RESUMEN
OBJECTIVE: To develop updated guidelines for the pharmacological management of rheumatoid arthritis (RA). METHODS: A group of experts representative of different geographical regions and various medical services catering to the Mexican population with RA was formed. Questions based on Population, Intervention, Comparison, and Outcome (PICO) were developed, deemed clinically relevant. These questions were answered based on the results of a recent systematic literature review (SLR), and the evidence's validity was assessed using the GRADE system, considered a standard for these purposes. Subsequently, the expert group reached consensus on the direction and strength of recommendations through a multi-stage voting process. RESULTS: The updated guidelines for RA treatment stratify various therapeutic options, including different classes of DMARDs (conventional, biologicals, and JAK inhibitors), as well as NSAIDs, glucocorticoids, and analgesics. By consensus, it establishes the use of these in different subpopulations of interest among RA patients and addresses aspects related to vaccination, COVID-19, surgery, pregnancy and lactation, and others. CONCLUSIONS: This update of the Mexican guidelines for the pharmacological treatment of RA provides reference points for evidence-based decision-making, recommending patient participation in joint decision-making to achieve the greatest benefit for our patients. It also establishes recommendations for managing a variety of relevant conditions affecting our patients.
Asunto(s)
Antirreumáticos , Artritis Reumatoide , Artritis Reumatoide/tratamiento farmacológico , Humanos , México , Antirreumáticos/uso terapéutico , Glucocorticoides/uso terapéutico , Femenino , Antiinflamatorios no Esteroideos/uso terapéutico , Embarazo , Analgésicos/uso terapéuticoRESUMEN
BACKGROUND: Palpation, a traditional haptic ability, is used daily by practitioners of all medical and surgical specialties to assess patients. In the current study, one of the authors, in a routine clinical setting, was able to deduce the dynamic features of the putative inferior belly of omohyoid. This led to a proof-of-concept study that yielded results consistent with the clinical findings. METHODS: The first part of the study involved a survey of 300 rheumatic disease patients in whom the greater supraclavicular fossa was explored by palpation. While the patient kept the head straight, the clinician placed his middle three fingers 2.5-3 cm dorsal to the clavicle in the window between the sternocleidomastoid and trapezius clavicular insertions, explored the supraclavicular fossa, and palpated the paired contractile inferior belly of the assumed omohyoid during flexion in the three orthogonal planes. In the second part of the study, five normal subjects were examined in a similar manner by the same clinician and had independent ultrasonography performed on the dominant side. Descriptive statistics were used, and Yates' corrected chi-squared test was applied to certain nominal variables. Additionally, a comparative anterolateral bilateral neck dissection was performed in a cadaveric specimen. RESULTS: Both studies showed that the contractile structure was the inferior belly of omohyoid and that its contraction occurred during anterior neck flexion and was opposite to the side of neck rotation, resembling the sternocleidomastoid. CONCLUSIONS: Palpation uncovered a previously unknown function of the inferior belly of omohyoid, suggesting that physical examination of the musculoskeletal system based on palpation may lead to hypotheses worthy of exploration.
RESUMEN
Syndemics are a framework that documents health inequities and vulnerabilities in populations with rheumatic diseases. Compared with other approaches, syndemics are able to conjunctly consider epidemiological, biological, sociodemographic and economic factors, and their interactions. OBJECTIVE: To estimate health inequity and vulnerability among Indigenous and non-Indigenous populations with rheumatic and musculoskeletal diseases (RMD) in Latin America using the syndemic approach. DESIGN: This is a secondary analysis of a previously published large-scale study on the prevalence of RMD. SETTING: Studies carried out in five Latin American countries (Argentina, Colombia, Ecuador, Mexico and Venezuela). Health inequity and vulnerability in RMD were identified through a syndemic approach using network and cluster analysis. PARTICIPANTS: A total of 44 560 individuals were studied: 29.78% self-identified as Indigenous, 60.92% were female, the mean age was 43.25 years. Twenty clusters were identified in the Indigenous population and 17 in the non-Indigenous population. RESULTS: The variables associated with RMD among Indigenous populations were rurality, public health system, high joint biomechanical stress, greater pain, disability and alcoholism; and among non-Indigenous people they were being a woman, urban origin, older age, private health system, joint biomechanical stress, greater pain and disability. We identified different health inequities among patients with RMD (ie, lower educational attainment, more comorbidities), associated with factors such as Indigenous self-identification and rural residence. CONCLUSIONS: A syndemic approach enables us to identify health inequities in RMD, as shown by higher prevalence of comorbidities, disability and socioeconomic factors like lower educational attainment. These inequities exist for the overall population of patients with RMD, although it is more evident in Indigenous groups with added layers of vulnerability.
