[Treatment of patients with osteoarthritis]. / Tratamiento del paciente con artrosis.

The therapeutic management of patients with osteoarthritis aims to decrease pain and inflammation, improve physical function, and to apply safe and effective treatments. A patient-centered approach implies the active participation of the patient in the design of the treatment plan and in timely and informed decision-making at all stages of the disease. The nucleus of treatment is patient education, physical activity and therapeutic exercise, together with weight control in overweight or obese patients. Self-care by the individual and by the family is fundamental in day-to-day patient management. The use of physical therapies, technical aids (walking sticks, etc.) and simple analgesics, opium alkaloids, and antiinflammatory drugs have demonstrated effectiveness in controlling pain, improving physical function and quality of life and their use is clearly indicated in the treatment of osteoarthritis. Conservative surgery and joint replacement is indicated when treatment goals are not achieved in specific patients.

Development of an application for mobile phones (App) based on the collaboration between the Spanish Society of Rheumatology and Spanish Society of Family Medicine for the referral of systemic autoimmune diseases from primary care to rheumatology. / Desarrollo de una aplicación para teléfonos móviles (app) basada en la colaboración Sociedad Española de Reumatología/Sociedad Española de Medicina de Familia y Comunitaria para derivación de enfermedades autoinmunes sistémicas.

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed.

[Effect of the Helicobacter pylori eradication in patients with functional dyspepsia: randomised placebo-controlled trial]. / Efecto del tratamiento erradicador en pacientes con dispepsia funcional e infección por Helicobacter pylori: ensayo clínico aleatorizado frente a placebo.

BACKGROUND AND OBJECTIVE: The Helicobacter pylori eradication in patients with functional dyspepsia has been the subject of controversy because trials come to contradictory conclusions. The objective of this trial was to evaluate the effect, compared with placebo, of the eradication treatment in patients with functional dyspepsia. PATIENTS AND METHOD: Randomized double blind placebo controlled trial. We included 158 patients attended by family physicians (Area 10 Primary Care, Health Institute of Madrid) with functional dyspepsia and Helicobacter pylori infection detected by the ureasa test in endoscopy. An OCA (ameprazole clarithromycin and amoxicillin group (n = 79) and a placebo group (n = 79) were randomized. During 7 days, patients at the OCA group received omeprazole (20 mg bid), clarithromycin (500 mg bid) and amoxicillin (1000 mg bid) daily, and patients at the control group received the placebo agent twice daily. Dyspepsia improvement according to a Likert scale (5 steps), and eradication of H. pylori by 13C-urea breath test were evaluated during one year. RESULTS: Both groups were homogeneous in relation to age, sex and dyspepsia degree. The average age (standard deviation) of studied patients was 41.99 (13.93) years. At one year of follow up, H. pylori was eradicated in 81.01% (64/79) of the OCA group and 5.06% (4/79) of the placebo group. The difference of dyspepsia improvement (22.78%; 95% confidence interval [CI], 7.62-37.79) between the OCA group (41.77%; 95% CI, 30.77-53.41), and the placebo group (18.99%; 95% CI 11.03-29.38) was significant (p = 0.0018). CONCLUSION: Eradication of Helicobacter pylori in patients with functional dyspepsia is more effective improving symptoms than placebo.

El médico de familia en el control y seguimiento del paciente en tratamiento con sarilumab / The role of the general practitioner in the monitoring and follow-up of patients treated with Sarilumab

Este capítulo se centra en intentar revisar y desarrollar de forma esquemática lo que refleja el título: ¿cuál es o debe ser el papel del médico de familia en el control y seguimiento del paciente con artritis reumatoide en tratamiento con sarilumab?, dado que tanto las indicaciones actualizadas del tratamiento, dosis, pautas de utilización y otras características del tratamiento ya se han abordado de forma exhaustiva en los capítulos anteriores. Las terapias biológicas son ya una realidad imparable en el abordaje terapéutico de múltiples enfermedades, entre ellas las enfermedades reumatológicas, lo que supone una gran innovación terapéutica en el presente, pero con una gran potencialidad de desarrollo e implantación en un futuro inmediato. Por ello, el médico de familia no solo no debe permanecer al margen de esta corriente de tratamiento con terapias biológicas, sino que debe incorporarse a ella, adquirir y mantener actualizados los conocimiento de todos los aspectos relacionados con el correcto control y administración de la medicación por parte del paciente (en este caso el sarilumab), valorar la presencia de comorbilidades, polifarmacia y posibles interacciones, realizar una detección precoz de aparición de efectos adversos, hacer un seguimiento del grado de adherencia y cumplimiento del tratamiento, etc. Todo ello redundará en una mayor eficacia y seguridad del tratamiento y en lo que se puede definir como una mayor calidad asistencial al paciente con artritis reumatoide

