We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Below we will list the departments and units that form part of Vall d’Hebron Hospital and the main diseases that we treat. We will also make recommendations based on advice backed up by scientific evidence that has been shown to be effective in guaranteeing well-being and quality of life.
We will guide you from your first visit to the centre, allowing you to find all the departments and make the most of our facilities. Whatever the reason for your visit, we will explain how to get about the hospital.
Sjögren's Syndrome is a chronic, systemic autoimmune disease, the cause of which is unknown. Its main symptoms are a dry mouth (xerostomia) and dry eyes (xerophthalmia). In this disease, the cells making up our defence system (immune system) attack parts of the body itself, such as the glands that keep the eyes and mouth moist, and glands in other parts of the body, altering their function. Symptoms in other organs, such as the lungs, joints or nervous system, may also occur.
Patients with Sjögren's Syndrome often have other conditions related to anomalous functioning of the immune system, such as systemic lupus erythematosus, scleroderma and rheumatoid arthritis.
Patients with Sjögren's Syndrome mainly have symptoms related to a lack of tear and saliva production, which causes dryness in the mouth and eyes. The main symptoms suffered by patients are a burning, gritty sensation in the eyes, red eyes, blurred vision, the need to drink water frequently, difficulty swallowing dry food and a higher propensity for tooth decay and mouth infections. This dryness may also affect the skin and vaginal area, which causes painful sexual relationships. Other symptoms that Sjögren's Syndrome patients may show are joint or muscle pain and fatigue. Less frequently, other organs, such as the lungs, kidney and nerve endings, may be affected.
Above all, the disease affects women aged between 40 and 60. It is calculated that the incidence is between 0.5% and 3% of the population.
There is no single test enabling diagnosis of Sjögren's Syndrome. Diagnosing Sjögren's Syndrome in a patient referred with dry eyes and mouth is based on tests that confirm the existence of a deficit in tear and saliva production and that prove that the dryness is associated with an imbalance in the immune system.
Treatment of Sjögren's Syndrome is essentially based on measures that alleviate the feeling of dryness shown by the patient. The treatment includes the use of artificial tears, eye gels, eye drops, nebulisers and tablets to stimulate saliva production. Particular patients may be given treatment to stimulate glandular secretion. In serious cases, where there are symptoms in organs other than the glands (lungs and peripheral nerves, etc) it may be necessary to administer medication that acts to decrease immune system activity (immunosuppressant drugs).
Patients with Sjögren's Syndrome must undergo a series of eye tests, blood and urine tests and, on certain occasions, it is necessary to do a small biopsy of lip mucous to confirm the existence of inflammation in the glands producing saliva.
The Musculoskeletal Techniques and Ultrasound Unit (MTU) at Vall d'Hebron Hospital Rheumatology Department is devoted to locomotive system ultrasound in all its forms (diagnostic/therapeutic) and other procedures and interventions and serves adult and paediatric patients.
Musculoskeletal ultrasound is a non-invasive technique allowing structures to be assessed in real time, which enables precise diagnosis and monitoring of rheumatic disorders. It has become a highly useful, essential tool in the field of rheumatology.
Paediatric age onset systemic autoimmune diseases are infrequent, complex entities that require a multi-disciplinary approach. The most frequent include juvenile onset systemic lupus erythematosus, mixed connective tissue disease, juvenile onset Sjögren’s syndrome, juvenile dermatomyositis, juvenile scleroderma, and paediatric age onset vasculitis, such as Kawasaki disease, IgA vasculitis (also known as Schönlein-Henoch purpura), polyarthritis nodosa and Takayasu disease.
The clinical manifestations of these diseases are highly varied. Juvenile systemic lupus erythematosus may affect several organs in the body, particularly the skin, joints, blood, kidneys and the central nervous system. In children, it is common for fever to appear without an infectious cause or an increase in the size of the lymph nodes.
Juvenile dermatitis is characterised by the presence of fatigue, muscle pain, weakness and the appearance of rashes that may affect the face, with inflammation around the eyes (periorbital oedema) There may also be reddening of the cheeks (malar rash) and other parts of the body (top part of the knuckles, knees and elbows), where the skin may become thicker (Gottron’s papules). Juvenile scleroderma, whose name comes from the Greek and means “hard skin”, is characterised by the presence of lesions on the skin and affects various organs. Two types can mainly be identified: localised scleroderma and systemic scleroderma.
