Comparison of the SLE Risk Probability Index (SLERPI) scale against the European League Against Rheumatism/American College of Rheumatology (ACR/EULAR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria.

INTRODUCTION: Timely diagnosis and proper recognition of Systemic Lupus Erythematosus (SLE) is essential to establish early management in inpatients and outpatients. There are different classification scales to identify SLE, which include various clinical and serological aspects. In 2021, the SLE Risk Probability Index (SLERPI) was published, which focuses predominantly on the clinical characteristics of patients with suspected SLE and uses a simple algorithm for early recognition of the disease. The aim of this study is to compare the European League Against Rheumatism/American College of Rheumatology (ACR/EULAR) classification criteria, the Systemic Lupus International Collaborating Clinics (SLICC) criteria, and the SLERPI criteria in a cohort of Colombian patients with SLE and to analyze the correlations observed between their absolute scores. METHODS: A registry of SLE patients from two referral hospitals in Bogotá, Colombia, was used. 2021 SLERPI, 2019 ACR/EULAR, and 2012 SLICC scores were calculated for each patient and the correlations found between the scales were analyzed. The sensitivities of each were compared, and frequency analyses were conducted among different clinical and laboratory variables. RESULTS: Between 2016 and 2019, 146 patients diagnosed with SLE were registered, including inpatients and outpatients. The median age was 36 years (interquartile range 26-51), and 82.2% were women. According to the SLERPI criteria, a high prevalence of antinuclear antibodies (92%), immunological disorders (71%), and arthritis (64%) were observed. The most used treatments were corticosteroids (87.6%) and chloroquine (67.8%). A Spearman evaluation analysis was performed, with a moderately strong correlation of 0.76 (p = .000) between the SLERPI and ACR/EULAR scales and very strong correlation of 0.80 (p = .000) between the SLERPI and SLICC. Patients classified with SLE according to the SLERPI scale exhibited a higher incidence of hematological compromise, along with elevated levels of serological markers such as anti-DNA antibodies. Additionally, this group more commonly received treatments involving corticosteroids and azathioprine, and displayed a higher prevalence of hypertension. CONCLUSION: The SLERPI scale could be useful in the diagnosis of SLE, especially in early stages, given its good correlation with other classification scales and its good sensitivity.

Effectiveness of Telemedicine Compared with Standard Care for Patients with Rheumatic Diseases: A Systematic Review.

Objective: The aim of this study was to systematically review the evidence on the effectiveness of telemedicine compared to standard care for patients with rheumatic diseases. Methods: A search was performed in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews; for the gray literature, GREYNET databases and a snowball search were used. MeSH or Emtree terms. Three authors independently selected systematic reviews, randomized controlled trail (RCTs), or non-RCTs with patients with autoimmune or inflammatory rheumatic diseases, where telemedicine was compared with standard care. Effectiveness was measured in terms of disease activity, quality of life, and functional activity. The patients' satisfaction was also measured. The risk of bias was assessed by the Cochrane collaboration tool for RCTs and AMSTAR II for systematic reviews. Results: Four RCTs, one cross-out study, and five systematic reviews were included. The studies were conducted with rheumatoid arthritis patients, and one study involved patients with systematic lupus erythematosus. The interventions mainly involved teleconsultation and telemonitoring, with patient-reported outcomes (PROs) being compared with standard care. Four studies measured the effectiveness of telemedicine using PROs, in which three of the RCTs did not find differences in the clinical outcomes, and one found that telemedicine improved the remission of diseases, functional impairment, and radiographic joint damage progression. Two studies measured patient satisfaction with telemedicine and standard care without a significant difference between the groups. Conclusions: Despite heterogeneity between studies, the findings were remarkably consistent in demonstrating that there was no significant difference between the telemedicine group and the control group in terms of PROs and patient satisfaction. Patients should be offered the option of telemedicine to manage their diseases as part of health-care support. Further research is needed on the effectiveness of telemedicine in the long term for patients with rheumatic diseases.