In this article, we focus on schematically reviewing and developing the topic: What should the role of general practitioners (GPs) be in monitoring patients with rheumatoid arthritis (RA) treated with sarilumab? Updated treatment indications, doses, indications for use, and other characteristics of treatment have been exhaustively addressed in previous articles. Biological therapies are a reality that cannot be ignored in the therapeutic approach to several diseases, including rheumatic diseases. This represents a significant therapeutic innovation in the present as well as strong potential for development and implementation in the immediate future. Consequently, GPs should tend towards treatment with biological therapies, including them in their therapeutic resources. They should therefore become familiar with every aspect concerning the correct management and administration of the patient's medication (in this case sarilumab) and remain up-to-date on the topic. Furthermore, they should also evaluate the presence of comorbidities, polypharmacy, and possible interactions through early detection of adverse reactions and monitoring the degree of treatment adherence, etc. Overall, all of this enhances the efficacy and safety of the treatment, resulting in a higher quality of care for patients with rheumatoid arthritis

El médico de familia en el control y seguimiento del paciente en tratamiento con metotrexato / The family physician in the follow-up patients treated with methotrexate

Ante un paciente en tratamiento con metotrexato, desde la consulta del médico de familia se debe contemplar no solo una atención puntual frente a un problema aislado con su medicación o con su enfermedad, sino que se deben desarrollar actividades que abarquen e integren dimensiones como la promoción de la salud, la educación sanitaria, la prevención de la enfermedad y la atención sanitaria accesible y continuada. Se podrían resumir de una forma esquemática cuáles serían las actividades básicas a desarrollar desde la consulta del médico de familia: 1) detección y registro codificado de los pacientes en tratamiento con metotrexato; 2) administración de la medicación según protocolos establecidos; 3) seguimiento del paciente con un plan de carácter individualizado, adaptado a las necesidades de cada caso, con 3 objetivos fundamentales: detección precoz de complicaciones, control del tratamiento (pauta de administración, grado de adherencia, educación, información, autocuidados), y actividades de seguimiento y control planificadas (AU)

In patients receiving methotrexate, the activities carried out by family physicians should not only include the provision of periodic attention when there is a problem with their medication or disease but should also include dimensions such as health promotion and education, disease prevention, and continued and accessible healthcare. The basic activities that should be provided by family physicians can be summarised as follows: 1) detection and anonymised registration of patients under methotrexate therapy; 2) drug administration following established protocols; 3) individualised follow-up adapted to the needs of each patient. The latter activity has three main goals: early detection of complications, treatment monitoring (dosing schedule, degree of adherence, education, information, self-care) and scheduled follow-up (AU)

[Pharmaco-economic optimization of cholesterol-lowering treatment with statins]. / Optimización fármaco-económica del tratamiento de la hipercolesterolemia con estatinas.

Current guidelines for the management of hypercholesterolemia identify LDL cholesterol (LDL-c) reduction as the primary therapeutic target and have highlighted the need to use statins to achieve it. There are six statins with four different doses and with different power-reducing LDL-c. By adding ezetimibe, there are 48 therapeutic possibilities. This extensive offer provides pharmaceutical treatment, but it is difficult to choose the most cost-effective statin because it is very difficult to remember all the powers and costs of treatment options. This paper offers a method to prioritize the best cost-effective lipid lowering, and chooses the cheapest statin that achieves the desired therapeutic goal of LDL-c.