Asunto(s)
Enfermedades Reumáticas , Sindémico , Humanos , Femenino , Adulto , Masculino , América Latina/epidemiología , Enfermedades Reumáticas/epidemiología , México , DolorRESUMEN
INTRODUCTION: The type of body composition modulates the severity of some musculoskeletal conditions, in fibromyalgia syndrome (FMS), this type of association remains relatively unexplored. OBJECTIVE: To analyze the association between the type of body composition and FMS using Principal Component Analysis (PCA). The FMS clinical outcome measures were: Symptom Severity Scale (SSS), Widespread Pain Index (WPI; and Fibromyalgia Impact Questionnaire (FIQ). METHODS: Forty-three women with FMS (ACR 2010 criteria) were clinically and anthropometrically evaluated. The anthropometric data were integrated into two indicators using a PCA methodology (PCA-Fat and PCA-muscle). Additionally, the patients were classified into high and low categories for each clinical indicator, which were used as dependent variables in binomial logistic regression (BLR) models. RESULTS: We found a positive correlation between PCA-Fat with WPI (r=0.326, P=.043) and FIQ (r=0.325, P=.044), and negative correlation (r=-0.384, P=.013) between PCA-muscle and SSS. In the BLR analysis, PCA-Fat was a significant predictor for high WPI (OR=2.477, P=.038); while for high SSS, PCA-muscle (OR=0.303, P=.009) was an inversely significant predictor. CONCLUSIONS: The results suggest that the volume of fat mass can negatively modulate the severity of FMS. We propose that the evaluation of body composition should be a basic element for the clinical approach of patients with FMS.
Asunto(s)
Fibromialgia , Humanos , Femenino , Fibromialgia/diagnóstico , Análisis de Componente Principal , Dolor , Dimensión del Dolor/métodos , Composición CorporalRESUMEN
INTRODUCTION: Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. OBJECTIVE: To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. METHODS: Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. RESULTS: Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals' variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). CONCLUSIONS: LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations. Key points ⢠Syndemic and syndemogenesis evidence health disparities in Latin-American populations, documenting the complexity of suffering from a disease such as low back pain that is associated with comorbidities, unhealthy habits, and the social and regional context where they live. ⢠The use of network and cluster analyses are useful tools for documenting the complexity and the multifaceted impact in health in large populations as well as the differences between countries. ⢠The variability and impact of socioeconomic indicators (e.g., Gini index) related to low back pain and comorbidities could be felt through the use of cluster analysis, which generates evidence of regional inequality in Latin America. ⢠Populations can be studied from different models (network and cluster analysis) and grouping, presenting new interpretations beyond geographical groupings, such as syndemic and inequity in health.
Asunto(s)
Dolor de la Región Lumbar , Adulto , Análisis por Conglomerados , Femenino , Humanos , América Latina/epidemiología , Dolor de la Región Lumbar/epidemiología , Masculino , Calidad de Vida , Sindémico , Estados Unidos , Adulto JovenRESUMEN
INTRODUCTION: The effect of overweight/obesity on clinical status in rheumatoid arthritis (RA) is still a controversial topic. AIM: To assess the association between body composition and clinical status in RA patients. METHODS: A prospective, comparative, cross-sectional study was performed on 123 (98.4% women, 86.3% FR+, 9.3±8.7 duration years) RA patients diagnosed according to ACR/EULAR 2010 criteria who were assessed for inflammatory activity (DAS 28), functional status (HAQ-Di), and type of treatment. Body composition was evaluated by BMI, waist, hip, and middle arm girths, waist/hip ratio, skin fold measurements, and bioelectrical impedance analysis. RESULTS: The prevalence of overweight and obesity (BMI-WHO cut-off points) was 30.9% and 45.5% respectively. Using Stavropoulos-Kalinoglou cut-off points, each corresponding prevalence increased to 31.7% and 58.5%, respectively. Pooled patients in the overweight/obesity classification (Stavropoulos-Kalinoglou classification) exhibited a significantly higher number of swollen joints as compared to subnormal/normal body composition subjects (3.8±3.3 vs. 1.9±2.5; p=.02). Swollen joint count showed significant positive correlation with 6 out of 11 body composition parameters: BMI; arm and hip girths, triceps skin fold, body fat average determined by bioelectrical impedance analysis, and skin fold measurements. CONCLUSIONS: Prevalence of obesity in RA varies according to BMI cut-off points. Overweight and obesity were associated with higher inflammatory activity characterized by a higher count of tender and swollen joints. A positive correlation was found between swollen joint amount and the majority of the body fat mass indicators assessed. Body composition assessment/improvement should be an important part of the routine care of RA patients.
