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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of bisphosphonates has increased in recent years&#44; especially for the treatment of osteoporosis&#46; This circumstance&#44; together with the fact that these treatments are lengthy&#44; has resulted in the development of adverse effects&#58; osteonecrosis of the maxilla&#44; bone and muscle pain&#44; atrial fibrillation&#44; atypical fractures or ocular inflammatory disorders&#46; The latter include conjunctivitis&#44; uveitis &#40;most frequently&#44; anterior uveitis&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and episcleritis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 51-year-old woman with a history of hypothyroidism&#44; tension headache&#44; polymyalgia rheumatica and a posteriori clinical suspicion of temporal arteritis with a negative biopsy&#44; worsening polyarthralgia and back pain&#46; Treatment consisted of an intermittent prednisone regimen with doses ranging between 1 and 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#46; She underwent a lateral radiograph of the spine&#44; which focused on thoracic vertebra T8 and lumbar vertebra L2 and&#44; as there was reasonable clinical suspicion of vertebral fracture &#40;back pain of recent onset and height loss of 2<span class="elsevierStyleHsp" style=""></span>cm in a postmenopausal woman who had received several regimens of glucocorticoids at doses higher than 7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#41;&#44; treatment with ibandronic acid was begun&#46; Approximately 4 months after the initiation of treatment&#44; she presented with ocular discomfort consisting of pain and conjunctival erythema&#44; and was referred to the ophthalmology department&#44; where she was diagnosed with anterior uveitis&#46; Oral glucocorticoid therapy was discontinued and treatment with eye drops containing dexamethasone was begun&#46; The patient was then referred to the rheumatology department&#44; where an autoimmune origin of her condition was ruled out and treatment with bisphosphonates was discontinued&#44; whereas the ophthalmological treatment was maintained&#46; In subsequent visits&#44; a progressive improvement of the anterior uveitis was observed and she chose not to continue with follow-up&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There have been several reports of ocular inflammatory events in patients taking oral bisphosphonates&#44; suggesting that these ocular effects are underdiagnosed&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Only 1 epidemiological study has examined the risk of scleritis and uveitis associated with the use of oral bisphosphonates&#58; a 1-year follow-up of a cohort of United States veterans&#46; The relative risk of scleritis and uveitis was 1&#46;23 higher among the users of bisphosphonates&#44; but this finding was not statistically significant&#46; Only 9 cases were recorded among the participants taking these drugs for the first time&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The majority of the cases of scleritis and uveitis developed after use of the bisphosphonate was begun and resolved when it was discontinued&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> although reports of recurrent uveitis after renewed treatment with pamidronate corroborate the causal relationship&#44; indicating that the use of bisphosphonates&#44; as a class&#44; may increase the risk of uveitis&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Anterior uveitis is usually bilateral and can be associated with fever and flu-like symptoms&#59; it can be mild or severe&#44; and recurs if the use of topical glucocorticoids is reduced&#46; Scleritis may resolve with topical ocular medication&#44; with no need to discontinue bisphosphonate therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding the pathophysiology&#44; inflammatory mediators are thought to play a major role in provoking a mechanism for induction of the inflammatory response&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> although&#44; in reality&#44; the mechanism is still not clear&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The risk of developing ocular disorders associated with the use bisphosphonates is very low&#46; Patients receiving this treatment should undergo an ophthalmological examination if they note a persistent loss of vision or ocular pain&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> as both uveitis and scleritis require immediate treatment to prevent additional complications such as cataracts&#44; glaucoma&#44; macular edema and scleral perforation&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Clinicians should inform their patients of the signs and symptoms of scleritis and uveitis in order that these diseases be detected and treated rapidly&#46; Patients taking oral bisphosphonates should be aware of these signs and symptoms so that they can be evaluated immediately by an ophthalmologist&#46;</p></span>"
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Letter to the Editor
Uveitis Due to Bisphosphonates: A Rare Side Effect?
Uveítis por bisfosfonatos: ¿un raro efecto secundario?
Sonia Martín Guilléna,
Corresponding author
kiaras24@hotmail.com

Corresponding author.
