Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Pediatria/história , Reumatologia/história , ChileRESUMO
El inicio de la Reumatología en nuestro país data del año 1873 con la primera publicación dedicada a la especialidad, pero no es hasta el año 1944 con la creación de la primera clínica en que la Reumatología nace formalmente. El segundo hito es la creación de la Sociedad Chilena de Reumatología en 1950, que desde esa fecha se ha preocupado de mantener actualizada a la comunidad científica y como apoyo constante a los pacientes. Desde el punto de vista de las patologías observadas son diferentes las frecuencias en complejos de atención primaria versus complejos de atención terciaria. En el año 2007 se incorpora el sistema Auge, que otorga a pacientes con algunas patologías reumatológicas garantías de atención y tratamiento, incluyendo biológicos en algunos casos. Se intenta en este artículo dar una revisión general a la historia y actualidad reumatológica chilena.
The start of Rheumatology in our country dates back to 1873 with the first publication devoted to the specialty, but not until 1944 with the creation of the first clinic in Rheumatology that the specialty formally born, the 2nd milestone was the creation of the Chilean Society of Rheumatology in 1950 which since then, has been concerned for keeping the scientific community update and give an ongoing support to patients. From the point of view of the observed diseases there are different frequencies when we compare the primary care vs. tertiary care health systems. In 2007 the AUGE system starts. This system gives to patients with specific rheumatologic diseases warranty of attention and treatment, including biologics therapies in some cases. We attempted in this paper give an overview of the history and current Chilean Rheumatology.
Assuntos
Humanos , História do Século XIX , História do Século XX , História do Século XXI , Reumatologia/história , Chile/epidemiologia , Osteoartrite/terapia , Artrite Juvenil/terapia , Artrite Reumatoide/terapia , Sociedades Médicas/históriaRESUMO
Therapeutic management of the vasculitides is closely linked to modern rheumatologic advances, particularly as it relates to the discovery and first clinical use of glucocorticoids. These compounds were introduced in the late-1940s for the treatment of rheumatoid arthritis, but soon after, clinicians in Europe and the United States realized that they could have a significant positive impact in systemic vasculitides. However, once it was realized that glucocorticoid use was associated with a high degree of morbidity, the search for better immunosuppressive agents with similar efficacy but improved safety profiles was on. During the past several years, several agents have been utilized for the therapeutic management of systemic vasculitides, and the list keeps growing with the development of newer compounds that have retained efficacy but with a better safety profile.
Assuntos
Glucocorticoides/história , Imunossupressores/história , Reumatologia/história , Vasculite/história , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , História do Século XX , História do Século XXI , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Indução de Remissão , Vasculite/tratamento farmacológicoRESUMO
OBJECTIVE: Digital clubbing is regarded as the oldest clinical sign of medicine. The cause of this unique finger deformity has remained elusive throughout the centuries. For 3 decades our group has studied the etiology of this acropachy. This article reviews the current knowledge on the cause of digital clubbing. METHODS: PubMed database (www.pubmed.gov) was accessed. In clinical queries/clinical study service we entered "clubbing" or "hypertrophic osteoarthropathy," choosing the "etiology" category with a "broad sensitive" search scope. The time span was from January 1975 to August 2006. Additionally, this article narrates the chronology of our research on the pathogenesis of clubbing. RESULTS: The many dreadful internal illnesses associated with digital clubbing have in common enhanced platelet/endothelial cell activation. Emerging evidence suggests that, in hypoxic conditions with extrapulmonary shunting of blood, large megakaryocyte fragments fail to enter the pulmonary circulation. Instead they gain access to the systemic circulation impacting at the most distal sites, there releasing growth factors and thus inducing clubbing. In cases of lung cancer, the purported growth factor could gain direct entrance to the systemic circulation. Vascular endothelial growth factor (VEGF) may play a central role in the development of digital clubbing. It is a platelet-derived factor induced by hypoxia, and it is also abnormally produced by diverse malignant tumors fostering their uncontrolled growth. On the other hand VEGF produces vascular hyperplasia, edema, and fibroblast/osteoblast proliferation. Such are clubbing histologic characteristics. Enhanced VEGF expression has been reported in practically all internal illnesses associated with this type of finger deformity. Recent studies have demonstrated high circulating levels as well as increased local expression of VEGF in different groups of patients with digital clubbing. CONCLUSION: Abnormal expression of VEGF may be the cause of digital clubbing.