Asunto(s)
Artritis Reumatoide/etiología , Composición Corporal , Obesidad/complicaciones , Sobrepeso/complicaciones , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Sobrepeso/epidemiología , Prevalencia , Estudios Prospectivos , Adulto JovenRESUMEN
Antecedents: The serum levels of some cytokines can be useful in the diagnosis of neonatal sepsis; the prognostic value of a cytokine profile has not, to our knowledge, been explored in this disease. Objective: The objective of this study is to evaluate the diagnostic value of the serum levels of cytokines IL-1, -2, -4, -5, -6, -7, -8, -10, -12, -13, and -17, TNF, IFNγ, G-CSF, GM-CSF, MCP1, and MIP1ß in neonates with high risk of developing sepsis. Methods: Sepsis was evaluated in 96 high-risk neonates. We assessed cytokine levels on hospital admission and during or not during sepsis. Results: Fifty (52%) presented sepsis (26 early and 24 late). Sepsis was associated with high levels of IL-6, IL-10, G-CSF, and MCP1 and low levels of IFNγ, early sepsis with high levels of IL-6 and G-CSF, severe sepsis with high levels of IL-6 and IL-10, while deaths or sequelae was associated with low levels of IL-4, IL-12, IFNγ, and high levels of GM-CSF. IL-6 values of ≥40.1 pg/mL were associated with the development of any type of sepsis (relative risk [RR]: 1.70; 95% confidence interval [95% CI]: 1.18-2.24; p = .01), while IL-6 values of ≥44.9 pg/mL were associated with early sepsis (RR: 1.29; 95% CI: 1.29-4.56; p = .01). Conclusion: In neonates with high risk for the development of sepsis, there is an association between levels of IL-6, IL-10, and G-SCF and the disease development/outcome.
Asunto(s)
Citocinas/sangre , Sepsis Neonatal/sangre , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Masculino , Sepsis Neonatal/diagnóstico , Sepsis Neonatal/mortalidad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de RiesgoRESUMEN
Epidemiological studies in Latin America suggest indigenous people lack proper healthcare for musculoskeletal (MSK) and rheumatic diseases. OBJECTIVES: This study aimed to estimate the prevalence of MSK disorders and rheumatic diseases in eight Latin American indigenous communities, and to identify which factors influence such prevalence using network analysis and syndemic approach. METHODS: This is a cross-sectional, community-based census study according to Community-Oriented Program for the Control of Rheumatic Diseases methodology. Individuals with MSK pain, stiffness or swelling in the past and/or during the last 7 days were evaluated by participating physicians. A descriptive, univariable and multivariable analysis was performed, followed by a network analysis. RESULTS: We surveyed 6155 indigenous individuals with a mean age of 41.2 years (SD 17.6; range 18-105); 3757 (61.0%) were women. Point prevalence in rank order was: low back pain in 821 (13.3%); osteoarthritis in 598 (9.7%); rheumatic regional pain syndromes in 368 (5.9%); rheumatoid arthritis in 85 (1.3%); undifferentiated arthritis in 13 (0.2%); and spondyloarthritis in 12 (0.1%). There were marked variations in the prevalence of each rheumatic disease among the communities. Multivariate models and network analysis revealed a complex relationship between rheumatic diseases, comorbidities and socioeconomic conditions. CONCLUSIONS: The overall prevalence of MSK disorders in Latin American indigenous communities was 34.5%. Although low back pain and osteoarthritis were the most prevalent rheumatic diseases, wide variations according to population groups occurred. The relationship between rheumatic diseases, comorbidities and socioeconomic conditions allows taking a syndemic approach to the study.