Desarrollo de una aplicación para teléfonos móviles (app) basada en la colaboración Sociedad Española de Reumatología/Sociedad Española de Medicina de Familia y Comunitaria para derivación de enfermedades autoinmunes sistémicas / Development of an application for mobile phones (App) based on the collaboration between the Spanish Society of Rheumatology and Spanish Society of Family Medicine for the referral of systemic autoimmune diseases from primary care to rheumatology

El diagnóstico y tratamiento de las enfermedades autoinmunes sistémicas (EAS) constituye un reto. Aunque infrecuentes, afectan a cientos de miles de pacientes en España. El médico de familia (MF) se enfrenta a síntomas o signos inespecíficos que hacen sospechar EAS al inicio del proceso, y tiene que decidir a quiénes debería derivar. Para facilitar su reconocimiento y mejorar su derivación, expertos de la Sociedad Española de Medicina de Familia y Comunitaria y de la Sociedad Española de Reumatología seleccionaron 26 síntomas/signos-guía y alteraciones analíticas. Se escogieron parejas de MF y reumatólogo para elaborar algoritmos diagnósticos y de derivación. Posteriormente se revisaron y adaptaron al formato de aplicación para móviles (app) descargable. El resultado es el presente documento de derivación de EAS para MF en formato de papel y app. Contiene algoritmos de fácil manejo utilizando datos de la anamnesis, exploración física y pruebas analíticas accesibles en atención primaria para orientar el diagnóstico y facilitar la derivación a reumatología o a otras especialidades

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed

Tratamiento del paciente con artrosis / Treatment of patients with osteoarthritis

El manejo terapéutico del paciente con artrosis tiene como objetivo disminuir la sintomatología dolorosa e inflamatoria, mejorar la capacidad funcional del paciente y la aplicación de intervenciones terapéuticas eficaces y lo más seguras posibles. Un enfoque centrado en el paciente implica su participación activa en el diseño del plan terapéutico y en la toma de decisiones informadas oportunas en todas las etapas de la enfermedad. La educación terapéutica, la actividad física y el ejercicio terapéutico junto con el control de peso, en caso de sobrepeso u obesidad, constituyen el núcleo central del tratamiento. Los autocuidados individuales y por los familiares son fundamentales en el control del día a día del paciente. El uso de terapias físicas, ayudas técnicas (bastón, etc.) y de fármacos tipo analgésicos simples, opioides y antiinflamatorios tiene evidencias demostradas en el control del dolor, mejora la funcionalidad y la calidad de vida del paciente y una clara recomendación de uso en el tratamiento de la artrosis. La cirugía conservadora y la de reemplazo articular se indican en los casos en los que no se logran los objetivos terapéuticos en casos concretos

The therapeutic management of patients with osteoarthritis aims to decrease pain and inflammation, improve physical function, and to apply safe and effective treatments. A patient-centered approach implies the active participation of the patient in the design of the treatment plan and in timely and informed decision-making at all stages of the disease. The nucleus of treatment is patient education, physical activity and therapeutic exercise, together with weight control in overweight or obese patients. Self-care by the individual and by the family is fundamental in day-to-day patient management. The use of physical therapies, technical aids (walking sticks, etc.) and simple analgesics, opium alkaloids, and antiinflammatory drugs have demonstrated effectiveness in controlling pain, improving physical function and quality of life and their use is clearly indicated in the treatment of osteoarthritis. Conservative surgery and joint replacement is indicated when treatment goals are not achieved in specific patients

Optimización fármaco-económica del tratamiento de la hipercolesterolemia con estatinas / Pharmaco-economic optimization of cholesterol-lowering treatment with statins

Las directrices sobre el tratamiento de la hipercolesterolemia identifican la reducción del colesterol unido a lipoproteínas de baja densidad (colesterol LDL) como el principal objetivo terapéutico y han puesto de manifiesto la necesidad de utilizar estatinas para conseguirlo. Existen seis estatinas con cuatro dosis distintas y con diferentes potencias reductoras de colesterol LDL. Al añadir ezetimiba, existen 48 posibilidades terapéuticas. Esta extensa oferta farmacéutica facilita el tratamiento, pero dificulta elegir la estatina más coste-efectiva porque es muy difícil recordar todas las potencias y costes de las opciones terapéuticas. En este artículo se ofrece un método para priorizar la mejor opción hipolipidemiante coste-efectiva, y selecciona la estatina más económica que consigue el objetivo terapéutico deseado de colesterol LDL (AU)

