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Psoriasis is a chronic, autoimmune, and inflammatory disease that affects 2% of the world's population. In recent years, it has been demonstrated that psoriasis confers a 25% increase in relative risk of cardiovascular disease, independent of factors such as hyperlipidemia, smoking, and obesity. The objective of this review was to analyze and describe the association between psoriasis and cardiovascular disease. In this review, we describe the epidemiological association of psoriasis and cardiovascular disease, pathophysiology, mechanisms, and its association with the well-known cardiovascular risk calculators. In addition, we describe diagnostic tools, such as imaging techniques and novel biomarkers, that are useful in the evaluation of atherosclerotic cardiovascular disease. Finally, we present different systemic therapies that are used in patients with psoriasis and their effect on atherosclerotic cardiovascular disease. This article provides an overview of the current literature on psoriasis and cardiovascular risk, which can be useful for primary care physicians in their daily clinical practice.
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Frontal fibrosing alopecia (FFA) is a cicatricial alopecia characterized by hairline recession. Multiple autoimmune pathologies have been reported in patients with FFA. Despite the fact that FFA etiology remains unknown, there has been described an association with autoimmune disorders probably caused by an altered activity of cytotoxic CD8 T lymphocytes. Moreover, other autoimmune pathologies develop TH1 and TH17 response. Genetics could be responsible, in part, for the role of multiple simultaneous autoimmune disorders. Herein, we describe a case of a female patient with vitiligo, lichen sclerosus, and autoimmune hypothyroidism who developed a pruritic band-like recession of the frontal hairline. More research is needed in this area since autoimmune events in these patients may not be a mere coincidence.
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Patients who are immunocompromised or have cognitive or physical disabilities are at a higher risk of being affected with infections such as crusted scabies. This is a rare skin hyperinfestation by Sarcoptes scabiei var. hominis. The main characteristic of this dermatosis is a thick crust due to the high concentration of mites; in addition, other manifestations such as papules, excoriations, and burrows may be absent. In severe cases, thick yellow-brown crusts and plaques with deep fissures are present. Diagnosis can be made by observing mites, ova, or feces from skin scrapings. Multiple therapies can be used in patients with this condition. Management with patient isolation is important to prevent institutional outbreaks. This disease can have high mortality, primarily due to sepsis. Awareness of this condition and its serious consequences is important to reduce its mortality and morbidity.
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Sarcoptes scabiei/crecimiento & desarrollo , Escabiosis/diagnóstico , Escabiosis/patología , Piel/patología , Piel/parasitología , Adulto , Animales , Femenino , HumanosRESUMEN
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Chronic inflammation and traditional risk factors increase cardiovascular risk (CVR) in these patients. Several CVR calculators are used in general population and in RA patients to predict cardiovascular outcomes and tailor therapy but the precision of these calculators in RA patients has yet to be determined. The aim of this study is to determine which risk calculator correlates best with carotid ultrasound (US) findings, specifically carotid plaque (CP) and carotid intima-media thickness (CIMT) in RA patients without clinical manifestations. This was a cross-sectional observational study relating CVR scores in RA patients with the presence of carotid US findings. A total of 97 patients 40 to 75 years old who fulfilled the 2010 ACR/EULAR and/or the 1987 ACR classification criteria for RA were selected. Clinical assessment of cardiovascular risk was performed using seven calculators and carotid US measurement of intima-media thickness and plaque. The tests with the highest sensitivity for CIMT were the Framingham BMI, Framingham lipids, ACC/AHA 2013, and QRISK2. In CP, the highest sensitivity was in QRISK2, SCORE, and ACC/AHA 2013. RA patients should be comprehensively evaluated to detect cardiovascular risk. Carotid US may be routinely recommended to detect subclinical atherosclerosis in RA patients. A lower cutoff point in CVR scales may be necessary to identify patients with a low and intermediate CVR to detect subclinical atherosclerosis earlier and personalize therapy.