Kawasaki disease is characterised by the presence of a high fever of unknown origin, irritability, reddening of the eyes and various skin lesions, such as a rash on the torso, flaking fingers and reddening of the tongue (normally called “strawberry tongue”). The involvement of the heart is the most serious manifestation of Kawasaki disease, due to the possibility of long-term complications.
Schönlein-Henoch purpura is characterised by a rash on the legs called “palpable purple” because the skin lesions can be touched, and painful and swollen joints, abdominal pain and kidney problems may appear.
All the conditions within the group are infrequent and have an incidence of less than 5 cases per 10,000 inhabitants, for which reason they are considered to be rare conditions. The spread is different depending on the disease. For example juvenile systemic lupus erythematosus, along with juvenile dermatomyositis and scleroderma, are more common in girls, while Schönlein-Henoch purpura is more common in boys.
Diagnosis of paediatric systemic autoimmune diseases is eminently clinical and we are guided by classification and diagnostics criteria in many of them. Blood tests are important for diagnosing the different systemic autoimmune diseases, as various autoantibodies can be identified that can help with the diagnosis and monitoring of these diseases. Supplementary tests, such as a capillaroscopy, chest X-ray, respiratory function tests, nuclear magnetic resonance and echocardiogram, amongst others, can be helpful when we come to approaching a paediatric patient with a suspected systemic disease.
Treatment fundamentally depends on the type of condition and the response to the therapy chosen. There is not currently any specific curative treatment for each one of the diseases, but the treatments available will help to control the signs and symptoms of the disease and prevent complications, including permanent damage to organs and tissue.
Idiopathic inflammatory myopathies are a heterogeneous group of illnesses whose main feature is muscular weakness and identification of an underlying inflammation in the muscular biopsy. The group includes dermatomyositis, polymyositis and, recently, inclusion body myosotis, which is most probably the least inflammatory, as well being the myopathy most frequently acquired by the over 50s. Although the main target organ is muscle, the skin and lungs, amongst other internal organs, are frequently affected, for which reason inflammatory myopathies are considered to be systemic illnesses.
The most common presentation of these illnesses is muscular weakness, which usually has a characteristic effect on the proximal skeletal muscles, that is to say, on the shoulder and hip girdles, which makes activities needing these muscles to work normally difficult, such as hanging out laundry, combing hair, going up stairs or getting up from a chair. Skin manifestations are characteristic in dermatomyositis and we can identify a wide range of lesions. The majority of them have a certain photosensitivity component which means they usually appear in areas exposed to the sun. Lilac-coloured or heliotrope palpebral oedema are considered to be pathognomic, as are Gottron's papules, which appear on the knuckles of the hands. Similar lesions can be seen in the extension areas, such as elbows and knees, and also on the hair line on the scalp and nape of the neck. Other cutaneous lesions, which are V-shaped on the neckline or shawl-shaped on the back, are also related to the stimulation of the sun.
The most well-known respiratory infection in patients with dermatomyositis and polymyositis is interstitial lung disease. In general, its inception is usually sub-acute or chronic and the clinical findings during the examination can detect dry, crackling rales, in “velcro”, which are characteristic of pulmonary fibrosis. Cardiac and digestive involvement is infrequent and should be assessed in each patient individually.
Inflammatory myopathies can be considered to be within the rare disease group due to their low incidence. Epidemiological studies carried out around the world set out an average annual incidence of 2.1 to 7.7 new cases for every million inhabitants per year.
It is considered to be a universally distributed disease, although it is a little more prevalent in Caucasians and less frequent in black people. It is twice as frequent in women than men. In addition, although a juvenile form exists that usually appears before the age of 16, signs of the illness are more frequent in 30 to 40 year olds.
The diagnosis is made using the convergence of clinical criteria. The most relevant finding in blood tests is elevated muscular enzymes, such as creatine kinase and aldolase, along with acute phase reactors such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Muscular biopsy is, for some authors, the benchmark test for diagnosing inflammatory myopathies.