Research-Practice-Collaborations Addressing One Health and Urban Transformation. A Case Study: Commentary on "Research-Practice-Collaborations in International Sustainable Development and Knowledge Production-Reflections from a Political-Economic Perspective".

One Health is an integrative approach at the interface of humans, animals and the environment, which can be implemented as Research-Practice-Collaboration (RPC) for its interdisciplinarity and intersectoral focus on the co-production of knowledge. To exemplify this, the present commentary shows the example of the Forschungskolleg "One Health and Urban Transformation" funded by the Ministry of Culture and Science of the State Government of Nord Rhine Westphalia in Germany. After analysis, the factors identified for a better implementation of RPC for One Health were the ones that allowed for constant communication and the reduction of power asymmetries between practitioners and academics in the co-production of knowledge. In this light, the training of a new generation of scientists at the boundaries of different disciplines that have mediation skills between academia and practice is an important contribution with great implications for societal change that can aid the further development of RPC.

« Une Santé¼ (en anglais: One Health) est un approche intégratif situé à l'interface entre les humains, les animaux, et l'environnement, qui peut être implémenté tel qu'une collaboration entre recherche et pratique (CRP) grâce à son interdisciplinarité et son accent sur la cocréation du savoir. Pour illustrer ce point, cet article prend le Forschungskolleg « Une Santé et Transformation Urbaine¼ (en anglais: One Health and Urban Transformation) financé par le Ministère de la Culture et Sciences du gouvernement du Nord-Rhin Westphalie en Allemagne. D'après nos analyses, les facteurs identifiés comme soutenant une meilleure implémentation du CRP pour le programme One Health sont ceux qui permettent une communication constante et une réduction des asymétries causés par le pouvoir entre les praticiens et les entités académiques dans la cocréation du savoir. Sur ce point, l'éducation d'une nouvelle génération de scientifiques, à l'intersection des différentes disciplines et avec des fortes aptitudes à la médiation entre la pratique et le monde académique, est une contribution important avec des grandes implications pour le changement sociétal, et qui peut en outre soutenir le développement du CRP.

Efficacy and safety of intravenous immunoglobulin in patients with lupus nephritis: A systematic review of the literature.

INTRODUCTION AND OBJECTIVE: Intravenous immunoglobulin (IVIg) is an anti-inflammatory drug with an unclear role in the treatment of patients with lupus nephritis (LN). This systematic review evaluates the evidence for IVIg in the care of patients with LN. METHODOLOGY: A systematic search was done in the PubMed, EMBASE, BVS and OVID databases - All EBM Reviews following the PRISMA methodology (registration in PROSPERO CRD42021236662). The variables were extracted: indications for use, dosage, partial or complete response, adverse reactions, initiation of renal replacement therapy, reduction of proteinuria, and mortality. The quality assessment was done with the "The Joanna Briggs Institute (JBI) Critical Appraisal tools for use in Systematic Reviews Checklist". In addition, synthesis reports were prepared through the Synthesis Without Meta-analysis - SWiM guide. RESULTS: A total of 2328 articles were obtained (28 were considered for inclusion). When the studies were evaluated, IVIg therapy was found to be between 60% to 70% effective (except for patients with class V LN) with overall responses (complete + partial) even for patients who are refractory to first line treatment. Normalization (<0.5 g) of nephrotic proteinuria occurred in 24% of cases with infrequent adverse events and a mortality plus dialysis composite of 11.5% and 24.1% (most representative study). CONCLUSION: In patients with LN refractory to conventional treatment or co-infection situations, the reported data seem to demonstrate effectiveness of IVIg therapy. There are few adverse reactions and caution is exercised when using it on patients with class V NL. However, given the lack of controlled studies with long-term follow-up, these data should be interpreted cautiously thus encouraging the development of high-quality RCTs.

Intersectoral collaboration shaping One Health in the policy agenda: A comparative analysis of Ghana and India.

