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Barcelona, Spain

Gomez-Puerta J.A.,Arthritis Unit | Pons-Estel G.,Hospital Clinic
Current Rheumatology Reviews | Year: 2010

Osteonecrosis (ON) or avascular necrosis of bone is a well recognised complication in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). The pathogenesis of ON is probably multifactorial, of which abnormal hemostatic state such as the presence of antiphospholipid antibodies (aPL) may play an important role. In patients with aPL, bilateral involvement of femoral head is often found, but some patients follow an asymptomatic course. Atypical site ON (talus, vertebral, carpal lunate) and/or multiple ON (more than three bones affected) are not uncommon in patients with APS. HIV patients positive for aPL had also a higher risk for the development of ON. By definition, frank and sustained arthritis are not usually seen in patients with Primary APS. On the other hand, arthralgias are not uncommon. Other anecdotal features such as stress fractures have been reported to be associated with aPL. The management of patient with aPL and ON without venous or arterial thrombosis is still controversial. A high diagnostic suspicion is crucial in order to prevent the onset of ON in new territories and to avoid the need of joint replacement. © 2010 Bentham Science Publishers Ltd.

Cabrera-Villalba S.,Arthritis Unit | Sanmarti R.,Arthritis Unit
International Journal of Clinical Rheumatology | Year: 2013

Palindromic rheumatism (PR) is characterized by acute, usually monoarticular, arthritis occurring intermittently and lasting for a few days. A significant number of patients with PR develop chronic rheumatic disease, especially rheumatoid arthritis (RA). There remains controversy as to whether PR is a disease entity in itself, or just a preclinical or abortive form of RA. Recently, a high frequency of anticitrullinated peptide/protein antibodies, the most specific biomarkers of RA, have been found in serum from PR patients, further strengthening the link with RA. However, although rheumatoid factor and anticitrullinated peptide/protein antibodies positivity are predictors of progression to RA in PR, a significant number of patients with these autoantibodies do not develop RA after a long follow-up. No controlled clinical trials have been carried out in PR and the treatment and management is still empirical. This review exhaustively analyzes and updates the epidemiological, clinical, diagnostic, prognostic and therapeutic aspects of PR, an entity that remains somewhat enigmatic and poorly treated in rheumatology texts. © 2013 Future Medicine Ltd.

Malakoutikhah M.,CSIC - Institute of Advanced Chemistry of Catalonia | Gomara M.J.,CSIC - Institute of Advanced Chemistry of Catalonia | Gomez-Puerta J.A.,Arthritis Unit | Sanmarti R.,Arthritis Unit | Haro I.,CSIC - Institute of Advanced Chemistry of Catalonia
Journal of Medicinal Chemistry | Year: 2011

Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation and, in many cases, destruction of the joints. To prevent progressive and irreversible structural damage, early diagnosis of RA is of paramount importance. The present study addresses the search of new RA citrullinated antigens that could supplement or complement diagnostic/prognostic existing tests. With this aim, the epitope anticitrullinated vimentin antibody response was mapped using synthetic peptides. To improve the sensitivity/specificity balance, a vimentin peptide that was selected, and its cyclic analogue, were combined with fibrin- and filaggrin-related peptides to render chimeric peptides. Our findings highlight the putative application of these chimeric peptides for the design of RA diagnosis systems and imply that more than one serological test is required to classify RA patients based on the presence or absence of ACPAs. Each of the target molecules reported here (fibrin, vimentin, filaggrin) has a specific utility in the identification of a particular subset of RA patients. © 2011 American Chemical Society.

Hernandez M.V.,Arthritis Unit | Sanmarti R.,Arthritis Unit | Canete J.D.,Arthritis Unit
Expert Opinion on Drug Safety | Year: 2016

Introduction: Tumor necrosis factor inhibitors (TNFi) were the first biologic therapy authorized for rheumatoid arthritis (RA) treatment and are currently the most used biological drugs in these patients. Although clinical efficacy is proven, adverse events associated with these agents have been described, and further knowledge is essential to facilitate detection at very early stages.Areas covered: We reviewed the safety profile of TNFi, including both articles and congress communications published on this topic, such as clinical trials, meta-analyses, observational studies, data from registries, and spontaneous clinical reports. We classified studies according to the most common and relevant adverse events associated with TNFi.Expert opinion: There is a broad spectrum of possible adverse events associated with TNFi treatment, ranging from mild to serious, and with diverse clinical manifestations. However, most adverse events may be minimized by appropriate screening before starting treatment and with ongoing surveillance to ensure an early diagnosis. In conclusion, TNFi have a reasonable safety profile, and, globally, the benefits far outweigh the possible risk of adverse events, especially compared with the risk of the untreated underlying inflammatory condition. © 2016 Informa UK Limited, trading as Taylor & Francis Group.

Hernandez M.V.,Arthritis Unit | Sanmarti R.,Arthritis Unit | Canete J.D.,Arthritis Unit | Descalzo M.A.,Spanish Society of Rheumatology | And 3 more authors.
Arthritis Care and Research | Year: 2013

Objective. To analyze the incidence rate (IR) and risk factors of cutaneous adverse events (CAE) in patients with chronic inflammatory rheumatic diseases treated with tumor necrosis factor (TNF) antagonists. Methods. We analyzed all patients from the BIOBADASER (Base de Datos de Productos Biológicos de la Sociedad Española de Reumatología) registry treated with a TNF antagonist (infliximab, etanercept, or adalimumab). Data collected included age, sex, diagnosis and duration of rheumatic disease, type of TNF antagonist, and concomitant treatment. Type of CAE was classified as local or systemic cutaneous manifestation related to treatment administration (infusion reaction), infection, malignancy, or autoimmune skin disease. Time of onset of CAE and outcome were also recorded. The IRs of CAE per 1,000 patient-years of exposure with 95% confidence intervals (95% CIs) were estimated. Multivariable analysis was performed to identify potential risk factors for CAE. Results. A total of 5,437 patients were included, representing 17,330 patient-years of exposure. A total of 920 CAE were reported; the IRs per 1,000 patient-years were 53 (95% CI 50-57) for CAE, 28 (95% CI 25-30) for infection, 15 (95% CI 13-17) for infusion reactions, 5 (95% CI 4-6) for autoimmune skin diseases, and 3 (95% CI 2-4) for skin malignancy. The mean time between starting TNF antagonist treatment and CAE was 1.78 years. In 32% of patients, CAE required TNF antagonist withdrawal. The main risk factors for CAE were female sex and treatment with infliximab, leflunomide, and glucocorticoids. Conclusion. The IR of CAE in patients treated with TNF antagonists is significant and should be addressed carefully, and withdrawal of therapy is required in some cases. Copyright © 2013 by the American College of Rheumatology.

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