Distribution and characteristics of the certification of rheumatologists in Mexico.

OBJECTIVE: Describe the distribution of adult and pediatric rheumatologists with current certification in Mexico and the factors associated with this distribution. METHODS: The databases of the Mexican Council of Rheumatology and the Mexican College of Rheumatology for 2020 were reviewed. The rate of rheumatologists per 100,000 inhabitants by state of the Mexican Republic was calculated. To find out the number of inhabitants by state, the results of the 2020 population census of the National Institute of Statistics and Geography were consulted. The number of rheumatologists with current certification by state, age, and sex was analyzed. RESULTS: In Mexico, there are 1002 registered adult rheumatologists with a mean age of 48.12 ±â€¯13 years. The male gender prevailed with a ratio of 1.18:1. Ninety-four pediatric rheumatologists were identified with a mean age of 42.25 ±â€¯10.4 years, with a predominance of the female gender with a ratio of 2.2:1. In Mexico City and Jalisco, more than one rheumatologist/100,000 inhabitants were reported in the specialty of adults and only in Mexico City in pediatrics. The current certification is 65%-70% on average and the factors associated with a higher prevalence were younger age, female gender and geographic location. CONCLUSIONS: There is a shortage of rheumatologists in Mexico and in the pediatric area there are underserved regions. It is important that health policies apply measures that allow a more balanced and efficient regionalization of this specialty. Although most rheumatologists have current certification, it is necessary to establish strategies to increase this proportion.

Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part I.

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.

Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part II.

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.

Intake of dehydrated nopal (Opuntia ficus indica) improves bone mineral density and calciuria in adult Mexican women.

BACKGROUND: The intake of dehydrated nopal (DN) at a high stage of maturity along with high calcium content could improve bone mineral density (BMD) and calciuria and thus prevent osteoporosis. OBJECTIVE: To evaluate the effect of calcium intake from a vegetable source (DN) on BMD and calciuria covering a 2-year period in menopausal and non-menopausal women with low bone mass (LBM). METHODS: The study was quasi-experimental, blinded, and randomized, and included 131 Mexican women aged 35-55. Urinary calcium/creatinine index (CCI) was determined; BMD was analyzed on lumbar spine and total hip regions. Four groups were studied: Control group (CG), women with normocalciuria and a minimum dose of DN; experimental group 1 (EG1), women with hypercalciuria and a minimum dose of DN; experimental group 2 (EG2), women with hypercalciuria, and a maximum dose of DN; and normal group (NG) for reference in BMD. RESULTS: After the first semester of treatment, calciuria levels in women from both experimental groups returned to normal, remaining constant for the rest of the treatment. The percentage difference in BMD increased in the total hip region in the CG (pre 4.5% and post 2.1%) and EG2 (pre 1.8% and post 2.5%) groups significantly in comparison to NG and EG1, which exhibited a significant decrease in their BMD. BMD increased only for the lumbar region in the EG2 group (premenopausal). CONCLUSION: The use of a vegetable calcium source such as nopal improves BMD in women with LBM in the total hip and lumbar spine regions principally in the premenopausal women, maintaining constant and normal calciuria levels.

Biosimilar drugs in Mexico: position of the Mexican College of Rheumatology, 2012.

Biotechnological drugs (BTDs) are complex molecules whose manufacturing process precludes the ability to identically reproduce the structure of the original product, and therefore there cannot be an absolute equivalence between the original (innovative) medication and its biosimilar counterpart. BTDs have been proven useful in the treatment of several rheumatic diseases, however their high cost has prevented their use in many patients. Several BTD patents have expired or are close to expire, triggering the development of structurally similar drugs with efficacy and safety profiles comparable to the innovative compound; however, these must be evaluated through evidence based medicine. The Mexican General Health Law contemplates the registry of these biosimilar drugs for their use in our country. This document is a forethought from members of the Mexican College of Rheumatology, pharmacologists, and epidemiologists, in accordance with Mexican health authorities regarding the necessary scientific evidence required to evaluate the efficacy and safety of biosimilar drugs before and after their arrival to the Mexican market.

Las mujeres evalúan sus factores de riesgo para osteoporosis / Osteoporosis risk factors autoevaluated by women

Esta encuesta incluyó 70 mujeres con edad promedio de 62 años y diagnóstico confirmado de osteoporosis por DEXA, quienes autoevaluaron los factores de riesgo (FR) en la aparición con la enfermedad. El promedio de FR fue 3.35 por caso. El 62.8 por ciento informó enfermedades coexistentes y en ese mismo porcentaje reconocieron vida sedentaria; el 43 por ciento refirió deficiente aporte alimentario de calcio, el 30 por ciento había sufrido fracturas previas (35 por ciento de muñeca) y también en 30 por ciento existió antecedente de menopausia quirúrgica, de las cuales sólo al 24 por ciento recibió prescripción para terapia de reemplazo hormonal que fue seguido por menos de un año en 41 por ciento. Se encontró significancia estadística (p < 0.05) para las características antropométricas, el número de factores asociados, años de menopausia, antecedentes hereditarios, fracturas previas y uso previo de corticoesteroides.

