Evaluation of medical ethics competencies in rheumatology: local experience during national accreditation process.

INTRODUCTION: Rheumatologists are the primary healthcare professionals responsible for patients with rheumatic diseases and should acquire medical ethical competencies, such as the informed consent process (ICP). The objective clinical structured examination is a valuable tool for assessing clinical competencies. We report the performance of 90 rheumatologist trainees participating in a station designed to evaluate the ICP during the 2018 and 2019 national accreditations. METHODS: The station was validated and represented a medical encounter in which the rheumatologist informed a patient with systemic lupus erythematosus with clinically active nephritis about renal biopsy. A trained patient-actor and an evaluator were instructed to assess ICP skills (with a focus on kidney biopsy benefits, how the biopsy is done and potential complications) in obtaining formal informed consent, delivering bad news and overall communication with patients. The evaluator used a tailored checklist and form. RESULTS: Candidate performance varied with ICP content and was superior for potential benefit information (achieved by 98.9% of the candidates) but significantly reduced for potential complications (37.8%) and biopsy description (42.2%). Only 17.8% of the candidates mentioned the legal perspective of ICP. Death (as a potential complication) was omitted by the majority of the candidates (93.3%); after the patient-actor challenged candidates, only 57.1% of them gave a clear and positive answer. Evaluators frequently rated candidate communications skills as superior (≥80%), but ≥1 negative aspect was identified in 69% of the candidates. CONCLUSIONS: Ethical competencies are mandatory for professional rheumatologists. It seems necessary to include an ethics competency framework in the curriculum throughout the rheumatology residency.

The VEGFA -1154G/A polymorphism is associated with reduced risk of rheumatoid arthritis but not with systemic lupus erythematosus in Mexican women.

BACKGROUND: Levels of circulating vascular endothelial growth factor (VEGF) (a potent endothelial-cell-specific angiogenic factor) have been correlated with disease activity in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). In addition, several single nucleotide polymorphisms (SNPs), including the VEGFA -2578C/A, have been associated with RA in some populations. By contrast, the role of different VEGFA SNPs in the susceptibility to SLE has received little attention. Thus, the present study aimed to determine whether the VEGFA -2578C/A, -1154G/A and -634G/C polymorphisms confer risk or were associated with reduced risk of RA or SLE in a Mexican population. METHODS: The present study included 903 women from Mexico: 405 were patients with RA, 282 had SLE and 216 were healthy individuals. The genotypes were obtained with TaqMan probes. RESULTS: The data obtained in the present study suggest that the VEGFA -2578C/A and -634G/C polymorphisms are not risk factors for RA or SLE; however, VEGFA -1154G/A was associated with reduced risk in women with RA (odds ratio = 0.6, pc  = 0.0051) but not with SLE (odds ratio = 0.7, pc  = 0.13). CONCLUSIONS: The present study is the first to document an association between VEGFA -1154G/A and reduced risk in women with RA but not with SLE.

Estudio clínico controlado de ciclosporina A y cloroquina en artritis reumatoide de inicio temprano. Reporte preliminar y revisión de la literatura / Controlled clinical trial with cyclosporine and chloroquine in early rheumatoid arthritis

Objetivo: Evaluar la eficacia y seguridad de ciclosporina A (CsA) + cloroquina (CLQ) o placebo en pacientes con AR de inicio temprano y comparar los resultados con una revisión de la literatura de la combinación de CsA con otras drogas modificadoras de la enfermedad (DMARD).Métodos: Reporte preliminar de un estudio doble ciego controlado, de 90 pacientes con AR de inicio temprano, comparando CsA + CLQ o placebo. Variable de desenlace ACR 20, 50 y 70. Revisión de la literatura de 10 estudios completos de terapia combinada que incluyeron a la CsA.Resultados: A los 6 meses de tratamiento, cumplieron los criterios de mejoría (ACR-20) 34 pacientes (83 por ciento) del grupo CsA + CLQ y 25 (61 por ciento) del grupo CsA + placebo (p=0.02). A los 12 meses, no hubo diferencia significativa en la mejoría con los criterios de ACR-20. La diferencia fue significativa con ACR-50 (54 por ciento vs 34 por ciento, p= 0.05) y con ACR-70 (51 por ciento vs 26 por ciento, p=0.05). No hubo diferencias significativas en los efectos adversos en ambos grupos. La revisión de la literatura mostró reportes de CsA en combinación con MTX, oro parenteral, HCQ, CLQ y SSZ. La combinación más estudiada y al parecer más eficaz fue CsA con MTX. Conclusión: La combinación de CsA + CLQ parece ser eficaz en pacientes con AR temprana. Aunque la literatura sugiere que la mejor combinación con CsA es MTX, la CLQ parece ser una opción útil en terapia combinada con CsA.