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Resumen La artritis psoriasica (APs) es una enfermedad inflamatoria sistemica cronica que afecta a la piel, las estructuras musculoesqueleticas y otros organos y sistemas, comprometiendo la funcionalidad, la calidad de vida y reduciendo la expectativa de vida de los pacientes. Es una enfermedad compleja que requiere atencion y manejo especializado y oportuno. Las alternativas para el tratamiento de las manifestaciones de la APs se han incrementado y, adicionalmente, el efecto de los distintos agentes sobre manifestaciones especificas ha sido aclarado en estudios recientes, por lo tanto, es conveniente incorporar la evidencia disponible para construir una estrategia en el tratamiento de estos pacientes. El Colegio Mexicano de Reumatologia selecciono una comision para evaluar estas distintas alternativas y generar recomendaciones. Metodos El grupo de estudio incluyo a 16 reumatologos y tres dermatologos certificados, que fueron seleccionados de diferentes instituciones de salud y regiones del pais. Se conformo un comite ejecutivo que coordino las reuniones y un comite de expertos que selecciono los criterios de busqueda en la literatura, elaboro las preguntas de investigacion, califico la calidad de la evidencia y genero las recomendaciones en los distintos dominios de la enfermedad con base en la metodologia GRADE. Resultados Se generaron 24 recomendaciones actualizadas para el tratamiento de pacientes con APs. Las recomendaciones establecen el papel de los medicamentos disponibles actualmente en nuestro pais. Se enfatiza la importancia del control adecuado de la enfermedad, individualizando el perfil de involucramiento de cada paciente en cada uno de los seis dominios potencialmente afectados por la enfermedad. Ademas, se establece la secuencia en la eleccion de los tratamientos disponibles para cada dominio, basada en su eficacia, perfil de seguridad y accesibilidad. Conclusiones Con este documento de consenso se podra mejorar la atencion de los pacientes con APs. Las recomendaciones se generaron de acuerdo con la mejor informacion disponible y en consideracion del sistema de salud de Mexico.

Psoriatic arthritis is a chronic systemic inflammatory disease that affects the skin, musculoskeletal structures and other organs and systems compromising functionality, quality of life and reducing the life expectancy of patients. It is a complex disease that requires specialist and timely care and management. The alternatives for treating the manifestations of psoriatic arthritis have increased and the effect of the different agents on specific manifestations has been clarified in recent studies. Therefore, we should incorporate the available evidence to build a strategy for the treatment of these patients. The Mexican College of Rheumatology selected a committee to evaluate these different alternatives and make recommendations. Methods The study group included 16 rheumatologists and 3 certified dermatologists, selected from different health institutions and regions of the country. An executive committee was formed to coordinate the meetings and a committee of experts selected the literature search criteria, prepared the research questions, rated the quality of the evidence, and produced the recommendations in the different disease domains based on the GRADE methodology. Results 24 updated recommendations were generated for the treatment of patients with psoriatic arthritis. The recommendations establish the role of the drugs currently available in our country. The importance of adequate disease control is emphasized, individualizing the level of involvement of each patient in each of the six domains potentially affected by the disease. In addition, the sequence in the choice of treatments available for each domain is established, based on their efficacy, safety profile and accessibility. Conclusions With this consensus document, it will be possible to improve the care of patients with psoriatic arthritis. The recommendations were generated based on the best available information and in consideration of the Mexican health system.

Introduction The risk of infection in systemic lupus erythematosus (SLE) is associated with factors related to disease activity and immunosuppressive treatment. Recently, the persistence of asymptomatic bacteriuria (ASB) has been proposed as an environmental trigger for SLE and its flares, raising the question whether it should be treated systematically to reduce the risk of infection. To our knowledge, there is limited evidence on the screening and treatment of ASB in SLE. Objective The objective is to analyze the occurrence of infection and flare in patients with lupus nephritis with and without ASB. Methods A cross-sectional study of a cohort of patients with lupus nephritis during induction therapy with high-dose cyclophosphamide regimen was carried out between January 2018 and 2020, with a total of 37 patients investigated. Urine and blood samples from the two groups (with ASB and without ASB) where taken before the administration of cyclophosphamide. Results From the sampled 37 patients, 19 (51.4%) had ASB and 18 (48.6%) without ASB; both groups were well balanced in their demographics and clinical characteristics. No statistically significant association was found between the presence of ASB and the systemic lupus erythematosus disease activity index score ( p = 0.604), and neither with the 24-h urine protein and leukocyte count ( p > 0.177). Urinary tract infection occurred in 5.3% (1) of the patients with ASB, while 5.6% (1) of the patients in the group without ASB presented the infection, and the RR was 0.944 (0.06, 16.33) 95% CI; in addition, no statistically significant association was found between the presence of ASB and the occurrence of infection ( p = 1,000). Conclusion Our study did not find a statistically significant association of ASB with the occurrence of infection or disease activity. Further studies need it to clarify this, since treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance.

La granulomatosis con poliangeítis es una vasculitis de pequeños vasos asociada a la presencia de anticuerpos anticitoplasma de neutrófilos, con manifestaciones cardíacas que son poco frecuentes, como pericarditis, miocarditis, arteritis coronaria y enfermedad valvular. Reportamos el caso de un paciente de 49 años con reciente diagnóstico de granulomatosis con poliangeítis, quien presentó infarto agudo del miocardio. Se consideró la actividad de la enfermedad como causa del infarto. Las manifestaciones clínicas cardiovasculares en la granulomatosis con poliangeítis son relevantes por ser marcadores de mal pronóstico.Granulomatosis with polyangiitis is a small vessel vasculitis associated to anti-neutrophil cytoplasmic antibodies, in which the cardiac manifestations are not common, as pericarditis, cardiomyopathy, coronary artery disease and vascular disease. We report a clinical case of a 49-year-old man with a recent diagnosis of granulomatosis with polyangiitis, he presented myocardial infarction. Disease activity was considered the cause of myocardial infarction. Cardiovascular clinical manifestations in granulomatosis with polyangiitis are relevant because are markers of poor prognosis.