In the case of dermatomyositis and, in general, inflammatory myopathies, there are a series of antibodies that help the clinician to classify the disease. Anti-Jo-1, anti-PL-7, anti-PL-12, anti-U1 and anti-PM-Scl, etc, stand out amongst these antibodies. Another complementary test enabling assessment of the extent of the adverse effect on muscles is the nuclear magnetic resonance which, in turn, is valuable when monitoring progress. Depending on whether there is pulmonary, cardiac or digestive involvement, the extra examinations needed to assess each affected organ will be carried out.
Treatment of inflammatory myopathies is based on administering glucocorticoids and immunosuppressants, without forgetting physical therapy or rehabilitation, even in the acute phase. A third of patients respond to a single glucocorticoid treatment, but the majority need the addition of a new immunosuppressant, such as disease modifying drugs, including methotrexate, ciclosporin, cyclophosphamide, azathioprine, mofetil mycophenolate and tacrolimus. Intravenous immunoglobulins may also be used as they act to improve muscle weakness. Biological therapies, such as etanercept, infliximab and rituximab, have been shown to be effective in some clinical cases or observational studies. In any event, the treatment must be individual for each patient.
The Paediatric Rheumatology Unit (PRU) at Vall d’Hebron University Hospital sits within the Rheumatology Department and is tasked with specialist care of locomotive system inflammatory disorders and other autoimmune diseases affecting paediatric patients. It consists of two rheumatology specialists with specific training in paediatric rheumatology disorders, Dr Estefanía Moreno Ruzafa and Dr Mireia López Corbeto, a specialist in Paediatrics with specific training in paediatric rheumatology, Dr Laia Martínez Mitjana, and a nurse specialising in rheumatic disorders in children, Julia Vivancos Pons.
The Paediatric Rheumatology Unit has always been a centre of reference within our Rheumatology Department. We have a close relationship with other paediatric units with the aim of setting up common strategies for diagnosing, treating and monitoring our patients.
The Bone Metabolism Unit (UMO) focuses on detecting, treating, and monitoring patients with metabolic bone disorders. Our specialized care comprises pathologies ranging from osteoporosis, which is the most common of these disorders, to Paget's disease and osteomalacia, and includes rare diseases like osteogenesis imperfecta.
We concern ourselves with detecting, treating, and monitoring patients with premenopausal, postmenopausal, and male osteoporosis, along with osteoporosis that can appear secondary to drugs and other diseases, such as transplants, blood and endocrine diseases, HIV infection, bariatric surgery, breast cancer, and chronic kidney failure. These pathologies can, through various mechanisms, cause osteoporosis.
Osteogenesis imperfecta (OI), also known as "brittle bone disease", is a genetic disorder that affects the production of collagen, a principal element in connective tissue and bone. These individuals easily sustain fractures, even without trauma. There are various types of OI, so symptoms can vary. In most cases, the disease is caused by a mutation in the gene coding for type I collagen.
OI can cause fragile bones, short stature, delays in growth, deformities of the spinal column and other bones, blue sclera, hearing loss, and problems with the formation of the teeth (dentinogenesis imperfecta). In its most severe form, babies die shortly after birth. There are mild forms that can manifest with premature osteoporosis.
It is a very infrequent disease and is considered rare. The estimated incidence of OI is
approximately 1 out of every 10,000-20,000 births, but we must keep in mind that the milder forms may not be diagnosed.
If a patient presents symptoms like those mentioned above, leading to the suspicion that they may have this disease, a genetic study must be carried out.
It requires a multidisciplinary approach. Treatment aims to improve the impact on quality of life and prevent complications. Physical therapy, occupational therapy, detecting and treating dental and respiratory problems, dealing with hearing loss, and surgery to correct deformities are very important. Pharmacological treatment is carried out using widely employed osteoporosis drugs.
Osteomalacia is a skeletal mineralisation disorder. The bones are soft and this causes deformation and fractures, even without trauma, especially affecting the pelvis, ribs, and spinal column. In addition, it can cause pain, especially in the spinal column, pelvis, legs, and ribs, as well as weakness in the legs. In childhood, this disorder is called rickets and it can also negatively affect growth.