Intersectoral collaborations are an integral component of the prevention and control of diseases in a complex health system. On the one hand, One Health (OH) is promoting the establishment of intersectoral collaborations for prevention at the human-animal-environment interface. On the other hand, operationalising OH can only be realized through intersectoral collaborations. This work contributes to broadening the knowledge of the process for operationalising OH by analysing the governance structures behind different initiatives that tackle health problems at the human-animal-environment interface. The cases taken as examples for the analysis are the control and response to rabies and avian influenza under "classical OH", and the management of floods and droughts for insights into "extended OH". Data from Ghana and India were collected and compared to identify the key elements that enable ISC for OH. Despite the case studies being heterogeneous in terms of their geographic, economic, social, cultural, and historical contexts, strong similarities were identified on how intersectoral collaborations in OH were initiated, managed, and taken to scale. The actions documented for rabies prevention and control were historically based on one sector being the leader and implementer of activities, while avian influenza management relied more on intersectoral collaborations with clearly defined sectoral responsibilities. The management of the impact of flood and droughts on health provided a good example of intersectoral collaborations achieved by sectoral integration; however, the human health component was only involved in the response stage in the case of Ghana, while for India, there were broader schemes of intersectoral collaborations for prevention, adaptation, and response concerning climate change and disaster.

Comparison of the sensitivity of the EULAR / ACR 2019 and SLICC 2012 classification criteria in a Colombian population with systemic lupus erythematosus.

BACKGROUND: /Objective: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a wide range of clinical manifestations. The latest classification criteria, EULAR/ACR 2019, have not been validated in a Latin American population of Amerindian ancestry. The objective of this study is to compare the sensitivity of the EULAR/ACR 2019 and SLICC 2012 classification criteria in a group of SLE patients with the above ancestry. METHODS: A cross-sectional study was done. Data were obtained from the review of medical records of patients who met the inclusion criteria. The overall sensitivity of the criteria was calculated and compared to each other using the McNemar test. RESULTS: 146 medical records of patients from two referral centers were included. There were no differences in the sensitivity of the EULAR/ACR and SLICC 2012 criteria (84.9% versus 85.6% p = 0.79) nor were differences found when the groups based on disease duration were compared: less than 5 years (91.0% versus 92.5% p = 0.70), between 5 and 10 years (82.8% versus 82.8% p = 1), and 10 years or more (76.7% versus 76.7% p = 1). However, SLICC 2012 criteria was found to better classify patients with a less than 5-year disease duration compared to those with 10-year duration or more (92.5% versus 76.4% p = 0.024). CONCLUSIONS: There are no statistically significant differences between the EULAR/ACR and SLICC 2012 criteria in the population studied. Nor were differences found when evaluating them by age at diagnosis and duration of the disease except when the group with less than 5 years of duration was compared to those with 10 years or more using the SLICC 2012 criteria.

SARS-CoV-2 (COVID-19) in patients with some degree of immunosuppression.

BACKGROUND: It is not clear whether patients with some degree of immunosuppression have worse outcomes in SARS-CoV-2 infection, compared to healthy people. OBJECTIVE: To carry out a narrative review of the information available on infection by SARS-CoV-2 in immunosuppressed patients, especially patients with cancer, transplanted, neurological diseases, primary and secondary immunodeficiencies. RESULTS: Patients with cancer and recent cancer treatment (chemotherapy or surgery) and SARS-CoV-2 infection have a higher risk of worse outcomes. In transplant patients (renal, cardiac and hepatic), with neurological pathologies (multiple sclerosis (MS), neuromyelitis optica (NMODS), myasthenia gravis (MG)), primary immunodeficiencies and infection with human immunodeficiency virus (HIV) in association with immunosuppressants, studies have shown no tendency for worse outcomes. CONCLUSION: Given the little evidence we have so far, the behaviour of SARS-CoV-2 infection in immunosuppressed patients is unclear, but current studies have not shown worse outcomes, except for patients with cancer.

[SARS-CoV-2 (COVID-19) in Patients with some Degree of Immunosuppression]. / SARS-CoV-2 (COVID-19) en pacientes con algún grado de inmunosupresión.

