dose to the synovium surface. Despite that 153Sm showed the best depth dose profile sparing doses to healthy tissues, the use of 166Dy could provide the advantage of being applied in patients that cannot be reached within a few hours from a nuclear reactor and to produce less radiation exposure to the medical personnel during the radiopharmaceutical administration.

Gomez FE, Cassís-Nosthas L, Morales-de-León JC, Bourges H. · Department of Nutritional Physiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF, Mexico. · Eur J Clin Nutr. · Pubmed #15042131 No free full text.

Abstract: BACKGROUND: Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease characterized by inflammatory lymphocytic infiltration of the salivary glands, leading to dryness of the mouth (xerostomia). It has been postulated that xerostomia is the preceding stage for the development of alterations in taste acuity (dysgeusia) in this type of patients. OBJECTIVES: To determine detection and recognition thresholds to the 4 basic tastes (sweet, salty, sour and bitter) in pSS patients and compare them to a control group. To determine if the long-term consumption of chile peppers and spicy Mexican diets had an effect on the taste perception and acuity of the pSS patients. SETTING: This study was done in the Department of Food Science and Technology of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), a third-level hospital in Mexico City. SUBJECTS: The patient group consisted of 21 Mexican females (mean +/- s.d., age: 53.1 +/- 9.8 y) diagnosed with pSS (time of duration of the disease, 8.6 +/- 6.6 y, median 7 y, range 1-25 y) who were recruited at the outpatient service of the Department of Immunology and Rheumatology of the INCMNSZ. The control group consisted of 20 healthy nonsmokers age-matched Mexican women (50.3 +/- 11.9 y) most of them personnel of the INCMNSZ, and some friends and nonblood relatives to the patients (sisters-in-law) who volunteered to participate in the study. INTERVENTIONS: Detection and recognition thresholds were determined by the method of least noticeable differences on three occasions during three nonconsecutive days. Saliva production was determined by Saxon's test on two separate occasions. RESULTS: Although saliva production was severely reduced in pSS patients (1.35 +/- 0.55 ml/2 min, P<0.001) compared to controls (6.26 +/- 2.41 ml/2 min), all subjects recognized the 4 basic tastes when these were tested at suprathreshold concentrations. The detection thresholds for the sweet, sour and bitter tastes were higher in pSS patients, as well as the recognition thresholds for the salty, sour and bitter tastes. A relationship between time of evolution of the disease and saliva production with individual thresholds could not be established. CONCLUSIONS: pSS patients exhibited different degrees of dysgeusia depending on the taste being studied, that is, they were mildly dysgeusic for the sweet and salty tastes and clearly dysgeusic for the sour and bitter tastes. Although both pSS patients and controls had consumed 'typical Mexican diets' their entire lives, our results showed that the consumption of chile peppers and spicy foods did not have any effect on the taste perception and acuity of the pSS patients.

Lazcano-Ponce E, Angeles-Llerenas A, Alvarez-del Río A, Salazar-Martínez E, Allen B, Hernández-Avila M, Kraus A. · Dirección de Enfermedades Crónicas, Centro de Investigaciones en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), Secretaría de Salud (SSA), Cuernavaca, Morelos, Mexico. · Arch Med Res. · Pubmed #15036803 No free full text.

Abstract: BACKGROUND: Despite evidence that open communication concerning diagnosis of a disease substantially improves the doctor-patient relationship, in developing countries physicians often provide partial information. METHODS: We carried out a cross-sectional study with 379 physicians practicing at 11 hospitals in Mexico City and in the central Mexican state of Morelos to quantify their communication patterns with patients with cancer, HIV/AIDS, and rheumatoid arthritis. Communication patterns were defined as physician self-reported communication with patients with regard to their diagnosis, prognosis, and treatment. Logistic, ordinal, multivariate models were constructed for analysis. RESULTS: Assigning a high level of value to communication (odds ratio [OR] 5.5, 95% confidence interval [95% CI] 2.1-14.8), and bioethics training (OR 1.5, 95% CI 1.0-2.3) were principal predictors of explicit communication with cancer patients. We found a very strong association between explicit communication with HIV/AIDS patients and an accepting attitude of the physician toward death (OR 34.6, 95% CI 8.5-141.0). As for communication with rheumatoid arthritis patients, we observed an association between a very paternalistic attitude on the part of the physician (OR 6.8, 95% CI 1.9-24.1) and complete communication. CONCLUSIONS: In Mexico, physicians exercise power and authority over patients in an effort that they perceive as beneficial or preventing harm. In most cases, physicians do not seem to recognize or respect their patients' autonomy; therefore, communication is generally partial and vague. Our study established the need among physicians for bioethics and communication training. A discussion of this topic is necessary to transform the doctor-patient relationship and to establish a consensus for policies and norms for communication that benefits patients.