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La espondilitis anquilosante, cau= sas y diagnóstico. Una revisión sistemática <= /span>

Ankylosing spondylitis, causes and diagnosis. A systematic revie= w

¹	Geovanny German Cańar Lascano=	https://orcid.org/0000-0003-3424-3740=
	Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador geovanny.canar@cu.ucsg.edu.ec=
²	Alberto Sper Sempértegui=	https://orcid.org/ 0000-0003-4793-97= 04
	Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador alberto.sper@cu.ucsg.edu.ec
³	Juan Gonzalo Fernández Villarroel	https://orcid.org/0000-0002-2037-565= 7
	Investigador Independiente, Ecuador jfshapes@hotmail.co.uk

=	Artículo de Investigación Científica y Tecnológica Enviado: 13/12/2021 Revisado: 29/12/2021 Aceptado: 28/01/2022 Publicado:05/02/2022 DOI: https://doi.org/10.33262/ap.v4i1.1.170
<= span style=3D'font-size:12.0pt;line-height:115%;font-family:"Times New Roman",= serif; mso-fareast-font-family:Calibri;color:blue'>
Cítese:		Chenche Jácome, W. L., & Posligua Espinoza, J. E. (2022). Utilización de la T= IC en los métodos tecno pedagógicos que inciden en la gestión docente . AlfaPublicaciones, 4(1.1), 448–472. https://doi.org/10.33262/= ap.v4i1.1.170
		ALFA PUBLICACIONES, es una Revista Multidisciplinar, Trimestral, que se public= ará en soporte electrónico tiene como misión contribuir a la &nbs= p; formación de profesionales competentes con visión humanística y crítica q= ue sean capaces de exponer sus resultados investigativos y científicos en la misma medida que se promueva mediante su intervención cambios positivos e= n la sociedad. https://alfapublicaciones.= com <= span style=3D'font-size:8.0pt;line-height:115%;font-family:"Times New Roman",s= erif; mso-fareast-font-family:Calibri'>La revista es editada por la Editorial Ciencia Digital (Editorial de prestigio registrada en la Cámara Ecuatoria= na de Libro con No de Afiliación 663) www.celibro.org.ec<= /a>
		Esta revista está protegida bajo una licencia Creative Commons Attribution Non Commercial No Derivatives 4.0 International. Copia de la licencia: http://creativecommons.org= /licenses/by-nc-nd/4.0/
Palabras claves: Espondilitis anquilosante, cal= idad de vida, genética, dolor, inflamación.		Resumen La espondilitis anquilosante es una artritis que se caracteriza por presentar inflamación crónica y las articulaciones se van degenerando, que afecta en gran proporción la columna vertebral y la articulación sacro ilíaca, esta enfermedad es más común que se presente en hombre que en mujeres, alreded= or de los 20 a 30 ańos, afectado la calidad de vida de los individuos, y generando malestar y limitación de su movilidad. El objetivo de esta investigación es describir las causas y el diagnóstico de la espondilitis anquilosante a través de una revisión sistemática. Como conclusión se menciona que, es evidente que existe una gran variedad de afecciones que = pueden estar asociadas con la EA, sin embargo, se observa la coincidencia que un= a de las principales consecuencias que genera esta enfermedad es el deterioro = de la calidad de vida de los individuos que padecen esta y otras enfermedades durante su vida, y que repercuten en el comportamiento psicológico de los mismos. Es importante destacar que se debe seguir realizando análisis y estudios genéticos y de casos de pacientes con esta patología que permita determinar de forma más clara las causas que generan esta enfermedad y la prevalencia de la misma en los individuos, así como poder determinar posi= bles nuevos tratamientos que permitan mejorar en gran medida los síntomas, com= o el dolor, la inflamación y la rigidez para que las personas con esta enferme= dad puedan realizar sus actividades sin depender de la ayuda de otras persona= s.
Keywords:= Ankylosing spondylitis, quality of life, genetic= s, pain, inflammation.		Abstr= act Ankylosing spondylitis is an arthritis that is characterized by chronic inflammation and the joints degenerate, which affects a large proportion of the spine and the sacroiliac joint, this disease is more common in men than in women, around the 20 to 30 years, affected the quality of life of individuals, and generating discomfort and limitation of their mobility. The objective of this research is to descri= be the causes and diagnosis of ankylosing spondylitis through a systematic review. In conclusion, it is mentioned that it is evident that there is a great variety of conditions that may be associated with AD, however, the coincidence is observed that one of the main consequences generated by th= is disease is the deterioration of the quality of life of individuals. who suffer from this and other illnesses during their lives, and which have repercussions on their psychological behavior? It is important to note th= at genetic analyzes and studies and case studies of patients with this patho= logy should continue to be carried out in order to more clearly determine the causes that generate this disease and its prevalence in individuals, as w= ell as to be able to determine possible new treatments. that greatly improve symptoms such as pain, swelling and stiffness so that people with this disease can carry out their activities without relying on the help of oth= ers. =

Introducción

La anatomía humana es compleja, y está conformada por células, músculos, nervios y huesos que le dan forma a = cada una de las partes del organismo. Uno de los elementos que conforma el cuerpo humano es la columna vertebral, la cual es una estructura igualmente comple= ja, que está ubicada en la parte medio y posterior del tronco que va desde el h= ueso occipital y termina en la pelvis (Rodríguez & Pérez, 2021).<= /span>

De igual manera, la estructura d= e la columna es osteofibrocartilaginosa y sus funciones principales son sostener= y soportar la cabeza, proteger el cordón medular, y las raíces nerviosas que = de ella emergen, resguarda órganos como el corazón y los pulmones, es el centr= o de gravedad del cuerpo humano pues permite la movilidad y flexibilidad del cue= rpo, otras funciones biomecánicas que se mencionan es que representa el al poder soportar la mitad superior del cuerpo representa un 60% del peso total del individuo (Sierra et al., 2018; Sinchiguano, 2018).

Esta estructura en los hombres p= osee una longitud de 70 cm y en las mujeres de 60 cm, es resistente y flexible y está conformada por vertebras, dispuestas una sobre otras que permiten sost= ener la cabeza, la caja torácica, los miembros superiores manteniendo el equilib= rio y transmite el peso a los miembros inferiores (Chiriboga, 2010).=

Asimismo, Sierra et al. (2018), menciona que la columna vertebral presenta dos pares de curvaturas fisiológ= icas que se muestran en la figura 1:

Figura 1

Curvaturas de la Columna Verte= bral

Fuente: Sierra et al. (2018)

En referencia a la figura anteri= or se menciona que estas curvaturas propias de la columna son de gran importan= cia y permiten relacionarlas con diversas patologías que puede presentar el ser humano, y que de acuerdo a las curvaturas se puede distinguir la edad, la m= asa corporal y hasta el género del individuo.