BACKGROUND: It is not clear whether patients with some degree of immunosuppression have worse outcomes in SARS-CoV-2 infection, compared to healthy people. OBJECTIVE: To carry out a narrative review of the information available on infection by SARS-CoV-2 in immunosuppressed patients, especially patients with cancer, transplanted, neurological diseases, primary and secondary immunodeficiencies. RESULTS: Patients with cancer and recent cancer treatment (chemotherapy or surgery) and SARS-CoV-2 infection have a higher risk of worse outcomes. In transplant patients (renal, cardiac and hepatic), with neurological pathologies (multiple sclerosis [MS], neuromyelitis optica [NMODS], myasthenia gravis [MG]), primary immunodeficiencies and infection with human immunodeficiency virus (HIV) in association with immunosuppressants, studies have shown no tendency for worse outcomes. CONCLUSION: Given the little evidence we have so far, the behaviour of SARS-CoV-2 infection in immunosuppressed patients is unclear, but current studies have not shown worse outcomes, except for patients with cancer.

One Health in the context of coronavirus outbreaks: A systematic literature review.

The ongoing coronavirus disease 2019 (COVID-19) pandemic threatens global health thereby causing unprecedented social, economic, and political disruptions. One way to prevent such a pandemic is through interventions at the human-animal-environment interface by using an integrated One Health (OH) approach. This systematic literature review documented the three coronavirus outbreaks, i.e. SARS, MERS, COVID-19, to evaluate the evolution of the OH approach, including the identification of key OH actions taken for prevention, response, and control. The OH understandings identified were categorized into three distinct patterns: institutional coordination and collaboration, OH in action/implementation, and extended OH (i.e. a clear involvement of the environmental domain). Across all studies, OH was most often framed as OH in action/implementation and least often in its extended meaning. Utilizing OH as institutional coordination and collaboration and the extended OH both increased over time. OH actions were classified into twelve sub-groups and further categorized as classical OH actions (i.e. at the human-animal interface), classical OH actions with outcomes to the environment, and extended OH actions. The majority of studies focused on human-animal interaction, giving less attention to the natural and built environment. Different understandings of the OH approach in practice and several practical limitations might hinder current efforts to achieve the operationalization of OH by combining institutional coordination and collaboration with specific OH actions. The actions identified here are a valuable starting point for evaluating the stage of OH development in different settings. This study showed that by moving beyond the classical OH approach and its actions towards a more extended understanding, OH can unfold its entire capacity thereby improving preparedness and mitigating the impacts of the next outbreak.

Autoimmune myelofibrosis and systemic lupus erythematosus: a case report

Bone marrow fibrosis is a rare disorder that can be associated with autoimmune diseases such as systemic lupus erythematosus (SLE), and can be confused with the manifestations of that disease. The case is presented on a patient with autoimmune myelofibrosis in the context of SLE.

La fibrosis de la médula ósea es una enfermedad rara que se puede ver asociada con enfermedades autoinmunes como el lupus eritematoso sistémico (LES) y que puede llegar a ser confundida con las manifestaciones propias de la enfermedad. Se presenta el caso de una paciente con mielofibrosis autoinmune en el contexto de LES.

Síndrome de Sjögren y evaluación de la calidad de vida / Sjögren's syndrome and quality of life assessment

