RESUMO
The risk to develop rheumatoid arthritis (RA) has been associated with the presence of HLA-DRB1 alleles encoding the "shared epitope" (SE). Additionally, HLA-DRB1 alleles encoding an aspartic acid at position 70 (D70+ ) have been associated with protection against the development of RA. In this study we tested the association between either SE or D70+ and rheumatoid arthritis in Mexican Mestizos. We included 84 unrelated Mexican Mestizos patients with RA and 99 unrelated healthy controls. The HLA-typing was performed by PCR-SSO and PCR-SSP. We used the chi-squared test to detect differences in proportions of individuals carrying at least one SE or D70+ between patients and controls. We found that the proportion of individuals carrying at least one HLA-DRB1 allele encoding the SE was significantly increased in RA cases as compared to controls (p(c) = 0.0004, OR = 4.1, 95% CI = 2.2-7.7). The most frequently occurring allele was HLA-DRB1*0404 (0.161 vs 0.045). Moreover, we observed a significantly increased proportion of HLA-DRB1 SE+ cases with RF titers above the median (p = 0.005). Conversely, the proportion of individuals carrying at least one HLA-DRB1 allele encoding the D70+ was significantly decreased (p(c) = 0.004, OR = 0.4, 95% CI 0.2-0.7) among RA patients compared with controls. In conclusion, the SE is associated with RA in Mexican Mestizos as well as with the highest titers of RF.
Assuntos
Alelos , Artrite Reumatoide/genética , Predisposição Genética para Doença , Antígenos HLA-DR/genética , Polimorfismo Genético/genética , Adulto , Substituição de Aminoácidos/genética , Ácido Aspártico/genética , Epitopos/genética , Epitopos/imunologia , Feminino , Cadeias HLA-DRB1 , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Calcium crystal-associated diseases are still a challenge in clinical and basic science. Advances in understanding crystal formation and dissolution and crystal participation in inflammation are reported here. Studies on different methods of identification are reviewed, emphasizing the need for accurate and reproducible ways to study and diagnose calcium crystal-associated diseases. Reports of uncommon presentations are also described, including a controlled study on calcification of the ligamenta flava of the spine and a study involving 19 years of clinical follow-up of families with hydroxyapatite chondrocalcinosis with spondyloepiphyseal dysplasia. Studies on miscellaneous crystals are few. Two recent reviews are described on cholesterol crystal embolization syndrome and cryocrystalglobulinemia.
Assuntos
Condrocalcinose/patologia , Condrocalcinose/fisiopatologia , Apatitas/metabolismo , Pirofosfato de Cálcio/metabolismo , Colesterol/fisiologia , Condrocalcinose/diagnóstico , Crioglobulinas/fisiologia , Cristalização , Humanos , InflamaçãoRESUMO
AIM: To assess the utility of the chest roentgenogram (CR) in hospitalized patients in terms of its diagnostic and therapeutic influence on the clinician. DESIGN: A survey in a group of residents of internal medicine at a tertiary care teaching hospital was carried out. Two questionnaires were applied: one when a follow-up CR was ordered (inquiring about reasons for ordering the film, the likelihood that the CR would show changes and physician's therapeutic plan); the second questionnaire was applied after the CR was obtained (inquiring about how unexpected the CR finding was and its degree of influence on therapy). Both questionnaires were analyzed in regard to the CR interpretation by a radiologist. RESULTS: One hundred surveys were analyzed. CR ruled out the suspicion of a new pulmonary event (55% of cases) or of the worsening of a known lung disease (50%) as predicted by the physician. In turn, CR confirmed the absence of a new pulmonary event (92%), or the improvement/stabilization of the course of a known lung disease (92%), as predicted by the physician. Sixty-one percent of these CR had a definite influence on patients' treatment. CONCLUSION: CR in hospitalized patients is of practical benefit to physicians, mainly in avoiding overdiagnosis and unnecesary treatment to their patients.