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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "621" "paginaFinal" => "622" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "‘Lesiones pulmonares vasculíticas’ – ¡No olvides el corazón!" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2135 "Ancho" => 2610 "Tamanyo" => 740385 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Contrast enhanced computed tomography of chest showed multiple irregular nodules in both lung with central cavitation and surrounding consolidation. 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"tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "623" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Raquel Viterbo de Freitas, Fátima Godinho" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Raquel Viterbo de" "apellidos" => "Freitas" "email" => array:1 [ 0 => "raquelvifreitas@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Fátima" "apellidos" => "Godinho" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Garcia de Orta, Rheumatology Department, Almada, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artritis reumatoide y enfermedad renal crónica en diálisis: ¿son los anti-TNF una opción?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The management of a patient with rheumatoid arthritis (RA) and chronic kidney disease (CKD) represents a recognized therapeutic dilemma. CKD is a limiting factor for the use of synthetic DMARD (disease modifying antirheumatic drugs) such as methotrexate, because of an increased risk of toxicity making them unsafe. Therefore, the availability of therapeutic alternatives would improve our treatment options in CKD patients with RA. Clinical studies addressing the efficacy and safety of biological DMARD in patients with CKD on dialysis are rare, and usually these patients are excluded from clinical trials. We only found a few clinical cases in the literature regarding the use of anti-TNF in patients with CKD undergoing dialysis.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–4</span></a> Therefore, we decided to report a clinical case of a patient with RA and CKD on hemodialysis that we successfully treated with an anti-TNF.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of a 71-year old women with RA with more than 15 years of disease duration. She was previously treated with methotrexate, which was interrupted by end-stage CKD, and hemodialysis was started. Disease activity was controlled for 2 years with low-dose prednisolone. However, due to clinical RA worsening (DAS-28 (Disease Activity Score-28) of 5.25) and development of an osteoporotic fracture, it was decided to modify the therapy to better control RA and tapper corticosteroid dose.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Anti-TNF agents are hydrolyzed by lysosomes and their excretion does not appear to be influenced by renal function.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,5</span></a> Thus, these agents are a possible therapeutic alternative in patients with CKD. There are some case series with a small number of patients that show efficacy and safety of Infliximab,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Adalimumab<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and Etanercept<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> in patients with CKD on dialysis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Based on these data, we decided to start Etanercept on monotherapy. Etanercept is usually used in RA at a dose of 50<span class="elsevierStyleHsp" style=""></span>mg once a week. In our patient, a 25<span class="elsevierStyleHsp" style=""></span>mg dose twice per week was chosen (injection after hemodialysis session). Although Don and collaborators demonstrated that hemodialysis did not affect Etanercept excretion,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> we decided to choose 25<span class="elsevierStyleHsp" style=""></span>mg twice a week instead of 50<span class="elsevierStyleHsp" style=""></span>mg once a week. At one year of follow-up, the patient has a good response (DAS-28 2.81) and there were no adverse events registered.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We present the first case of our center with the use of an anti-TNF in a patient undergoing hemodialysis, with good response and no adverse events. Anti-TNF drugs appear to be safe and effective in CKD under dialysis, however, clinical experience is still insufficient.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The efficacy and safety of etanercept in patients with rheumatoid arthritis and spondyloarthropathy on hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Senel" 1 => "B. Kisacik" 2 => "Y. Ugan" 3 => "T. Kasifoglu" 4 => "E. Tunc" 5 => "V. Cobankara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-011-1782-6" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2011" "volumen" => "30" "paginaInicial" => "1369" "paginaFinal" => "1372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21618077" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infliximab treatment in a patient with rheumatoid arthritis on haemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Hammoudeh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/kei264" "Revista" => array:6 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2006" "volumen" => "45" "paginaInicial" => "357" "paginaFinal" => "359" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16368727" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adalimumab treatmentin patients with rheumatoid arthritis with renal insufficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Sumida" 1 => "Y. Ubara" 2 => "T. Suwabe" 3 => "N. Hayami" 4 => "R. Hiramatsu" 5 => "E. Hasegawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Care Res" "fecha" => "2013" "volumen" => "65" "paginaInicial" => "471" "paginaFinal" => "475" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and efficacy of etanercept in Rheumatoid arthritis with end-stage chronic renal failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Mahmoud" 1 => "L. Gafsi" 2 => "R. Tekaya" 3 => "O. Saidane" 4 => "H. Sahli" 5 => "L. Abdelmoula" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2515/therapie/2015020" "Revista" => array:6 [ "tituloSerie" => "Therapie" "fecha" => "2015" "volumen" => "70" "paginaInicial" => "311" "paginaFinal" => "312" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25997838" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pharmacokinetics of etanercept in patents with end-stage renal disease on haemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.R. Don" 1 => "I. Nestorov" 2 => "M. Hutmacher" 3 => "A. Rose" 4 => "G.A. Kaysen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1211/jpp.57.11.0005" "Revista" => array:6 [ "tituloSerie" => "J Pharm Pharmacol" "fecha" => "2005" "volumen" => "57" "paginaInicial" => "1407" "paginaFinal" => "1413" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16259772" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001800000010/v1_202211240657/S2173574322001629/v1_202211240657/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001800000010/v1_202211240657/S2173574322001629/v1_202211240657/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574322001629?idApp=UINPBA00004M" ]
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