La columna vertebral posee entre= 33 a 34 vertebras (ver figura 2) y se dividen de la siguiente manera:

· = 7 Cervicales (C1-C7)

· = 12 Torácicas (T1-T7)

· = 5 Lumbares (L1-L5)

· = 5 Sacras (S1-S5)

· = 3 a 5 Coccígeas (Sinchiguano, 2018)

Figura 2

Clasificación de las vertebras según su ubicación

Fuente: Espinoza (2017)

De esta manera Chiriboga (2010), menciona que:

Cada vertebra está conformada po= r un segmento abultado que se le denomina cuerpo vertebral un arco óseo de concavidad anterior conocido como arco vertebral. Éstos rodean un espacio llamado agujero vertebral, este arco vertebral está formado a cada lado por= dos pedículos en la porción anterior y por dos láminas en la posterior. Este ar= co óseo posee un saliente medio posterior, la apófisis espinosa, dos apófisis transversas y cuatro apófisis articulares. (p. 26)

En este sentido cada zona de la columna cumple una función específica, en el caso de la columna cervical por ejemplo, es la que posee mayor movilidad y permite que la cabeza se oriente= en distintas direcciones, su curvatura es la menos pronunciada y convexa hacia adelante, la C1 denominada atlas es más larga que el resto de las cervicale= s no posee cuerpo ni apófisis espinosa, por arriba se une con los cóndilos del h= ueso occipital del cráneo y por debajo se une con la siguiente vertebra (axis) (= C2) (ver figura 3) (Sinchiguano, 2018).

Figura 3

Verteb= ras atlas y axis

Fuente: Chiriboga (2010)

La vertebra C7 es la que se le denomina vertebra de transición Sinchiguano (2018), que posee una apófisis espinosa de gran longitud y una transversal, y que en conjunto con todas las demás vértebras cervicales realizan movimientos de extensión, flexión, rota= ción y latero flexión.

En la zona de la columna dorsal o torácica sus vertebras son más gruesas que las cervicales estas tienen form= a de corazón, las apófisis espinosas son inclinadas hacia abajo, y el agujero vertebral es pequeńo y con forma circular y están conformadas por facetas costales en las apófisis transversales que se unen de forma articulada en a= mbos lados con los tubérculos de las costillas (Chiriboga, 2010).

De firma más precisa se detallan= sus características descritas por Chiriboga (2010) así:

· = Los cuerpos son grandes y tienen forma= de rińón

· = La concavidad mira hacia el agujero vertebral triangular

· = Los pedículos son cortos, gruesos y rígidos hacia atrás.

· = Las láminas son cortas, gruesas y relativamente desiguales, extendiéndose por debajo del nivel de los pedícul= os.

· = Las apófisis transversas son largas y delgadas. (p.30)

En cuanto a la vértebras lumbares Sinchiguano (2018), menciona que están conformadas por 5 vertebras desde la= L1 a la L5 y están diseńadas para poder resistir la mayor parte del peso del cuerpo del individuo y se caracterizan por el volumen de la apófisis transversales y espinosas así como por la masa con la que están conformadas (ver Figura 4), además permite una movilidad de flexión (60ş), extensión (3= 5ş), latero flexión (20ş), rotación (5ş), asimismo el agujero vertebral es triangular en estas vertebras, tanto la L1 como la L5 poseen una estructura especial por ser las que se unen con la zona vertebral anterior y la siguie= nte respectivamente.

En referencia a la columna pélvi= ca, sus vertebras están fusionadas y conforman dos huesos denominados sacro y coxis, con respecto al sacro es de forma triangular donde se fusionan 5 vertebras sacras (S1 a S5), en el borde superior está ubicada una masa cent= ral que conforma la parte más anterior del sacro y es llamado promontorio o áng= ulo sacro vertebral (Sierra et al., 2018). Así mismo, posee cuatro orificios qu= e se ubican a cada lado del hueso sacro y a través de ellos pasan los nervios sacros, de igual manera en la zona lateral está ubicada la superficie artic= ular que se une con la pelvis y conforma la zona de la articulación sacroilíaca.=

La zona del coxis está conformada por cuatro vertebras fusionadas que forman un hueso triangular, su superfic= ie es cóncava y tiene la capacidad de flexionarse y extenderse, estos movimien= tos permiten la defecación y también durante el parto (Sinchiguano, 2018).=

De esta manera la columna verteb= ral también está conformada por ligamentos, articulaciones y sus discos intervertebrales (ver Figura 4), y es que dentro del organismo tiene un pro= ceso complejo, que puede sufrir diversas afecciones musculo esqueléticas, y algu= nas de ellas degenerativas que afectan y limitan con el paso del tiempo la movilidad de tanto de la estructura como del organismo causando hasta rigid= ez, generando cambios morfológicos evidentes y una de estas afecciones son las espondilo artropatías (Plischuk & Salceda, 2015).

Figura 4

Disco Intervertebral

Fuente: Chiriboga (2010)

En este sentido, se menciona que= una de las afecciones presentes en la columna vertebral es la espondilitis anqu= ilosante, la cual es una artritis que se caracteriza por presentar inflamación crónic= a y las articulaciones se van degenerando, que afecta en gran proporción la col= umna vertebral y la articulación sacroilíaca (Torres, 2019), asimismo las vérteb= ras afectadas por esta patología con el paso del tiempo se pueden unir.

Etimológicamente se menciona que según el diccionario médico de la Universidad de Salamanca citado por Manot= oa (2019), se refiere a la inflamación de una o dos vértebras de allí que el origen de su nombre proviene de la palabra spondyl “vertebra” + itis “inflamación”. Se realizaron los primeros hallazgos de esta patología en el siglo XVII y XVIII en un cadáver, que, al verificar su estructura ósea, se = notó que las articulaciones sacroilíacas, vertebras y apófisis estaban fusionada= s.

Se desconocen las causas de forma precisa de esta afección, y se ha asociado a esta la presencia de un gen llamado HLA-B27, sin embargo, algunas personas poseen este gen y no desarro= llan nunca la Espondilits Anquilosante, por lo tanto, no es concluyente que esta= sea una causa especifica (López-Guillen, 2019).

Se han realizado estudios que determinan que existen una serie de factores de riesgo como la edad, el sex= o y la genética, en este caso se indica que los hombres tienen mayores posibilidades de desarrollar esta patología, y aparece al final de la adolescencia o en la adultez temprana (López-Guillen, 2019).

La espondilitis anquilosante por= ser una enfermedad autoinmune se han realizado numerosas investigaciones para p= oder determinar la fisiopatología de esta, considerando los factores genéticos, microbiota, ambientales y la posible existencia de anormalidades endocrinas (Manotoa, 2019).

En este sentido se muestra en la Tabla 1 una descripción de estas interacciones para tener más claro los factores que se estudian para determinar las razones de la existencia de es= ta enfermedad.

Tabla 1

Factores que se estudian para determinar las razones de la existencia de la EA

Interacciones

Descripción

Factor genético

Hace más de 50 ańos que se realizó la primera id= ea para la relación genética, para revelar gradualmente l naturaleza poligén= ica. La probabilidad de riesgo de recurrencia relativa en familiares de primer grado o hermanos en comparación a la prevalencia de la población general = es de 52-94, esto disminuye al aumentar la distancia de relación familiar. E= ste riesgo es más recurrente en familiares de primer grado con HLA B27 positi= vo, en comparación con portadores de la población general. La EA está implica= do con múltiples alelos HLA B con mayor riego en el HLA B27 13:02, 40:01, 40= :02, 47:01 y 51:01 y con mejor riesgo en HLA B07:02 presentes en HLA B27 tanto positivo como negativo.