, Robert Hurtado Garcíab, Antonio Álvarez Cienfuegosc
a Medicina Familiar y Comunitaria, Hospital Vega Baja, Orihuela, Alicante, Spain
b Servicio de Medicina Interna del Hospital Vega Baja, Orihuela, Spain
c Servicio de Medicina Interna, Sección de Reumatología, Hospital Vega Baja, Orihuela, Alicante, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of bisphosphonates has increased in recent years&#44; especially for the treatment of osteoporosis&#46; This circumstance&#44; together with the fact that these treatments are lengthy&#44; has resulted in the development of adverse effects&#58; osteonecrosis of the maxilla&#44; bone and muscle pain&#44; atrial fibrillation&#44; atypical fractures or ocular inflammatory disorders&#46; The latter include conjunctivitis&#44; uveitis &#40;most frequently&#44; anterior uveitis&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and episcleritis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 51-year-old woman with a history of hypothyroidism&#44; tension headache&#44; polymyalgia rheumatica and a posteriori clinical suspicion of temporal arteritis with a negative biopsy&#44; worsening polyarthralgia and back pain&#46; Treatment consisted of an intermittent prednisone regimen with doses ranging between 1 and 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#46; She underwent a lateral radiograph of the spine&#44; which focused on thoracic vertebra T8 and lumbar vertebra L2 and&#44; as there was reasonable clinical suspicion of vertebral fracture &#40;back pain of recent onset and height loss of 2<span class="elsevierStyleHsp" style=""></span>cm in a postmenopausal woman who had received several regimens of glucocorticoids at doses higher than 7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#41;&#44; treatment with ibandronic acid was begun&#46; Approximately 4 months after the initiation of treatment&#44; she presented with ocular discomfort consisting of pain and conjunctival erythema&#44; and was referred to the ophthalmology department&#44; where she was diagnosed with anterior uveitis&#46; Oral glucocorticoid therapy was discontinued and treatment with eye drops containing dexamethasone was begun&#46; The patient was then referred to the rheumatology department&#44; where an autoimmune origin of her condition was ruled out and treatment with bisphosphonates was discontinued&#44; whereas the ophthalmological treatment was maintained&#46; In subsequent visits&#44; a progressive improvement of the anterior uveitis was observed and she chose not to continue with follow-up&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There have been several reports of ocular inflammatory events in patients taking oral bisphosphonates&#44; suggesting that these ocular effects are underdiagnosed&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Only 1 epidemiological study has examined the risk of scleritis and uveitis associated with the use of oral bisphosphonates&#58; a 1-year follow-up of a cohort of United States veterans&#46; The relative risk of scleritis and uveitis was 1&#46;23 higher among the users of bisphosphonates&#44; but this finding was not statistically significant&#46; Only 9 cases were recorded among the participants taking these drugs for the first time&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The majority of the cases of scleritis and uveitis developed after use of the bisphosphonate was begun and resolved when it was discontinued&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> although reports of recurrent uveitis after renewed treatment with pamidronate corroborate the causal relationship&#44; indicating that the use of bisphosphonates&#44; as a class&#44; may increase the risk of uveitis&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Anterior uveitis is usually bilateral and can be associated with fever and flu-like symptoms&#59; it can be mild or severe&#44; and recurs if the use of topical glucocorticoids is reduced&#46; Scleritis may resolve with topical ocular medication&#44; with no need to discontinue bisphosphonate therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding the pathophysiology&#44; inflammatory mediators are thought to play a major role in provoking a mechanism for induction of the inflammatory response&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> although&#44; in reality&#44; the mechanism is still not clear&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The risk of developing ocular disorders associated with the use bisphosphonates is very low&#46; Patients receiving this treatment should undergo an ophthalmological examination if they note a persistent loss of vision or ocular pain&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> as both uveitis and scleritis require immediate treatment to prevent additional complications such as cataracts&#44; glaucoma&#44; macular edema and scleral perforation&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Clinicians should inform their patients of the signs and symptoms of scleritis and uveitis in order that these diseases be detected and treated rapidly&#46; Patients taking oral bisphosphonates should be aware of these signs and symptoms so that they can be evaluated immediately by an ophthalmologist&#46;</p></span>"
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Article information
ISSN: 21735743
Original language: English
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2020 August 29 18 47
2020 July 16 10 26
2020 June 31 17 48
2020 May 28 9 37
2020 April 27 28 55
2020 March 18 5 23
2020 February 1 0 1
2018 May 4 1 5
2018 April 47 13 60
2018 March 56 10 66
2018 February 24 7 31
2018 January 54 4 58
2017 December 27 7 34
2017 November 18 8 26
2017 October 22 6 28
2017 September 19 7 26
2017 August 19 4 23
2017 July 23 8 31
2017 June 38 9 47
2017 May 35 16 51
2017 April 21 7 28
2017 March 21 4 25
2017 February 20 14 34
2017 January 20 5 25
2016 December 58 18 76
2016 November 28 20 48
2016 October 41 18 59
2016 September 40 8 48
2016 August 41 8 49
2016 July 25 10 35
2016 April 2 15 17
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