Asunto(s)
Dolor Musculoesquelético/epidemiología , Grupos de Población/estadística & datos numéricos , Enfermedades Reumáticas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Salud Pública , Factores Socioeconómicos , Sindémico , Adulto JovenRESUMEN
BACKGROUND: There is limited information about the factors related with the development of long-term permanent work disability (PWD) in rheumatoid arthritis (RA) treated with a combination of conventional synthetic disease-modifying antirheumatic drugs (cs-DMARDs). OBJECTIVE: The aim of this study was to evaluate incidence and factors associated with the development of PWD in RA treated with combination therapy using conventional synthetic cs-DMARDs. METHODS: We assessed in multivariate models the effect of clinical and demographic factors in the development of PWD in a long-term retrospective cohort of 180 workers with RA who were treated with a combination of cs-DMARDs. RESULTS: Incidence rates of PWD were 2.2% at 1 year, 7.7% at 5 years, 24.9% at 10 years, 34.9% at 15 years, and 45% at 20 years. In the adjusted Cox regression analysis, factors associated with PWD development were the first failure with combination of cs-DMARDs (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.05-5.46; P = 0.03), poor functioning at time of cohort onset (HR, 2.2; 95% CI, 1.05-4.70; P = 0.03), and requirement for joint replacement (HR, 3.3; 95% CI, 1.28-8.79; P = 0.01). CONCLUSIONS: Around 25% of workers with combination therapy with cs-DMARDs developed PWD in 10 years following the diagnosis of RA. Some factors increase the risk of disability. Permanent work disability generates a relevant society burden and increases health care costs. Therefore, indicators predicting failure of combination therapies with cs-DMARDs might provide clinicians of useful tools for modifying treatments avoiding the disease progression.
Asunto(s)
Antirreumáticos , Artritis Reumatoide , Costo de Enfermedad , Ausencia por Enfermedad/estadística & datos numéricos , Adulto , Antirreumáticos/clasificación , Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/economía , Artritis Reumatoide/fisiopatología , Evaluación de la Discapacidad , Quimioterapia Combinada/métodos , Femenino , Costos de la Atención en Salud , Humanos , Masculino , México , Persona de Mediana Edad , Pronóstico , Estadística como AsuntoRESUMEN
This study aimed to generate a minimum list of structural and functional anatomical items about the pelvis/hip, knee, ankle/foot, gait, and lower limb innervation, which are most relevant to the practice of rheumatology. To determine their perceived relevance to clinical practice, seven members of the Mexican Clinical Anatomy Task Force compiled an initial list of 470 anatomical items. Ten local and international experts according to a 0-10 Likert scale ranked these items. Of the original list, 101 (21.48%) items were considered relevant (global rate >40). These included 36/137 (26.27%) pelvis and hip items, 25/82 (30.48%) knee items, 22/168 (13.98%) ankle/foot items, 11/68 (16.17%) neurologic items, and 7/15 (46.66%) gait-related items. We propose that these 101 anatomical items of the lower extremity, when added to the 115 anatomic items of the upper extremity and spine we previously reported, may represent an approximation to the minimal anatomical knowledge central to the competent practice of rheumatology. The meager representation of ankle and foot items may reflect a lesser emphasis in these anatomical regions during rheumatologic training. Attention to these and related items during rheumatologic training and beyond may sharpen the rheumatologist's ability in the differential diagnosis of regional pain syndromes as well as strengthen an endangered art: the rheumatologic physical examination.