Fuente: Manotoa (2019)

Tabla 1

Factores que se estudian para determinar las razones de la existencia de la EA

(continuación)

Interacciones

Descripción

Factor inmune y genético<= /span>

Inmuni= dad intestinal: la clínica de la espondilitis anquilosante está asociada a la enfermedad inflamatoria intestinal (EII), en la mucosa intestinal intervi= enen genes para la activación de células linfoides intestinales y detección de bacterias y una anormalidad en ellos se asocia a la EII

Aminopeptidasa en EA

Se ha demostrado genéticamente que intervienen tres aminopeptidasas, ERAP 1 codifica el retículo endoplásmico, ERAP 2 y NPEPPS que codifica a la puromicina, están relacionadas con la EA. Las proteínas codificadas por e= stos genes es reducir los péptidos al tamańo apropiado para su presentación po= r el HLA. Si se produce una alteración en los péptidos antigénicos, tiene un efecto en la presentación del antígeno HLA B27 por el brazo de cadenas pesadas, la activación de células T ayudadoras (TH17) y la implicación de receptores de células asesinas, lo cual produce inestabilidad en la activ= idad enzimática de las aminopeptidasas.

Factores ambientales

El tabaquismo eleva el riesgo de presentar enfermedades autoinmunes, incrementando de manera importante el riesgo de enfermedades cardiovascul= ares en pacientes con enfermedades reumáticas. Adicional a ello se ha observado que los pacientes fumadores con espondiloartritis presentan más lesiones = en sus radiografías de columna que los que no fuman, se asocia el tabaquismo= con la aparición temprana de la enfermedad y empeoramiento de la calidad de v= ida.

Fuente: Manotoa (2019)

Asimismo, existe una serie de comorbilidades, esto debido a que esta enfermedad forma huesos como un inte= nto que tiene el organismo para mejorarse y curarse generando la fusión de secciones de algunas vertebras lo que puede afectar la movilidad y hasta se puede afectar la caja torácica, además puede provocar inflamación ocular (uveítis) la cual es muy frecuente en la AE, y genera dolor en los ojos, las personas son más sensibles a la luz y su visión puede tornarse borrosa, pue= den aparecer fracturas por compresión, pues los huesos se afinan en algunas personas cuando la enfermedad está iniciando, y al presentar este debilitamiento vertebral pueden colapsar y causar fracturas, que pueden lle= gar a dar la medula espinal y los nervios. También puede provocar problemas a n= ivel cardíaco donde se ve afectada la aorta y esta al inflamarse puede causar que sus tamańos aumenten causando que la válvula aortica se distorsione y su funcionamiento puede verse afectado (López-Guillen, 2019).

En este sentido, a través de esta investigación se desea lograr realizar una revisión sistemática que permita describir las causas y el diagnóstico de la espondilitis anquilosante.=

Metodología

Con el propósito de lograr alcan= zar el objetivo de esta investigación se realizó una revisión sistemática que s= egún menciona Moreno et al. (2018), se caracteriza por:

Tener y describir el proceso de elaboración transparente y comprensible para recolectar, seleccionar, evalu= ar críticamente y resumir toda la evidencia disponible con respecto a la efectividad de un tratamiento, de un diagnostico o algún pronóstico, donde = la diferencia radica principalmente en los estudios primarios que serán inclui= dos y evaluados. (p.184)

Se procedió a realizar la selecc= ión del material necesario que incluye artículos científicos y trabajos de grado indexados en bases de datos como Elsevier, Google académico, y Scielo, para= la investigación considerando una serie de criterios de inclusión y exclusión = que permitieron garantizar confiabilidad en esta investigación.

Selección de la información:

Se consideró como aspectos incluyentes para la elección de los temas la siguiente información:

·      =    Idioma espańol

·      =    De nivel científico, maestría, o docto= ral

·      =    Fecha de búsqueda del 2011 al 2021

·      =    Relación con Espondilitis anquilosante= en título, palabras clave, y objetivos

Se realizó la investigación considerando artículos y trabajos de grado realizados desde el 2011 hasta el ańo 2021, seleccionando los temas más adecuados, y considerando aspectos que excluyan aquellos temas que no contengan los criterios de inclusión anteriormente descritos, de esta manera se procedió a seleccionar 16 artícu= los y trabajos de grado para realizar el análisis correspondiente de 388 referencias halladas en las bases de datos anteriormente descritas.

Resultados y Discusión

Con base en los 16 documentos seleccionados que cumplían con los criterios de inclusión, se procede a realizar un análisis detallado con información que se obtuvo de cada uno de ellos para la revisión con el propósito de poder conocer los resultados de = cada uno de los documentos y poder realizar un resumen acerca de las conclusiones analizadas (ver tabla 2).

Tabla 2

Proceso de Análisis=

Fuente

Ańo

País

Título

Objetivo

Conclusiones Principales

Rodríguez-Hernández et al.

2011

México

Baja densidad mineral ósea en espondilitis anquilosante=

Evaluar la frecuencia de densidad mineral ósea baja y osteoporosis en EA

La presencia de baja DMO= en pacientes con EA es mayor que en la población en general; esto favorece un deterioro estructural óseo que lleva al desarrollo de fracturas por osteoporosis, lo que repercute en la funcionalidad y calidad de vida de l= os pacientes, por lo que su detección precoz y el empleo de terapéutica efic= az disminuirá las probabilidades de este evento.

Suárez et al.

2012

Cuba

Formación de hueso nuevo y espondilitis anquilosante

Demostrar que en el tratamiento con anti TNF se logra contro= lar el proceso inflamatorio,

Todas estas hipótesis so= bre la formación de hueso nuevo participando en la patogenia de la EA se encuentran en estudio en los últimos ańos, las cuales podría proporcionar= los medios necesarios para la producción de nuevos fármacos que no solo actúen sobre la inflamación, sino también sobre la formación de hueso nuevo en e= sta enfermedad, que es el resultado que evoluciona a la limitación funcional y perdida de la calidad de vida.

González-Rodríguez et al.

2013

México

Espondilitis anquilosante. Conceptos Generales

Conocer los conceptos generales de la AE

La EA es la segunda caus= a de consulta en el servicio de reumatología de un hospital de segundo nivel. A pesar de ello, la evaluación clínica de estos pacientes sigue siendo un r= eto para los médicos. Se debe llegar a un diagnóstico de manera precoz a fin = de instaurar un tratamiento eficaz que evite el desarrollo de una discapacid= ad y/o un dańo estructural en las articulaciones afectadas, porque el grupo = de presentación es de gente joven y productiva. En los últimos ańos los inhibidores del factor de necrosis tumoral han mostrado un gran avance terapéutico en esta entidad,

Tabla 2

Proceso de Análisis (continuac= ión)

Fuente

Ańo

País

Título

Objetivo

Conclusiones Principales

González-Rodríguez et al.

2013

México

Espondilitis anquilosante. Conceptos Generales

Conocer los conceptos generales de la AE

con una mejora en la cal= idad de vida de muchos pacientes resistentes a los antiinflamatorios no esteroideos (AINE). Los antagonistas del TNF-α son eficaces y seguro= s a largo plazo, pero es necesario su uso continuo para un adecuado control sintomático

Solís et al.