El cuello del fémur en la tercera edad: estudio multicéntrico de la densidad mineral / The femoral neck in the third age: multicentric study

Durante un período de 6 meses en tres centros de investigación (León, Puebla y Querétaro), se estudiaron 374 casos que fueron enviados por primera vez para su examen, siendo requisito una edad mínima de 60 años. Todos los casos correspondieron al sexo femenino; la edad promedio fue de 69.25 años ñ 6.54, con límites entre 60 a 91 años. El 56 por ciento abarcó la década de 60 a 69 (208 casos), el 37 por ciento de los 70 a los 79 años (138 casos) y el 7 por ciento (28 casos) de los 80 años en adelante. En los tres centros de diagnostico se determinó la densidad mineral ósea en el cuello del fémur y se aplicaron los criterios de Johnston para interpretar los resultados. Estos revelaron un 65 por ciento de pacientes osteoporóticos, 24 por ciento de osteopénicos y sólo 17 por ciento de casos normales. De acuerdo con estos hallazgos, la osteoporosis parece ser muy frecuente en la etapa geriátrica, por lo que la cuantificación de la densidad mineral ósea en la actualidad es el mejor recurso para tomar decisiones clínicas y detectar casos con alto riesgo de fracturas de la cadera

Osteoporosis en reumatología y ortopedia

La incidencia de la osteoporosis, sus complicaciones, repercusiones funcionales, económicas y sociales han sido frecuentemente menospreciadas por el médico; para demostrarlo, a lo largo de un año se estudiaron 83 pacientes (79 del sexo femenino y 4 del masculino), de los cuales correspondieron 36 casos al servicio de Reumatología y 47 al de Ortopedia. En los pacientes referidos a Reumatología, se detectó dorso-lumbalgia de predominio nocturno en el 80 por ciento, antecedentes familiares en el 24 por ciento y fracturas previas en el 30 por ciento. los 47 pacientes evaluados en Ortopedia, se presentaron todos con fracturas, predominando las vértebras en 34 (42.2 por ciento), cadera en 30 (36.2 por ciento) y radio en 15 (16.6 por ciento). De los pacientes, sólo en un caso se había sospechado el padecimiento y ninguno (!) había recibido tratamiento preventivo por lo que la alta morbilidad y el elevado costo del tratamiento quirúrgico obligan a difundir los conocimientos sobre este padecimiento y en especial sobre la detección temprana de factores de riesgo, diagnóstico oportuno y tratamiento preventivo

Morfometría vertebral radiológica: valores de índices, alturas y áreas vertebrales en columnas dorsal y lumbar de mujeres mexicanas: estudio multicéntrico / Radiological vertebral morphometry: vertebral indices, heights and areas in thoracic and lumbar spine in Mexican women: multicentric study

La morfolometría vertebral (MV) es un método empleado para la medición de contornos vertebrales en placas radiográficas de columna. Nuestro objetivo fue establecer valores normales de alturas, áreas e índices de deformidad vertebral en mujeres mexicanas sanas para poder ser empleados en estudios de MV. Evaluamos los cambios producidos por el envejecimiento en alturas y áreas vertebrales entre mujeres jóvenes (40-59 años) y mujeres ancianas (60-79 años). Se evaluaron 130 MV de columna dorsal y lumbar; se midieron alturas y áreas vertebrales T4-L5 y se calcularon índices de deformidad vertebral. Se encontró un aumento en la altura anterior (Aa) y posterior (Ap) de las vértebras T4-L3 pero en L4-L5 Ap fue inferior que Aa. El aumento promedio en Aa de T4-T8 fue de 1.1 mm mientras que de T8 a L3 fue de 10.9 mm. El aumento progresivo en el tamaño de los cuerpos vertebrales condiciona un aumento en el área vertebral. El aumento promedio del área vertebral T4-L3 fue 8.2 cm. La comparación entre mujeres jóvenes y ancianas indican que no hay diferencias en los valores absolutos de alturas vertebrales; sin embargo, los índices de contorno vertebrales (ICV) muestran: el índice por ciento Acuñamiento y el índice por ciento Concavidad aumentan con la edad de T8-T10 mientras que el Indice por ciento Compresión Específica es mayor en todos los niveles vertebrales en las mujeres de mayor edad