Asunto(s)
Tobillo/anatomía & histología , Pie/anatomía & histología , Marcha/fisiología , Rodilla/anatomía & histología , Pelvis/anatomía & histología , Tobillo/fisiología , Fenómenos Biomecánicos/fisiología , Pie/fisiología , Humanos , Rodilla/fisiología , Pelvis/fisiología , ReumatologíaRESUMEN
Objective: To provide a summary of scientific open access resources Cognitive Behavioral Therapy interventions in patients with fibromyalgia. Method: Bibliographical search performed in Pubmed and PsycInfo, Latindex, Scielo and Redalyc online databases. No year of publication criterion was applied. Results: 377 citations were reduced to a list of 59 relevant publications, from 1993 to 2016. Most studies were performed in adult samples, in Spain or the United States, with pre-post quantitative design. Only 15 publications were open access. Conclusions: Empirical evidence is ample, yet mostly restricted. Open access material might promote interest in and encourage the design, implementation and evaluation of CBT interventions in the benefit of fibromyalgia patients, the health system and science.
Objetivo: Proveer un resumen de la evidencia científica de accesos abierto sobre intervenciones con Terapia Cognitivo Conductual en pacientes con fibromialgia. Método: Se realizó una búsqueda bibliográfica en las bases en línea de Pubmed y PsycInfo, Latindex, Scielo y Redalyc. No aplicó criterio por año de publicación. Resultados: Las primeras 377 citas obtenidas se redujeron a una lista de 59 publicaciones relevantes, publicadas entre 1993 y 2016. La mayoría de los estudios se realizaron en muestras de pacientes adultos, en España o Estados Unidos, con un diseño cuantitativo de tipo pre - post. Únicamente 15 publicaciones fueron de acceso abierto. Conclusiones: La evidencia empírica es amplia; sin embargo, el acceso a la misma es generalmente restringido. El material de acceso abierto puede promover el interés en las intervenciones con Terapia Cognitivo Conductual y estimular su diseño, implementación y evaluación, todo esto en beneficio de los pacientes con fibromialgia, los sistemas de salud y la ciencia.
RESUMEN
This study aimed to identify the anatomical items of the upper extremity and spine that are potentially relevant to the practice of rheumatology. Ten rheumatologists interested in clinical anatomy who published, taught, and/or participated as active members of Clinical Anatomy Interest groups (six seniors, four juniors), participated in a one-round relevance Delphi exercise. An initial, 560-item list that included 45 (8.0 %) general concepts items; 138 (24.8 %) hand items; 100 (17.8 %) forearm and elbow items; 147 (26.2 %) shoulder items; and 130 (23.2 %) head, neck, and spine items was compiled by 5 of the participants. Each item was graded for importance with a Likert scale from 1 (not important) to 5 (very important). Thus, scores could range from 10 (1 × 10) to 50 (5 × 10). An item score of ≥40 was considered most relevant to competent practice as a rheumatologist. Mean item Likert scores ranged from 2.2 ± 0.5 to 4.6 ± 0.7. A total of 115 (20.5 %) of the 560 initial items reached relevance. Broken down by categories, this final relevant item list was composed by 7 (6.1 %) general concepts items; 32 (27.8 %) hand items; 20 (17.4 %) forearm and elbow items; 33 (28.7 %) shoulder items; and 23 (17.6 %) head, neck, and spine items. In this Delphi exercise, a group of practicing academic rheumatologists with an interest in clinical anatomy compiled a list of anatomical items that were deemed important to the practice of rheumatology. We suggest these items be considered curricular priorities when training rheumatology fellows in clinical anatomy skills and in programs of continuing rheumatology education.