RESUMEN Introducción: El síndrome de Sjögren (SS) es una enfermedad autoinmune, con compromiso multisistémico, especialmente de la función de las glándulas exocrinas. Los pacientes cursan con una alta carga de la enfermedad que compromete su calidad de vida, asociado sobre todo a fatiga crónica, ansiedad, depresión y disfunción sexual, entre otras dificultades. Objetivo: Describir las generalidades de las principales escalas (específicas y no específicas) para la evaluación de la calidad de vida en pacientes con SS. Métodos: Se realizó una revisión narrativa y ampliada de la literatura. Se hizo una búsqueda en las diferentes bases de datos (PubMed, Embase, Cochrane, BVS) y de literatura gris, seleccionando los artículos relacionados con el tema y realizando una extracción de datos de estos. Resultados: Se encontraron 3 escalas realizadas específicamente para pacientes con SS: Sjögren's Syndrome Patient Reported Index, Psychometric Testing of the Primary Sjögren's Syndrome Quality of Life Questionnaire y Profile of Fatigue and Discomfort, y 14 escalas realizadas en el contexto de otras enfermedades (no específicas), utilizadas en pacientes con SS. Conclusiones: Como en otras afecciones, en pacientes con SS es importante la evaluación de la calidad de vida. A tal efecto se cuenta con múltiples escalas, a parte de las 3 citadas, elaboradas específicamente para este tipo de pacientes, sin dejar de lado las escalas no específicas, como el Beck Depression Inventory y el Ocular Surface Disease Index, que tienen su mayor utilidad en la evaluación específica de síntomas asociados a esta enfermedad. Resultados: Se encontraron 3 escalas realizadas específicamente para pacientes con SS: Sjögren's Syndrome Patient Reported Index, Psychometric Testing of the Primary Sjögren's Syndrome Quality of Life Questionnaire y Profile of Fatigue and Discomfort, y 14 escalas realizadas en el contexto de otras enfermedades (no específicas), utilizadas en pacientes con SS.

ABSTRACT Introduction: Sjögren's syndrome (SS) is an autoimmune disease, with multisystemic invol- vement, particularly compromising the function of exocrine glands. The patients have a high burden of the disease associated with chronic fatigue, anxiety, depression, sexual dysfunction, among others. Objective: To describe the generalities of the main scales (specific and non-specific) for the evaluation of quality of life in patients with SS. Methods: A narrative review and expanded review was performed, including a search conducted in the different databases (PubMed, Embase, Cochrane, VHL) and grey literature. Articles related to the topic were selected and data extracted from them. Results: Three scales were developed specifically for patients with SS, and included Sjögren's Syndrome Patient Reported Index, Psychometric Testing of the Primary Sjögren's Syndrome Quality of Life Questionnaire, and Profile of Fatigue and Discomfort, and 14 scales performed in context of other diseases (non-specific) used in patients with SS. Conclusions: As is the case in other diseases, it is important to evaluate the quality of life in patients with SS. There are multiple scales for this evaluation, including the 3 scales mentioned before, specifically developed for these types of patients. The non-specific scales worth noting are, the Beck Depression Inventory and the Ocular Surface Disease Index, having their greatest use in the specific evaluation of symptoms associated with this disease.

Dermatomiositis hipomiopática y calcinosis universal: reporte de un caso / Hypomyopathic dermatomyositis and universal calcinosis: a case report

Presentamos el caso de una mujer de 32 años, con dos años de evolución de lesiones enpiel tipo placas, induradas, nodulares, dolorosas, inicialmente en miembros inferiores conposterior compromiso generalizado, con evidencia de lesiones cutáneas sugestivas dedermatomiositis y biopsia de piel que reporta calcinosis; inicialmente sin evidencia clínicani paraclínica que sugiriera compromiso muscular inflamatorio asociado. La resonanciamagnética nuclear de músculos y la biopsia muscular confirmaron la presencia de estecompromiso, definiendo los diagnósticos de dermatomiositis hipomiopática y calcinosisuniversal, dos espectros de una patología con baja frecuencia de presentación en lapoblación adulta.

The case is presented of a 32 year-old woman with indurated, raised and painful plaques in the skin of 2 years onset. It began in the legs, but later with a generalized extension to other regions, with evidence of cutaneous lesions very suggestive of dermatomyositis. The skin biopsy reported as calcinosis; initially without clinical evidence of inflammatory muscle compromise. A Nuclear Magnetic Resonance study and muscle biopsy showed this compromise, leading to the diagnosis of hypomyopathic dermatomyositis and universal calcinosis, two pathologies with rare presentation in an adult patient.