2014

Cuba

Espondilitis anquilosante y enfermedad de Von Recklinhausen.= Una asociación infrecuente

Encontrar una respuesta etiopatogénica para la asociación de ambas enfermedades

En el estudio del pacien= te con neurofibromatosis tipo 1 presenta síntomas generales con dolor lumbar inflamatorio crónico, limitando su movilidad en todos los segmentos de su columna vertebral en base a estos síntomas se determinó que padece de EA,= sin embargo, no se encontró algún indicio de asociación entre ambas afeccione= s. Se determina que debido a estas dos afecciones la calidad de vida del paciente se ve afectado de forma significativa, así como la de otras pers= onas que padecen las mismas enfermedades.

Castro-Santos et al.

2014

Chile

Genética HLA-B27 y espondilitis anquilosante: 40 ańos

Comprender la influencia de HLA-B27 en la etiología y patogénesis de la enfermedad

El estudio avanzado en el campo de la genética y la genómica permitirá poder conocer diversas variaciones genéticas en los individuos y como unos tienen mayor probabil= idad de padecer la EA, y no solo predecir quienes la pueden padecer sino tambi= én encontrar maneras para prevenir diversos hábitos de vida que puedan gener= ar la aparición de esta y otras enfermedades ayudando a mejorar la calidad de vida de las personas.

Tabla 2

Proceso de Análisis (Continuación)<= /o:p>

Porro et al.

2014

Cuba

Guía para la rehabilitación de la espondilitis anquilosante<= o:p>

Crear una guía de rehabilitación para ser aplicado en pacien= tes con EA

De forma general el grupo de expertos en EA de la Sociedad internacional de espondiloartritis (acuerdo compilado de un 92 %) y las recomendaciones de la Liga Europea de Reumatología plantean que la rehabilitación es especialmente efectiva en la función física de estos pacientes.

El 100 % coincide que la terapia debe incluir ejercicios, así como un 98 % refiere la utilidad de = la educación e instrucciones, datos corroborados en nuestra experiencia, a través del seguimiento sistemático de los pacientes con EA que se atienden por nuestro servicio.

Casas et al.

2014

Cuba

Capacidad funcional y factores asociados en pacientes con espondilitis anquilopoyética

Evaluar la capacidad funcional y determinar factores asociad= os en los pacientes con espondilitis anquilopoyética.

La capacidad funcional se asocia de forma significativa con la edad de inicio de la enfermedad, el tiempo de demora del diagnóstico, la afectación del segmento cervical, la ocupación laboral, la sacroilitis y la actividad de la enfermedad.=

Solís et al. (Espondilitis Anquilosante= y Síndrome de Klippel-Feil. Una asociación infrecuente)

2015

Cuba

Espondilitis Anquilosante y Síndrome de Klippel-Feil. Una asociación infrecuente

Determinar la asociación existente entr= e el síndrome de Kliper-Feil y la Espondilitis anquilosante<= /p>

El paciente evaluado en = esta investigación presenta síntomas generales, con presencia de dolor lumbar inflamatorio crónico, entensopatías y limitación de la movilidad de todos= los segmentos de la columna vertebral, a través de estos síntomas se pudo diagnosticar al paciente con espondilitis anquilosante y no se evidencia = la asociación de ambas afecciones ni relación mediante mecanismos etiopatogénicos que expliquen la presencia de ambas enfermedades.<= span style=3D'font-size:10.0pt;line-height:115%;font-family:"Times New Roman",= serif; color:black;mso-themecolor:text1'>

Arevalo et al.

2016

México

Espondilitis anquilosante en mujer con inicio en edad tardía=

Estudiar el desarrollo de la EA en mujer con inicio en edad tardía

Caso interesante de EA p= or la presentación tardía y en mujer, ya que la enfermedad afecta predominantemente a hombres e inicia en la juventud.

Tabla 2

Proceso de Análisis (Continuación)<= /o:p>

Ańo<= /span>

Arevalo et al.

2016

México

Espondilitis anquilosante en mujer con inicio en edad tardía=

Estudiar el desarrollo de la EA en mujer con inicio en edad tardía

El desarrollo de terapias efectivas para la EA, en particular, los medicamentos biológicos antifact= or de necrosis tumoral alfa, han logrado la mejoría de los síntomas, la capacidad funcional y la calidad de vida de muchos pacientes.<= /span>

Arevalo et al.

2016

México

Espondilitis anquilosante en mujer con inicio en edad tardía=

Estudiar el desarrollo de la EA en mujer con inicio en edad tardía

Los estudios clínicos y radiográficos sugieren que pueden retardar las secuelas esqueléticas, aun= que los reportes son contradictorios. Por el momento, hay escasa información = del uso de medicamentos anti-TNF alfa en individuos con EA de inicio en edad avanzada. Es bien conocida la mayor incidencia de infecciones, incluyendo tuberculosis, y de trastornos mieloproliferativos, por lo que su administración amerita especial cuidado en este grupo de enfermos. <= /o:p>

Al igual que lo referido= en la literatura, los FARME fallaron en controlar las manifestaciones axiale= s de la enfermedad, lo que ameritó el uso de etanercept. En nuestro caso la eficacia y tolerancia al etanercept fue tan buena como la que se obtiene = en los jóvenes, pero se requiere realizar estudios en casos semejantes al descrito para normar la conducta a seguir. La buena respuesta obtenida con etanercept es debido a que éste actúa como un receptor de la citocina inflamatoria factor de necrosis tumoral (FNT) bloqueándola e inhibiendo de esta forma la respuesta inflamatoria. El FNT ha sido encontrado en las ar= ticulaciones inflamadas de pacientes con EA.

Tabla 2

Proceso de Análisis (Continuación)<= /o:p>

Fuente

Ańo

País

Título

Objetivo

Conclusiones Principales

Delgado

2016

Espańa

Bases temperamentales del sentido del humor y actividad de la enfermedad en pacientes con espondilitis anquilosante y artritis reumatoi= de

contribuir desde una aproximación psicológica a un mejor entendimiento de la influencia que tienen algunos de factores psicológicos sin explorar sobre el estado de salud que tienen pacientes con espondilit= is anquilosante y artritis reumatoide

Se evidencia la relación= de factores emocionales negativos (estrés, la ansiedad y depresión) como positiva a (problemas cardiovasculares, quejas somáticas, relaciones soci= ales y dolor crónico) Contexto de estudio en el que habría que situar una de l= as variables psicológicas estudiadas en esta tesis doctoral, es decir la ale= gría estado-rasgo y sus posibles efectos beneficiosos ante determinadas patolo= gías o procesos de salud. Tal y como se viene insistiendo en la presente tesis doctoral, la alegría está relacionada con un afrontamiento más eficiente = de los problemas, a la vez que una mayor facilidad para recobrar el equilibr= io ante circunstancias difíciles

Sanhueza et al.

2016

Chile

Espondilitis anquilosante: revisión de hallazgos imagenológi= cos en la columna

Realizar una revisión pictográfica de hallazgos imagenológic= os presentes en la columna vertebral de pacientes portadores de EA.