In order to correctly mineralise, bones need calcium and phosphate. The absorption of these substances (especially calcium) depends on vitamin D, which is synthesized in the skin using UVB rays from the sun. Thus, osteomalacia is caused by a severe deficiency in vitamin D and/or phosphate.
The main causes of a severe vitamin D deficiency are varied and include:
Another, more infrequent cause is phosphate deficiency, either congenital (such as X-linked hypophosphataemic rickets or fibrous dysplasia) or acquired (Fanconi syndrome, tumours, IV iron administration, antiretroviral therapy, etc.).
The diagnosis will be performed based on the symptoms, blood analysis, urinalysis, and X-rays.
Treatment consists of correcting the vitamin D and calcium deficiencies and also treating the causes underlying these.
This is the second most frequent bone disorder, following osteoporosis. It affects 1.5-3% of the population over 65 years of age. It was described by Sir James Paget in 1876. In this disease, the natural process of the destruction of old bone and the formation of new bone (called bone remodelling) is abnormal and disordered. As a consequence, the bone is fragile, it increases in size, and it presents deformity. Thus, it also receives the name of deforming osteitis. It usually affects the cranium, spinal column, and the pelvis. The risk of having this disease increases with age, and it is very rare in young people.
The underlying cause is not known for sure, but it's known to have an important genetic and family component. Thus, the probability of suffering this disease increases if family member has it. It could also be associated with a viral infection like measles or rubella.
It usually does not produce symptoms. In fact, the diagnosis is usually made based on an unusually high alkaline phosphatase level or findings suggestive of the disease on imaging tests that were ordered for another reason. However, it can cause pain in the affected area that does not improve with rest due to the increase in bone, as well as redness and heat secondary to the increased number of blood vessels in that area. If it affects a joint, it can cause arthrosis. If it compresses nerve roots, it can cause sciatica or even deafness (if the head is affected). It can also cause fractures. A rare complication is the degeneration into bone cancer (osteosarcoma).
Bone scintigraphy is the nuclear medicine technique that reveals which bones are affected by the disease.
The medical treatment includes pharmaceuticals to improve pain (analgesics and anti-inflammatory agents) and pharmaceuticals that inhibit bone remodelling, such as biphosphonates (zoledronat, alendronat), which are widely used for osteoporosis. Measures to improve quality of life, such as using a cane if arthrosis is present or using hearing aids if the illness has caused deafness, are very important. If a bone or joint is a severely affected, surgery can be considered. In general, the illness responds well to treatment and has a good prognosis.
Immunotherapy has revolutionised the treatment of some cancers in recent years. The immune system's job is to recognise and eliminate tumour cells, which prevents the appearance of tumours. However, when the tumour cells evade the immune system or it is not able to contain the tumour, that is when the cancer becomes apparent. The principle underlying immunotherapy is over-activating the immune system so that it can act against tumour cells. Nevertheless, this over-activation of the immune system can favour the appearance of inflammatory autoimmune diseases such as arthritis or myositis.
These adverse effects of immunotherapy, called immune-related adverse events (irAE), can manifest in any organ in the body. In rheumatology, the most common effects are joint issues with pain and swelling (arthritis) and inflammation in the muscles in the form of myositis. Other presentations include dry eye syndrome (dry eyes with a feeling of having "sand" in them), inflammation of vessels (vasculitis), or even kidney problems (nephritis).
These effects can occur in any patient being treated with immunotherapy, but it is more commonly seen in relation to the medications nivolumab, pembrolizumab, and ipilimumab. Diagnosing it requires an evaluation by a rheumatologist, who will take the symptoms into account, along with the analytical and imaging results, to make a more precise diagnosis.
Treatment is complex, as the immunotherapy must be continued due to the cancer. The oncologist and rheumatologist must carry out a joint evaluation to decide on the best treatment. The most commonly used treatments are anti-inflammatory agents and glucocorticoids, although in more severe cases, treatment with biological drugs (such as TNF-alpha inhibitors) can be considered.
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