Asunto(s)
Anatomía/educación , Competencia Clínica , Reumatología/educación , Reumatología/métodos , Algoritmos , Brazo/anatomía & histología , Educación Médica , Cabeza/anatomía & histología , Humanos , Cuello/anatomía & histología , Columna Vertebral/anatomía & histología , Estadística como AsuntoRESUMEN
This study assessed the overall and specific prevalence of the main rheumatic regional pain syndromes (RRPS) in four Latin-American indigenous groups. A Community Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology-based census study was performed in 4240 adults (participation rate: 78.88 %) in four indigenous groups: Chontal (Oaxaca, Mexico, n = 124), Mixteco (Oaxaca, Mexico; n = 937), Maya-Yucateco (Yucatán, Mexico; n = 1523), and Qom (Rosario, Argentina; n = 1656). Subjects with musculoskeletal pain were identified using a cross-cultural, validated COPCORD questionnaire administered by bilingual personnel, and reviewed by general practitioners or rheumatologists using standardized case definitions for the 12 most frequent RRPS. The overall prevalence of RRPS was confirmed in 239 cases (5.64 %, 95 % CI: 4.98-6.37). The prevalence in each group was Chontal n = 19 (15.32 %, 95 % CI: 10.03-22.69); Maya-Yucateco n = 165 (10.83 %, 95 % CI: 9.37-12.49); Qom n = 48 (2.90 %, 95 % CI: 2.19-3.82); and Mixteco n = 7 (0.75 %, 95 % CI: 0.36-1.53). In the whole sample, the syndrome-specific prevalence was rotator cuff tendinopathy: 1.98 % (95 % CI: 1.60-2.45); lateral epicondylalgia: 0.83 % (95 % CI: 0.59-1.15); medial epicondylalgia: 0.73 % (95 % CI: 0.52-1.04); biceps tendinopathy: 0.71 % (95 % CI: 0.50-1.01); anserine syndrome: 0.64 % (95 % CI: 0.44-0.92); inferior heel pain: 0.61 % (95 % CI: 0.42-0.90); trochanteric syndrome: 0.49 % (95 % CI: 0.25-0.64); de Quervain's tendinopathy: 0.45 % (95 % CI: 0.29-0.70); trigger finger: 0.42 % (95 % CI: 0.27-0.67); carpal tunnel syndrome: 0.28 % (95 % CI: 0.16-0.49); Achilles tendinopathy (insertional): 0.12 % (95 % CI: 0.05-0.28); and Achilles tendinopathy (non-insertional): 0.07 % (95 % CI: 0.02-0.21). Leaving aside the comparison between Maya-Yucateco and Chontal groups (p = 0.18), we found significant differences (p < 0.001) in overall RRPS prevalence between the remaining pairs of indigenous groups. Syndrome-specific prevalences were also different between groups. Our findings support the hypothesis that overall RRPS prevalence and syndrome-specific prevalences are modulated by population-specific factors.
Asunto(s)
Indígenas Centroamericanos , Indígenas Sudamericanos , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/etnología , Enfermedades Reumáticas/etnología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Censos , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Enfermedades Reumáticas/clasificación , Encuestas y Cuestionarios , Adulto JovenRESUMEN
The impact of living with arthritis in a rural Mexican Mayan community along with the barriers encountered by people living with this chronic condition were investigated in this study. The community needs around this health issue were investigated by conducting an ethnographic study using data obtained during two time periods (August 2012-April 2013 and December 2013-December 2014). During the first period, fieldwork observations and interviews with 65 individuals, which included people with arthritis, health professionals, traditional health providers, and community leaders were undertaken. During the second period, 46 community meetings were conducted to identify the needs associated with arthritis in the municipality. Data were analyzed following a modified version of the Framework approach. The results show that arthritis reduces the health-related quality of life of the people in Chankom through a process of disablement, conditioning a need to access culturally sensitive healthcare. Availability, attainability, and acceptability barriers prevent access to this type of healthcare and result from power imbalance between indigenous and non-indigenous people. There is a need to develop culturally sensitive rehabilitation services for people living with arthritis in Chankom. Mayan people should be involved in the design and implementation of these services. Moreover, it is important to improve our understanding of the processes behind the healthcare access inequities identified in this study by attending to the historical generation of current social, economical, cultural, and political structures.
Asunto(s)
Artritis/tratamiento farmacológico , Asistencia Sanitaria Culturalmente Competente , Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud , Calidad de Vida , Artritis/etnología , Personas con Discapacidad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Indígenas Norteamericanos , Masculino , México , Investigación Cualitativa , Población RuralRESUMEN
Multilevel studies have gained importance for highlighting social inequalities in health. These associations have been reported previously in diseases such as arthritis and chronic pain. We conducted a cross-sectional study using multilevel analysis to identify individual and contextual factors associated with the variation of prevalence of osteoarthritis (OA) in the Mexican population. The sample included 17,566 individuals of which 10,666 (60.7%) were women. The relationship between individual and contextual factors and OA were analyzed with a multilevel strategy. From the total population, 1,681 individuals had OA. Multilevel analysis showed that individual variables such as female gender (odds ratio (OR) = 1.3, 95% confidence interval (CI) 1.1, 1.4), age range 55-65 years (OR = 1.6, 95% CI 1.3, 2.0), musculoskeletal pain in the last 7 days (OR = 2.6, 95% CI 2.3, 3.0), and use of pain treatments (OR = 1.4, 95% CI 1.2, 1.7) were associated with OA. At the regional level, the Social Gap Index (SGIx) was associated with the diagnosis of OA (coefficient 0.5, 95% CI 0.2-1.1). The SGIx contextual variable was positively associated with the regional prevalence of OA and the variation in prevalence of OA in different regions. The larger the social gap, the greater the variation in OA prevalence. These factors were independently associated with the prevalence of OA: female gender, pain intensity, physical limitation, and the use of pain treatments were individual variables associated with OA. The association between OA prevalence and regional variations with SGIx reflects inequities in health provisions that should be considered in health programs.