La EA se caracteriza por típicas manifestaciones en RM, sin embargo, estas no son específicas y pu= eden verse en múltiples otras patologías de columna. Es de utilidad tener en cuenta que los cambios inflamatorios de la columna en patologías inflamatorias no ocurren de forma aislada y están asociados en su mayoría= a afección de articulaciones sacroilíacas, teniendo características imagenológicas clave en sitios específicos y una evolución determinada en= el tiempo. En pacientes con historia de dolor referido a la columna vertebral inespecífico que son evaluados con imágenes es importante clasificar correctamente los hallazgos, para iniciar otros test diagnósticos correspondientes

Tabla 2

Proceso de Análisis (Continuación)<= /o:p>

Fuente

Ańo

País

Título

Objetivo

Con= clusiones Principales

Andaluz et al.

2017

Cuba

Afecciones oftalmológicas más frecuentemente asociadas a enfermedades reumáticas

revisar las afecciones oftalmológicas m= ás frecuentemente asociadas a enfermedades reumática

En resumen, las enfermed= ades reumáticas son frecuentemente infravaloradas en las distintas estrategias= de atención al enfermo crónico, pues los esfuerzos se enfocan en las patolog= ías que exhiben mayor mortalidad, minimizando entonces la discapacidad, fuent= e de gran coste socio sanitario. Es fundamental que se profundice en la comprensión y manejo de aspectos esenciales presentes en la relación entre enfermedades reumáticas y las diversas manifestaciones oftalmológicas, ya= que el diagnóstico correcto de estas, puede de hecho ayudar a destacar el rol= del proceso sistémico y viceversa: en las personas que sufren un proceso reumático con afectación ocular, no se resolverá el problema oftalmológic= o si no se trata correctamente la ER. Resulta indispensable desarrollar estrategias de prevención destinadas a disminuir la morbilidad asociada a= las ER y es necesario un trabajo multidisciplinario que garantice la adecuada evaluación, tratamiento y seguimiento de estas manifestaciones, contando = con la participación conjunta de reumatólogos y oftalmólogos.

El tratamiento precoz, t= ras un acertado diagnóstico de las afecciones oculares, contribuye a mejorar = el pronóstico visual del paciente.

Tabla 2

Proceso de Análisis (Continuación)<= /o:p>

Fuente

Con= clusiones Principales

Andaluz et al.<= o:p>

Afecciones oftalmológicas más frecuentemente asociadas a enfermedades reumáticas

Las manifestaciones ofta= lmológicas requieren ser evaluadas para su diagnóstico y tratamiento oportuno, ya que pueden ser causa de ceguera y se presentan acompańando enfermedades sistémicas de reconocida morbimortalidad

Fernández et al= .

2018

Cuba

Análisis de un caso= de espondilitis anquilopoyética

Mostrar con la presentación del caso el tratamiento de un paciente afectado con espondil= itis anquilopoyética, toma de articulaciones periféricas y el resultado obteni= do con la cirugía correctora y la rehabilitación.

La cirugía reparadora y = las modalidades fisioterapéuticas utilizadas en el paciente mostraron ser eficaces. La hidroterapia y el ejercicio fueron los pilares fundamentales= en la rehabilitación. Se mejoró la calidad de vida y la autoestima del pacie= nte, incluso se logró su reinserción socio-laboral.

=

2019

Espańa

Espondilitis anquilosante, ayuno intermitente, probióticos y ejercicio anaeróbico: una revisión sistemática sobre las formas de tratamiento más actualizadas

Evaluar la efectivi= dad del empleo de ayuno intermitente, probióticos y de los ejercicios de tipo anaeróbico en términos de funcionalidad, movilidad, actividad de la enfermedad y calidad de vida en pacientes con EA.

Teniendo en cuenta el impacto negativo significativo de la EA en la funcionalidad y la calidad = de vida, es fundamental investigar sobre las modalidades potencialmente efectivas en el tratamiento del paciente con espondilitis anquilosante. S= egún los resultados de la presente investigación, el entrenamiento de tipo anaeróbico tiene un efecto positivo no solo sobre la disminución de los síntomas de la enfermedad (dolor, rigidez, fatiga), sino también sobre los parámetros fisiológicos (VO2, VSG) y psicológicos (ansiedad, nivel de angustia).

Tabla 2

Proceso de Análisis (Continuación)<= /o:p>

Fuente

Ańo

País

Conclusiones Principales

Di Bonaventura

2019

Espańa=

Espondilitis anquilosante, ayuno intermitente, probióticos y ejercicio anaeróbico: una revisión sistemática sobre las formas de tratamiento más actualizadas

Evaluar la efectivi= dad del empleo de ayuno intermitente, probióticos y de los ejercicios de tipo anaeróbico en términos de funcionalidad, movilidad, actividad de la enfermedad y calidad de vida en pacientes con EA.

En cuanto al uso de probióticos, a pesar de la estrecha relación entre microbiota y EA, aún n= o se dispone de una evidencia solida que justifique su implementación. Resulta= dos similares se encuentran para el ayuno intermitente. Cabe destacar que las mejorías que emergen de los estudios analizados, evidencian un posible pa= pel relevante de estos tratamientos en la disminución de la inflamación cróni= ca y de los altos niveles de glucosa sobre el cartílago y su degeneración en pacientes con Espondilitis Anquilosante. Para finalizar, el presente estu= dio agrega valor científico a la evidencia actual en comparación con las revisiones publicadas anteriormente, ya que es una revisión sistemática q= ue compara diferentes tipos de tratamiento para la misma patología.

Montiel-Esparza et al.

2019

México

Arteritis de Takayasu con espondilitis anquilosante

Evaluar la asociación existente entre la arteritis de Takayasu y la espondilitis anquilosante

Como causa de deceso se llegó a la conclusión de muerte súbita ocasionada por la hipertrofia mioc= árdica abunda a la estenosis de la aorta ocasionada por la arteritis de Takayasu= que padecía el paciente, en este caso no se encontraron malformaciones cardia= cas concomitantes con espondilitis anquilosante.

Tabla 2

Proceso de Análisis (Continuación)<= /o:p>

Fuente

Ańo

País

Título

Objetivo

Con= clusiones Principales

Montiel-Esparza et al.

2019

México

Arteritis de Takayasu con espondilitis anquilosante

Evaluar la asociación existente entre la arteritis de Takayasu y la espondilitis anquilosante

La arteritis de Takayasi= no siempre es una enfermedad aislada, asimismo, la espondilitis anquilosante= , si bien se ha relacionado, con muchas enfermedades autoinmunitarias, puede simular síntomas de arteritis de Takayasu como diagnostico agregado en sujetos con espondilitis.

El paciente en cuestión = que infortunadamente falleció, demuestra una vez más la necesidad de realizar= un concienzudo examen en los pacientes. Asimismo, se sugiere que ante el nue= vo sistema penal acusatorio y ante una muerte súbita se efectúe durante la necropsia la tinción con azul de tetrazoilo que ayudara a distinguir entre afección miocárdica por infractor agudo de miocardio y otra enfermedad de repercusión miocárdica como el caso comunicado a quien no se le efectúo t= al prueba.

Bazán et al.