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Artritis Reumatoide/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Adulto , Anciano , Índice de Masa Corporal , Enfermedades Cardiovasculares/etiología , Enfermedades de las Arterias Carótidas/etiología , Estudios Transversales , Diabetes Mellitus Tipo 2 , Femenino , Humanos , Lípidos/sangre , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
Patients with rheumatoid arthritis (RA) have a high risk for comorbid conditions which increase mortality, hospital admissions, costs of care and inability. To evaluate the prevalence of comorbidities in Mexican mestizo patients with RA and determine the associated risk factors. Cross-sectional study in which RA patients admitted to our outpatient clinic were consecutively enrolled. We collected data regarding demographics, disease characteristics and comorbidities at the time of the patient's visit to the clinic. We analyzed 225 patients. Their mean age was 55.7 ± 8.3 years; disease duration, 9.5 (3.8-15.5) years; female gender, 93.8%; Disease Activity Score using 28 joints-C-reactive protein, 3 (2-4); methotrexate use, 84.9%; use of any other conventional disease modifying anti-rheumatic drug, 65.7%; use of biological agents, 8%. The most frequently associated diseases were: hypertension, 29.8%; dyslipidemia, 27.1%; osteoporosis, 19.1%; diabetes, 12.4%; hypothyroidism, 6.2%; solid malignancies 4.4%. Risk factors were also evaluated, the most prevalent was overweight in 101 (44.9%) of our patients. A total of 71 (31.6%) had obesity. We also detected high blood pressure in 12.4%, hyperglycemia in 27.1% and hyperlipidemia in 49.8%. Due to the high frequency of comorbidities among RA patients, it is important to follow existing recommendations for their timely detection and management. Cardiovascular diseases must be evaluated with priority. The initial evaluation should include a thorough examination to prevent the deleterious effect of comorbidities in RA.
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Artritis Reumatoide/etnología , Indígenas Norteamericanos , Adulto , Anciano , Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
Variability of the 10-year cardiovascular (CV) risk predicted by the Framingham Risk Score (FRS) using lipids, FRS using body mass index (BMI), Reynolds Risk Score (RRS), QRISK2, Extended Risk Score-Rheumatoid Arthritis (ERS-RA), and algorithm developed by the American College of Cardiology and the American Heart Association in 2013 (ACC/AHA 2013) according to the European League Against Rheumatism (EULAR) 2015/2016 update of its evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis (RA) has not been evaluated in Mexican mestizo patients. CV risk was predicted using six different risk calculators in 116 patients, aged 40-75, who fulfilled the ACR/EULAR 2010 classification criteria. Results were multiplied by 1.5 according to the EULAR 2015/2016 update. Global comparison of the risk predicted by all scales was done using the Friedman test, considering a P value of ≤0.05 as statistically significant. Individual comparison between the algorithms was made using the Wilcoxon signed-rank test, and a P value of ≤0.003 was considered statistically significant. All calculators showed to be different in the Friedman test (p ≤ 0.001). Median values of predicted 10-year CV risk were 11.02% (6.18-17.55) for FRS BMI; 8.47% (4.6-13.16) for FRS lipids; 5.55% (2.5-11.85) for QRISK2; 5% (3.1-8.65) for ERS-RA; 3.6% (1.5-9.3) for ACC/AHA 2013; and 1.5% (1.5-4.5) for RRS. ERS-RA showed no difference when compared against QRISK2 (p = 0.269). CV risk calculators showed variability among them and cannot be used indistinctly in RA-patients.
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Artritis Reumatoide/complicaciones , Enfermedades Cardiovasculares/etiología , Anciano , Artritis Reumatoide/epidemiología , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Medición de Riesgo/métodosRESUMEN
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in rheumatoid arthritis (RA) patients. Guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA) 2013 and the Adult Treatment Panel III (ATP-III) differ in their strategies to recommend initiation of statin therapy. The presence of carotid plaque (CP) by carotid ultrasound is an indication to begin statin therapy. We aimed to compare the recommendation to initiate statin therapy according to the ACC/AHA 2013 guidelines, ATP-III guidelines, and CP by carotid ultrasound. We then carried out an observational, cross-sectional study of 62 statin-naive Mexican mestizo RA patients, aged 40 to 75, who fulfilled the 1987 or 2010 ACR/European League Against Rheumatism (EULAR) classification criteria. CP was evaluated with B-mode ultrasound. Cohen's kappa (k) was used to assess agreement between ACC/AHA 2013 guidelines, ATP-III guidelines, and the presence of CP, considering a p < 0.05 as statistically significant. Agreement was classified as slight (0.01-0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80), and an almost perfect agreement (0.81-1.00). Slight agreement (k = 0.096) was found when comparing statin recommendation between CP and ATP-III. Fair agreement (k = 0.242) was revealed between ACC/AHA 2013 and ATP-III. Comparison between ACC/AHA 2013 and CP showed moderate agreement (k = 0.438). ACC/AHA 2013 guidelines could be an adequate and cost-effective tool to evaluate the need of statin therapy in Mexican mestizo RA patients, with moderate agreement with the presence of CP by ultrasound.