Asunto(s)
Dolor Crónico/etiología , Disparidades en el Estado de Salud , Dolor Musculoesquelético/etiología , Osteoartritis/epidemiología , Anciano , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , México/epidemiología , Persona de Mediana Edad , Análisis Multinivel , Oportunidad Relativa , Dimensión del Dolor , Prevalencia , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Reports regarding the association between body composition and inflammatory activity in rheumatoid arthritis (RA) have consistently yielded contradictory results. OBJECTIVE: To perform a systematic review on the association between overweight/obesity and inflammatory activity in RA. METHODS: FAST approach: Article search (Medline, EBSCO, Cochrane Library), followed by abstract retrieval, full text review and blinded assessment of methodological quality for final inclusion. Because of marked heterogeneity in statistical approach and RA activity assessment method, a meta-analysis could not be done. Results are presented as qualitative synthesis. RESULTS: One hundred and nineteen reports were found, 16 of them qualified for full text review. Eleven studies (8,147 patients; n range: 37-5,161) approved the methodological quality filter and were finally included. Interobserver agreement for methodological quality score (ICC: 0.93; 95% CI: 0.82-0.98; P<.001) and inclusion/rejection decision (k 1.00, P>.001) was excellent. In all reports body composition was assessed by BMI; however a marked heterogeneity was found in the method used for RA activity assessment. A significant association between BMI and RA activity was found in 6 reports having larger mean sample size: 1,274 (range: 140-5,161). On the other hand, this association was not found in 5 studies having lower mean sample size: 100 (range: 7-150). CONCLUSIONS: The modulation of RA clinical status by body fat mass is suggested because a significant association was found between BMI and inflammatory activity in those reports with a trend toward higher statistical power. The relationship between body composition and clinical activity in RA requires be approached with further studies with higher methodological quality.
Asunto(s)
Artritis Reumatoide/fisiopatología , Composición Corporal , Obesidad/fisiopatología , Artritis Reumatoide/complicaciones , Progresión de la Enfermedad , Humanos , Obesidad/complicaciones , Sobrepeso/complicaciones , Sobrepeso/fisiopatología , Índice de Severidad de la EnfermedadRESUMEN
This study aims to evaluate the impact of arthritis on the physical function of people living in a Maya-Yucateco rural community and to assess the association of known modifiable risk factors with the prevalence of overall arthritis and its main types (osteoarthritis and rheumatoid arthritis). Using a cross-sectional, community-based census design, data collected from the adult population (≥18 years) of the Municipality of Chankom, Yucatán, México, were analyzed (n = 1523). Participants' physical function was assessed using a culturized version of the health assessment questionnaire disability index. Social, physical, and behavioral factors linked to overall arthritis, osteoarthritis, and rheumatoid arthritis, were assessed through the "Community-Oriented-Program-for-the-Control-of-Rheumatic-Diseases [COPCORD]" questionnaire. A physiatrist and a rheumatologist confirmed all osteoarthritis and rheumatoid arthritis cases using the American College of Rheumatology criteria. Arthritis was confirmed in 169 cases (22 %, 95 % confidence interval (CI) 19-25) of those assessed for musculoskeletal symptoms (n = 779): osteoarthritis = 144, rheumatoid arthritis = 17, and non-specific arthritis = 8. Arthritis was associated with a higher prevalence of disability after controlling for age, gender, and number of comorbidities (odds ratio = 4.0, 95 % CI 3.0-6.0). Higher level of wealth was associated with lower arthritis prevalence (odds ratio = 0.9, 95% CI 0.8-0.9). Higher body mass index was associated with higher hip and/or knee osteoarthritis prevalence (odds ratio = 1.1, 95 % CI 1.03-1.1). Arthritis is highly associated with disability in the Mayan people living in Chankom. The prevalence of arthritis in Chankom is associated with social factors, such as people's level of wealth, while the prevalence of low-extremity osteoarthritis is associated with people's body mass index.