2021

Argentina

Fractura de la columna vertebral en pacientes con espondilit= is anquilosante

Considerar las dificultades diagnósticas, describir las lesi= ones y la decisión terapéutica, analizar la presentación de complicaciones y realizar una actualización bibliográfica

Los pacientes con EA cor= ren más riesgo de sufrir una fractura vertebral por traumatismo de baja energ= ía que la población general. Es importante tener un alto nivel de sospecha a= nte un paciente con EA y un antecedente traumático que solo sufra dolor, para= evitar las complicaciones neurológicas. En nuestro estudio, el promedio de días hasta el diagnóstico fue 12 y se relacionó con la falta de estudios o la = mala calidad de estos.

Tabla 2

Proceso de Análisis (Continuación)<= /o:p>

Fuente

Ańo

País

Título

Objetivo

Conclusiones Principales

Bazán et al.

2021

Argentina

Fractura de la columna vertebral en pacientes con espondilit= is anquilosante

Considerar las dificultades diagnósticas, describir las lesi= ones y la decisión terapéutica, analizar la presentación de complicaciones y realizar una actualización bibliográfica

En esta serie, el mecani= smo de lesión más frecuente fue la hiperflexión con la consiguiente lesión de= la banda de tensión posterior asociada o no con traslación. Los antiinflamatorios no esteroides brindarían un efecto protector frente al riesgo de sufrir una fractura vertebral en pacientes con EA. El tratamien= to quirúrgico con fijaciones largas y liberación por vía posterior es el más utilizado. En nuestra serie, no se observaron complicaciones postquirúrgi= cas. Se cree necesaria una muestra con más pacientes

Fuente: Autor (2022)<= /span>

En las investigaciones realizadas por Rodríguez-Hernández et al. (2011), Suárez et al. (2012) y Bazán et al. (2021), mencionan que el deterioro óseo en los pacientes con EA genera mayor porcentaje de fracturas por osteoporosis en comparación con la población en general, y que al detectar a tiempo la enfermedad podría evitarse este tipo= de acontecimientos que entorpece la calidad de vida del paciente, e igualmente estas evidencias podrían proporcionar información importante acerca del comportamiento de esta enfermedad con el propósito de producir nuevos medicamentos que no solamente alivien los procesos inflamatorios sino tambi= én evitar la formación de hueso nuevo en las fusiones existentes así como evit= ar fracturas que podría permitir una mejor calidad de vida de los pacientes.

De la misma manera González-Rodr= íguez et al. (2013) coincide en que la detección temprana de la EA mejorara en gr= an medida la calidad de vida de los pacientes, que cada día es más común la existencia de ellos en los centros de reumatología, es importante poder detectar a tiempo esta enfermedad para indicar un tratamiento acorde a las necesidades de los pacientes que disminuya su discapacidad y un posible dańo estructural en sus articulaciones.

Los autores Solís et al. (2014), Solís et al. (2015), Delgado (2016), Andaluz et al. (2017) y Montiel-Esparz= a et al. (2019), determinan que la EA puede estar presente con otras patologías, como afecciones oftalmológicas, artritis psoriásica y reumatoide, Síndrome = de Klippel-Feil y Arteritis de Takayasu, unas más comunes que otras, sin embar= go además de afectar el organismo del individuo también compromete el estado psicológico de las personas pues estas enfermedades o síndromes afectan la = vida cotidiana, su vida laboral y la interacción social lo que genera estrés y depresión en estas personas.

Asimismo Porro et al. (2014), Sanhueza et al. (2016) y Di Bonaventura (2019), establecen en sus investigaciones que esta enfermedad puede ser diagnosticada a través de imagenología, (RX, RM) además de exámenes de laboratorio y exámenes físicos donde se determinan la forma de la columna y otras complicaciones que pueden estar presentes en el cuerpo de las personas, donde además de tratamiento médico con fármacos la rehabilitación física es una terapia efectiva donde = se deben incluir ejercicios anaeróbicos que ayudan a disminuir los síntomas de dolor, rigidez, fatiga entre otros, y mejora los niveles de estrés, angusti= a y ansiedad.

De la misma manera Castro-Santos= et al. (2014), muestra en su investigación que la EA está asociada a alteracio= nes genéticas con presencia positiva del HLA B27 aunque no necesariamente todas= las personas que estén positivas en este gen manifiesten síntomas existe eviden= cia de la presencia de EA en un gran porcentaje de individuos, estos avances en= los estudios genéticos permitirán analizar y poder prevenir diversos hábitos de vida que generan la aparición de esta enfermedad y de muchas otras enfermed= ades que dará paso a la mejora de la calidad de vida de estos pacientes.

Conclusiones

·      =    Es evidente que existe una gran variedad de afecciones que pueden estar asocia= das con la EA, sin embargo, se observa la coincidencia en que la mayoría de los autores analizados manifiestan que una de las principales consecuencias que genera esta enfermedad es el deterioro de la calidad de vida de los individ= uos que padecen esta y otras enfermedades durante su vida, y que repercuten en = el comportamiento psicológico de los mismos.

·         Es importante destacar que se debe seguir realizando análisis y estudios genét= icos y de casos de pacientes con esta patología que permita determinar de forma = más clara las causas que generan esta enfermedad y la prevalencia de la misma en los individuos, así como poder determinar posibles nuevos tratamientos que permitan mejorar en gran medida los síntomas, como el dolor, la inflamación= y la rigidez para que las personas con esta enfermedad puedan realizar sus actividades sin depender de la ayuda de otras personas.

Referencias Bibliográficas

Andaluz, M., Cifuentes, M., Dávila, E., & Reyes, L. (2017). Afecciones oftalmológicas más frecuentemente asociadas a enfermedades reumáticas. Revista Cubana de Reumatología 19(3), 202-208.

Arevalo, F., Badia, J., &a= mp; Arciniega, A. (2016). Espondilitis anquilosante en mujer con inicio en e= dad tardía. Acta Médica Grupo Ángeles 14(2), 108-110.

Bazán, P., Bravo, M., Gutiérrez, E., Terraza, S., Cortés, C., Borri, Á. M., y otros. (2021). Frac= tura de la columna vertebral en pacientes con espondilitis anquilosante. Rev = Asoc Argent Ortop Traumatol 86(1), 58-63.

Casas, N., Vidal, J., Pére= z, D., Castell, C., & Gutiérrez, Á. (2014). Capacidad funcional y factores asociados en pacientes con espondilitis anquilopoyética. Revista Cubana = de Medicina 53(1), 50-60.

Castro-Santos, P., Gutiérr= ez, M., & Díaz-Peńa, R. (2014). Genética HLA-B27 y espondilitis anquilosant= e: 40 ańos. Rev. Med. Chile 142, 1165-1173.

Chiriboga, A. (2010). E= nfermedades músculo esqueléticas de la columna vertebral mas frecuentes atentidas en el área de rehabilitación física de la Cruz Roja Ecuatoriana junta provincial = de Pichincha, sede Norte durante el ańo 2008. Quito, Ecuador: Trabajo especial de grado d= e la Pontificia Universidad Católica del Ecuador para optar al título de Licenciatura en Terapia Física.

Delgado, C. (2016). Bas= es temperamentales del sentido del humor y actividad de la enfermedad en pacie= ntes con espondilitis anquilosante y artritis reumatoide. Trabajo especial de grado de la Universidad D Córdoba.

Di Bonaventura, S. (2019). Espondilitis anquilosante, ayuno intermitente, probióticos y ejercicio anaeróbico: una revisión sistemática sobre las formas de tratamiento más actualizadas. Espańa: Trabajo especial de grado de la Universidad Camilo Jo= sé Cela.