Validez de la gammagrafía ósea de sacroilíacas para el diagnóstico de sacroiliítis en una cohorte colombiana de pacientes con espondiloartritis (SpA) / Accuracy of sacroiliac joint (SIJ) bone scintigraphy in the diagnosis of sacroiliitis in a Colombian cohort with spondyloarthritis (SpA)

Introducción: La identificación radiológica de sacroiliítis es de vital importancia para el diagnóstico de las SpA, el uso de la resonancia magnética nuclear (RNM) ha ayudado en la detección temprana de este hallazgo, mejorando el tratamiento y pronóstico de los pacientes, con el inconveniente de ser un estudio costoso y de limitado acceso, lo que restringe su uso en la práctica clínica, situación que facilita la solicitud de estudios más económicos y de fácil acceso, como la radiografía de pelvis y la gammagrafía ósea (GO).Objetivos: Establecer la utilidad de la GO para el diagnóstico de sacroiliítis, en pacientes con SpA.Materiales y métodos: Se determinó sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la GO para el diagnóstico de sacroiliítis, usando como patrón de oro diagnóstico la RNM, en una cohorte colombiana de pacientes con diagnóstico de SpA.Resultados: Se analizaron 55  pacientes, 43.6% mujeres y 53.3% hombres, promedio de duración de la enfermedad 9.1±8.4 años, edad promedio de 31±10.5 años al inicio de los síntomas. Predominaron los pacientes con espondiloartritis no diferenciada (uSpA) (60.5%), y compromiso mixto (axial y periférico) (58,2%). El comportamiento de la GO fue sensibilidad 15% (IC 95% 0.04-0,25), especificidad 81% (IC 95% 0.72-0,9), valor predictivo positivo 32% (IC 95% 0.11-0.52), valor predictivo negativo 62% (IC 95% 0.52-0.72). Conclusiones: Se evidencia una sensibilidad variable de la GO con baja especificidad, valor predictivo positivo y valor predictivo negativo, para la detección de sacroiliítis, lo que permite establecer que no es útil como ayuda diagnóstica en espondiloartritis (SpA).

Introduction: Radiological identification of sacroiliitis is essential in the diagnosis of Sacroiliitis spondyloarthritis. Nuclear Magnetic Resonance has helped to optimize its early detection, Scintigraphy leading to improved treatment and a better prognosis for patients. The problem with NMR Spondyloarthritis is that it is expensive and there is limited access to it. For this reason cheaper studies such Magnetic resonance imaging pelvis x-rays and scintigraphy used more often than nuclear magnetic resonance in clinical practice. Objective: To determine the usefulness of scintigraphy in diagnosing sacroiliitis. Methods: The sensitivity, specificity, positive predictive value, negative predictive value of Bone Scintigraphy were analyzed for the diagnosis of sacroiliitis in a Colombian patient cohort with Spondyloarthritis using nuclear magnetic resonance as the gold standard. Results: A total of 55 patients were analyzed, 43.6% females and 53.3% males, with a mean disease duration of 9.1± years. The mean age of onset of symptoms was 31± years. Undifferentiated spondyloarthritis was the most frequent pathology (60.5%), and mixed pattern was the most common (58.2%). The scintigraphy performance compared to NMR was, sensitivity: 15% (95% CI; 0.04- 0.25), specificity: 81% (95% CI; 0.72- 0.9), positive predictive value: 32% (95% CI; 0.11-0.52), and negative predictive value: 62% (95% CI; 0.52-0.72). Conclusions: Scintigraphy has variable sensitivity but a low specificity, positive predictive value, and negative predictive value, for sacroiliitis detection, thus it can be said that it is not useful in the diagnosis of spondyloarthritis.

Prevención del abuso de alcohol y otras drogas en el ámbito laboral / Prevention of alcohol abuse and other drugs in the laboral area

Se presenta una revisión de los principales hallazgos epidemiológicos acerca del abuso de alcohol y otras drogas en la población y en el medio laboral. Se describen algunas de las consecuencias que dicho problema tiene en la economía y productividad de las empresas. Con esos antecedentes se plantean las bases para la prevención en las empresas. Se propone un modelo de programa de prevención, describiéndose las etapas del proceso. Finalmente, se anticipan algunas de las dificultades que es preciso vencer para poder introducir tales programas de prevención