LES del anciano, a propósito de un caso clínico

Notas del editor

• #8: Smoking — Numerous epidemiologic studies indicate that tobacco smoking is overwhelmingly the most important risk factor for COPD. As an example, a retrospective cohort study (n = 8045) found that subjects who smoked cigarettes throughout a 25 year observation period were more likely than never smokers to develop COPD (36 versus 8 percent). Smoking tobacco through a Chinese water pipe (narghile) is also associated with an increased risk of COPD compared with never smoking (adjusted OR, 10.61; 95% CI, 6.89-16.34), challenging the assumption that filtering the tobacco smoke through water might be protective. Genetic influences may enhance an individual's susceptibility to the detrimental effects of cigarette smoke. This is supported by an observational study that found that bronchodilator responsiveness (a surrogate measure of risk for accelerated lung function decline) was increased among current or former smokers who had a first-degree relative with severe early-onset COPD, compared to current or former smokers who did not have such a relative. Smoking both tobacco and marijuana synergistically increases the risk of COPD and respiratory symptoms
• #9: Smoking — Numerous epidemiologic studies indicate that tobacco smoking is overwhelmingly the most important risk factor for COPD. As an example, a retrospective cohort study (n = 8045) found that subjects who smoked cigarettes throughout a 25 year observation period were more likely than never smokers to develop COPD (36 versus 8 percent). Smoking tobacco through a Chinese water pipe (narghile) is also associated with an increased risk of COPD compared with never smoking (adjusted OR, 10.61; 95% CI, 6.89-16.34), challenging the assumption that filtering the tobacco smoke through water might be protective. Genetic influences may enhance an individual's susceptibility to the detrimental effects of cigarette smoke. This is supported by an observational study that found that bronchodilator responsiveness (a surrogate measure of risk for accelerated lung function decline) was increased among current or former smokers who had a first-degree relative with severe early-onset COPD, compared to current or former smokers who did not have such a relative. Smoking both tobacco and marijuana synergistically increases the risk of COPD and respiratory symptoms
• #13: Varios estudios experimentales han demostrado la regulación positiva de factor tisular debido a la activación directa o indirecta de monocitos. El sistema inmune en el curso del envejecimiento sufre cambios morfológicos y funcionales continuamente y la capacidad para defender el organismo contra agentes patógenos externos disminuye, mientras que la respuesta de los autoantígenos aumenta9. En los últimos años han empezado a conocerse los cambios asociados al proceso de envejecimiento que sufren los individuos ancianos en su sistema inmunitario, proceso conocido como inmunosenescencia. Trabajos recientes han demostrado que las células del sistema inmunitario innato también presentan alteraciones en individuos de avanzada edad, lo que pone de manifiesto que tanto alteraciones del sistema inmunitario innato como adaptativo son importantes para explicar los cambios que sufren las personas ancianas en su inmunidad10. Estos cambios pueden contribuir a un curso atípico de la enfermedad o a la ocurrencia de otras enfermedades inflamatorias, además se ha evidenciado una reducción significativa en la proliferación de células T reguladoras y en la producción de factores de crecimiento de células B11, así como disminución en las subpoblaciones de células T CD4 y CD8 positivas y reducción de la expresión del correceptor CD28, cuya deficiencia se ha considerado como responsable de la pérdida de respuesta a los antígenos y mitógenos. Todos estos aspectos favorecen a la génesis del lupus de inicio tardío12.
• #17: S: 94% frente a 86% de los anteriores criterios) y especificidad similar (92% vs. 93%),
• #38: S: 94% frente a 86% de los anteriores criterios) y especificidad similar (92% vs. 93%)
• #50: Smoking — Numerous epidemiologic studies indicate that tobacco smoking is overwhelmingly the most important risk factor for COPD. As an example, a retrospective cohort study (n = 8045) found that subjects who smoked cigarettes throughout a 25 year observation period were more likely than never smokers to develop COPD (36 versus 8 percent). Smoking tobacco through a Chinese water pipe (narghile) is also associated with an increased risk of COPD compared with never smoking (adjusted OR, 10.61; 95% CI, 6.89-16.34), challenging the assumption that filtering the tobacco smoke through water might be protective. Genetic influences may enhance an individual's susceptibility to the detrimental effects of cigarette smoke. This is supported by an observational study that found that bronchodilator responsiveness (a surrogate measure of risk for accelerated lung function decline) was increased among current or former smokers who had a first-degree relative with severe early-onset COPD, compared to current or former smokers who did not have such a relative. Smoking both tobacco and marijuana synergistically increases the risk of COPD and respiratory symptoms
• #79: no hay estudios específicos para el tratamiento propio de LES del anciano, sin embargo, el tratamiento es similar independientemente de la edad del paciente. Es importante el manejo de comorbilidades ya que pueden aumentar el riesgo de recaídas, además del control de medicamentos debido a la predisposición de toxicidad en pacientes adultos mayores