Espinoza, L. (2017). Sistema para monitorear el grado de curvatura de la columna vertebral, medi= ante la utilización de sensores IMU. Riobamba, Ecuador: Trabajo especial de grado de la Escuela Superior Politécnica de Chimborazo para optar al título= de Ingeniería en Electrónica Control y Redes Industriales.

Fernández, L., Heredia, Y, Chacón, M., & Coronado, Y. (2018). Análisis de un caso de espondilitis anquilopoyética. Revista Cubana de Medicina Física y Rehabilitación 10(3= ), 1--10.

González-Rodríguez, M., Guerrero-Soto, A., Corona-Sánchez, E., Rocha-Muńoz, A., Díaz-González, E., & González-López, L. (2013). Espondilitis anquilosante. Conceptos Generales. El Residente 883), 106-113.

López-Guillen, A. (2019). = Evaluación del menoscabo por Espondilitis Anquilosante. Unión Pericial Sanitaria.<= o:p>

Manotoa, M. (2019). Eva= luar calidad de vida y funcionalidad en pacientes con espondilitis anquilosante.= Quito, Ecuador: Trabajo especial de grado de la Pontificia Universidad Cató= lica del Ecuador para optar al título de Especialista en Medicina Interna.<= /o:p>

Montiel-Esparza, A., Sosa-Morales, V., Bullón-Alcalá, S., & Zavaleta-Martínez, M. (2019). Arteritis de Takayasu con espondilitis anquilosante. Med. Int. Méx 35(3), 448-453= .

Moreno, B., Muńoz, M., Cuellar, J., Domancic, S., & Villanueva, J. (2018). Metodología. Revisi= ones sistemáticas: definición y nociones básicas. Rev. Clin. Periodoncia Implantol. Rehabil. Oral 11(3), 184-186.

Plischuk, M., & Salced= a, S. (2015). Espondilitis anquilosante en una población contemporánea de La Plata, Argentina. Rev. Esp. Antrop. Fís. 36, 22-32.

Porro, J., Estévez, A., Rodríguez, A., Suárez, R., & González, B. (2014). Guía para la rehabili= tación de la espondilitis anquilosante. Revista Cubana de Reumatología XVI (2), 245-252.

Rodríguez, M., & Pérez= , N. (2021). Manual de anatomía humana normal. Chile: Universidad Andrés Bello 2da edición.

Rodríguez-Hernández, D., Villalpando-Gómez, Y., De la Cerda-Trujillo, L., Rocha-Muńoz, A., Fuentes-González, C., Moreno-Sandoval, I., y otros. (2011). Baja densidad mineral ósea en espondilitis anquilosante. El Residente VI (1), 14-19.<= o:p>

Sanhueza, A., Prieto, J., Weisz, J., Leiter, F., Soto, S. F., & Lira, L. (2016). Espondilitis anquilosante: revisión de hallazgos imagenológicos en la columna. Revista Chilena de Radiología 22(4), 171-183.

Sierra, A; Lozano, L; Dávi= la, C; Mora, J; Tramontini, C. (2018). Anatomía de la Columna Vertebral en radiografía convencional. Revista Medica Sanitas 21(1), 39-46.<= /o:p>

Sinchiguano, A. (2018). Caracterización de patologías músculo-esqueléticas de la columna vertebral en usuarios de 1= 8 a 65 ańos del centro de rehabilitación física en la facultad de educación fís= ica de la Universidad Central del Ecuador durante el período enero-diciembre 20= 17. Quito, Ecuador: Trabajo especial de grado de la Universidad Central del Ecu= ador para optar al título de Licenciado en Terapia Física.

Solís, U., Morejón, J., &a= mp; de Armas, A. (2014). Espondilitis anquilosante y enfermedad de Von Recklinhausen. Una asociación infrecuente. Revista Cubana de Reumatologí= a XVI (2), 240-244.

Solís, U., Morejón, J., de Armas, A., Prada, D., & Amador, D. (2015). Espondilitis Anquilosante y Síndrome de Klippel-Feil. Una asociación infrecuente. Revista Cubana de Reumatología XVII (2), 206-210.

Suárez, R., Molinero, C., Prada, D., López, A., & Lemagne, Y. (2012). Formación de hueso nuevo y espondilitis anquilosante. Revista Cubana de Reumatología XIV (20), 1-6.=

Torres, A. (2019). Meta= análisis sobre la efectividad de la realización de ejercicio físico en pacientes con Espondilitis Anquilosante. Archives of Nursing Research, 3(1), 1-18.

El artículo que se publica es de exclusiva responsabilidad de los autores y no necesariamente reflejan el pensamiento = de la Revista Alfa Publicaciones.

El artíc= ulo queda en propiedad de la revista y, por tanto, su publicación parcial y/o t= otal en otro medio tiene que ser autorizado por el director de la Revista Alfa Publicaciones.<= /o:p>

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Interacciones	Descripción
Factor inmune y genético<= /span>	Inmuni= dad intestinal: la clínica de la espondilitis anquilosante está asociada a la enfermedad inflamatoria intestinal (EII), en la mucosa intestinal intervi= enen genes para la activación de células linfoides intestinales y detección de bacterias y una anormalidad en ellos se asocia a la EII
Aminopeptidasa en EA	Se ha demostrado genéticamente que intervienen tres aminopeptidasas, ERAP 1 codifica el retículo endoplásmico, ERAP 2 y NPEPPS que codifica a la puromicina, están relacionadas con la EA. Las proteínas codificadas por e= stos genes es reducir los péptidos al tamańo apropiado para su presentación po= r el HLA. Si se produce una alteración en los péptidos antigénicos, tiene un efecto en la presentación del antígeno HLA B27 por el brazo de cadenas pesadas, la activación de células T ayudadoras (TH17) y la implicación de receptores de células asesinas, lo cual produce inestabilidad en la activ= idad enzimática de las aminopeptidasas.
Factores ambientales	El tabaquismo eleva el riesgo de presentar enfermedades autoinmunes, incrementando de manera importante el riesgo de enfermedades cardiovascul= ares en pacientes con enfermedades reumáticas. Adicional a ello se ha observado que los pacientes fumadores con espondiloartritis presentan más lesiones = en sus radiografías de columna que los que no fuman, se asocia el tabaquismo= con la aparición temprana de la enfermedad y empeoramiento de la calidad de v= ida.