Asunto(s)
Artritis Reumatoide/etnología , Indígenas Centroamericanos , Osteoartritis de la Cadera/etnología , Osteoartritis de la Rodilla/etnología , Población Rural , Adulto , Índice de Masa Corporal , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Humanos , Modelos Logísticos , Masculino , México/epidemiología , Persona de Mediana Edad , Dimensión del Dolor , Factores de Riesgo , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. OBJECTIVES: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphospholipid antibody syndrome (APS). METHODOLOGY: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and grading of recommendations, internal validation by peers, and external validation of the final document. The quality criteria of the AGREE II instrument were followed. RESULTS: The various panels answered the 37 questions related to maternal and fetal care in SLE, RA, and APS, as well as to the use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. We present the recommendations for pregnant women with SLE in this first part. CONCLUSIONS: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with SLE integrate the best available evidence for the treatment and follow-up of patients with these conditions.
Asunto(s)
Síndrome Antifosfolípido/terapia , Artritis Reumatoide/terapia , Lupus Eritematoso Sistémico/terapia , Complicaciones del Embarazo/terapia , Atención Prenatal/métodos , Cuidados Posteriores/métodos , Síndrome Antifosfolípido/diagnóstico , Artritis Reumatoide/diagnóstico , Femenino , Humanos , Lupus Eritematoso Sistémico/diagnóstico , México , Embarazo , Complicaciones del Embarazo/diagnósticoRESUMEN
BACKGROUND: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. OBJECTIVES: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus, rheumatoid arthritis (RA) and antiphospholipid syndrome (APS). METHODOLOGY: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and staging of recommendations, internal validation by peers and external validation of the final document. The quality criteria of the AGREE II instrument were followed. RESULTS: The panels answered 37 questions related to maternal and fetal care in lupus erythematosus, RA and APS, as well as for use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. In this second part, the recommendations for pregnant women with RA, APS and the use of antirheumatic drugs during pregnancy and lactation are presented. CONCLUSIONS: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with RA and APS integrate the best available evidence for the treatment and follow-up of patients with these conditions.
Asunto(s)
Síndrome Antifosfolípido/terapia , Artritis Reumatoide/terapia , Lupus Eritematoso Sistémico/terapia , Complicaciones del Embarazo/terapia , Atención Prenatal/métodos , Cuidados Posteriores/métodos , Síndrome Antifosfolípido/diagnóstico , Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico , Toma de Decisiones Clínicas , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Lupus Eritematoso Sistémico/diagnóstico , México , Embarazo , Complicaciones del Embarazo/diagnósticoRESUMEN
BACKGROUND: The overall estimated prevalence of rheumatoid arthritis (RA) in Mexico is 1.6%, but there are major variations in different geographic areas of the country. OBJECTIVE: This study aimed to determine the impact of individual and regional variables on the geographic distribution of RA in Mexico. METHODS: This multilevel analysis used data from a cross-sectional study that investigated the prevalence of RA among 19,213 individuals older than 18 years throughout 5 geographic regions in Mexico. Logistic regression models were used to determine predictors of RA, including individual and regional variables as well as cultural factors. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were determined. RESULTS: The prevalence of RA varied from 0.77% to 2.8% across the 5 regions. Individual factors associated with RA were sex (OR, 2.32; 95% CI, 1.74-3.07), previous medical diagnosis of RA ( OR 3.3, 95%CI: 29195.1 [corrected]), disability (OR, 2.07; 95% CI, 1.48-2.93), and the 56- to 65-year age group (OR, 1.95; 95% CI, 1.08-3.74). The regional factor of speaking an indigenous language had an OR of 2.27 (95% CI, 1.13-4.55). CONCLUSIONS: Various individual and regional factors were associated with variations in the prevalence of RA in the Mexican population.