Fuente	Ańo	País	Título	Objetivo	Conclusiones Principales
Rodríguez-Hernández et al.	2011	México	Baja densidad mineral ósea en espondilitis anquilosante=	Evaluar la frecuencia de densidad mineral ósea baja y osteoporosis en EA	La presencia de baja DMO= en pacientes con EA es mayor que en la población en general; esto favorece un deterioro estructural óseo que lleva al desarrollo de fracturas por osteoporosis, lo que repercute en la funcionalidad y calidad de vida de l= os pacientes, por lo que su detección precoz y el empleo de terapéutica efic= az disminuirá las probabilidades de este evento.
Suárez et al.	2012	Cuba	Formación de hueso nuevo y espondilitis anquilosante	Demostrar que en el tratamiento con anti TNF se logra contro= lar el proceso inflamatorio,	Todas estas hipótesis so= bre la formación de hueso nuevo participando en la patogenia de la EA se encuentran en estudio en los últimos ańos, las cuales podría proporcionar= los medios necesarios para la producción de nuevos fármacos que no solo actúen sobre la inflamación, sino también sobre la formación de hueso nuevo en e= sta enfermedad, que es el resultado que evoluciona a la limitación funcional y perdida de la calidad de vida.
González-Rodríguez et al.	2013	México	Espondilitis anquilosante. Conceptos Generales	Conocer los conceptos generales de la AE	La EA es la segunda caus= a de consulta en el servicio de reumatología de un hospital de segundo nivel. A pesar de ello, la evaluación clínica de estos pacientes sigue siendo un r= eto para los médicos. Se debe llegar a un diagnóstico de manera precoz a fin = de instaurar un tratamiento eficaz que evite el desarrollo de una discapacid= ad y/o un dańo estructural en las articulaciones afectadas, porque el grupo = de presentación es de gente joven y productiva. En los últimos ańos los inhibidores del factor de necrosis tumoral han mostrado un gran avance terapéutico en esta entidad,

Porro et al.	2014	Cuba	Guía para la rehabilitación de la espondilitis anquilosante<= o:p>	Crear una guía de rehabilitación para ser aplicado en pacien= tes con EA	De forma general el grupo de expertos en EA de la Sociedad internacional de espondiloartritis (acuerdo compilado de un 92 %) y las recomendaciones de la Liga Europea de Reumatología plantean que la rehabilitación es especialmente efectiva en la función física de estos pacientes. El 100 % coincide que la terapia debe incluir ejercicios, así como un 98 % refiere la utilidad de = la educación e instrucciones, datos corroborados en nuestra experiencia, a través del seguimiento sistemático de los pacientes con EA que se atienden por nuestro servicio.
Casas et al.	2014	Cuba	Capacidad funcional y factores asociados en pacientes con espondilitis anquilopoyética	Evaluar la capacidad funcional y determinar factores asociad= os en los pacientes con espondilitis anquilopoyética.	La capacidad funcional se asocia de forma significativa con la edad de inicio de la enfermedad, el tiempo de demora del diagnóstico, la afectación del segmento cervical, la ocupación laboral, la sacroilitis y la actividad de la enfermedad.=
Solís et al. (Espondilitis Anquilosante= y Síndrome de Klippel-Feil. Una asociación infrecuente)	2015	Cuba	Espondilitis Anquilosante y Síndrome de Klippel-Feil. Una asociación infrecuente	Determinar la asociación existente entr= e el síndrome de Kliper-Feil y la Espondilitis anquilosante<= /p>	El paciente evaluado en = esta investigación presenta síntomas generales, con presencia de dolor lumbar inflamatorio crónico, entensopatías y limitación de la movilidad de todos= los segmentos de la columna vertebral, a través de estos síntomas se pudo diagnosticar al paciente con espondilitis anquilosante y no se evidencia = la asociación de ambas afecciones ni relación mediante mecanismos etiopatogénicos que expliquen la presencia de ambas enfermedades.<= span style=3D'font-size:10.0pt;line-height:115%;font-family:"Times New Roman",= serif; color:black;mso-themecolor:text1'>
Arevalo et al.	2016	México	Espondilitis anquilosante en mujer con inicio en edad tardía=	Estudiar el desarrollo de la EA en mujer con inicio en edad tardía	Caso interesante de EA p= or la presentación tardía y en mujer, ya que la enfermedad afecta predominantemente a hombres e inicia en la juventud.

Ańo<= /span>
Arevalo et al.	2016	México	Espondilitis anquilosante en mujer con inicio en edad tardía=	Estudiar el desarrollo de la EA en mujer con inicio en edad tardía	El desarrollo de terapias efectivas para la EA, en particular, los medicamentos biológicos antifact= or de necrosis tumoral alfa, han logrado la mejoría de los síntomas, la capacidad funcional y la calidad de vida de muchos pacientes.<= /span>
Arevalo et al.	2016	México	Espondilitis anquilosante en mujer con inicio en edad tardía=	Estudiar el desarrollo de la EA en mujer con inicio en edad tardía	Los estudios clínicos y radiográficos sugieren que pueden retardar las secuelas esqueléticas, aun= que los reportes son contradictorios. Por el momento, hay escasa información = del uso de medicamentos anti-TNF alfa en individuos con EA de inicio en edad avanzada. Es bien conocida la mayor incidencia de infecciones, incluyendo tuberculosis, y de trastornos mieloproliferativos, por lo que su administración amerita especial cuidado en este grupo de enfermos. <= /o:p> Al igual que lo referido= en la literatura, los FARME fallaron en controlar las manifestaciones axiale= s de la enfermedad, lo que ameritó el uso de etanercept. En nuestro caso la eficacia y tolerancia al etanercept fue tan buena como la que se obtiene = en los jóvenes, pero se requiere realizar estudios en casos semejantes al descrito para normar la conducta a seguir. La buena respuesta obtenida con etanercept es debido a que éste actúa como un receptor de la citocina inflamatoria factor de necrosis tumoral (FNT) bloqueándola e inhibiendo de esta forma la respuesta inflamatoria. El FNT ha sido encontrado en las ar= ticulaciones inflamadas de pacientes con EA.

Fuente		Con= clusiones Principales
Andaluz et al.<= o:p>			Afecciones oftalmológicas más frecuentemente asociadas a enfermedades reumáticas		Las manifestaciones ofta= lmológicas requieren ser evaluadas para su diagnóstico y tratamiento oportuno, ya que pueden ser causa de ceguera y se presentan acompańando enfermedades sistémicas de reconocida morbimortalidad
Fernández et al= .	2018	Cuba	Análisis de un caso= de espondilitis anquilopoyética	Mostrar con la presentación del caso el tratamiento de un paciente afectado con espondil= itis anquilopoyética, toma de articulaciones periféricas y el resultado obteni= do con la cirugía correctora y la rehabilitación.	La cirugía reparadora y = las modalidades fisioterapéuticas utilizadas en el paciente mostraron ser eficaces. La hidroterapia y el ejercicio fueron los pilares fundamentales= en la rehabilitación. Se mejoró la calidad de vida y la autoestima del pacie= nte, incluso se logró su reinserción socio-laboral.
=	2019	Espańa	Espondilitis anquilosante, ayuno intermitente, probióticos y ejercicio anaeróbico: una revisión sistemática sobre las formas de tratamiento más actualizadas	Evaluar la efectivi= dad del empleo de ayuno intermitente, probióticos y de los ejercicios de tipo anaeróbico en términos de funcionalidad, movilidad, actividad de la enfermedad y calidad de vida en pacientes con EA.	Teniendo en cuenta el impacto negativo significativo de la EA en la funcionalidad y la calidad = de vida, es fundamental investigar sobre las modalidades potencialmente efectivas en el tratamiento del paciente con espondilitis anquilosante. S= egún los resultados de la presente investigación, el entrenamiento de tipo anaeróbico tiene un efecto positivo no solo sobre la disminución de los síntomas de la enfermedad (dolor, rigidez, fatiga), sino también sobre los parámetros fisiológicos (VO2, VSG) y psicológicos (ansiedad, nivel de angustia).