Current guidelines for the management of hypercholesterolemia identify LDL cholesterol (LDL-c) reduction as the primary therapeutic target and have highlighted the need to use statins to achieve it. There are six statins with four different doses and with different power-reducing LDL-c. By adding ezetimibe, there are 48 therapeutic possibilities. This extensive offer provides pharmaceutical treatment, but it is difficult to choose the most cost-effective statin because it is very difficult to remember all the powers and costs of treatment options. This paper offers a method to prioritize the best cost-effective lipid lowering, and chooses the cheapest statin that achieves the desired therapeutic goal of LDL-c (AU)

Efecto del tratamiento erradicador en pacientes con dispepsia funcional e infección por Helicobacter pylori: ensayo clínico aleatorizado frente a placebo / Effect of the Helicobacter pylori eradication in patients with functional dyspepsia: reandomised placebo-controlled trial

Fundamento y objetivo: El tratamiento erradicador en pacientes con dispepsia funcional ha sido frecuentemente objeto de discusión porque los ensayos llegan a conclusiones contradictorias, por lo que son necesarios más estudios para aclarar este tema. El objetivo de este ensayo es valorar el efecto del tratamiento erradicador en pacientes con dispepsia funcional comparándolo con placebo. Pacientes y método: Se trata de un ensayo clínico aleatorizado, doble ciego y controlado con placebo. Se seleccionó a 158 pacientes atendidos por médicos de familia (Área 10 IMSALUD), con dispepsia funcional e infección por Helicobacter pylori detectado por test de ureasa en la endoscopia. Se asignaron aleatoriamente a un grupo de tratamiento activo con omeprazol, claritromicina y amoxicilina (OCA) (n = 79) y a un grupo que recibió placebo (n = 79). Durante 7 días, el grupo OCA recibió omeprazol (20 mg/12 h), claritromicina (500 mg/12 h) y amoxicilina (1000 mg/12 h), mientras que el grupo control recibió placebo 2 veces al día. Se evaluaron durante un año las variaciones de mejoría de dispepsia según una escala Likert (5 grados), y la erradicación de Helicobacter pylori mediante prueba del aliento con urea-13C. Resultados: Ambos grupos eran homogéneos con respecto a la edad, el sexo y el grado de dispepsia. La edad media (desviación estándar) de los pacientes estudiados fue de 41,99 (13,93) años. Al año de seguimiento, H. Pylori se erradicó en el 81,01% (64/79) del grupo OCA y en el 5,06% (4/79) del grupo placebo. La diferencia de mejora de dispepsia (22,78%; intervalo de confianza [IC del 95%, 7,62-37,79]) entre el grupo OCA (41,77%, [IC del 95%, 30,77-53,41]) y el grupo placebo (18,99%; [IC del 95%, 11,03-29,38]) fue significativa (p = 0,0018). Conclusión: El tratamiento erradicador de H. pylori en pacientes con dispepsia funcional es más efectivo que el placebo, tanto para la erradicación del germen como en la mejoría de la dispepsia

Background and objective: The Helicobacter pylori eradication in patients with functional dyspepsia has been the subject of controversy because trials come to contradictory conclusions. The objective of this trial was to evaluate the effect, compared with placebo, of the eradication treatment in patients with functional dyspepsia. Patients and method: Randomized double blind placebo controlled trial. We included 158 patients attended by family physicians (Área 10 Primary Care, Health Institute of Madrid) with functional dyspepsia and Helicobacter pylori infection detected by the ureasa test in endoscopy. An OCA (ameprazole clarithromycin and amoxicillin group (n = 79) and a placebo group (n = 79) were randomized. During 7 days, patients at the OCA group received omeprazole (20 mg bid), clarithromycin (500 mg bid) and amoxicillin (1000 mg bid) daily, and patients at the control group received the placebo agent twice daily. Dyspepsia improvement according to a Likert scale (5 steps), and eradication of H. pylori by 13C-urea breath test were evaluated during one year. Results: Both groups were homogeneous in relation to age, sex and dyspepsia degree. The average age (standard deviation) of studied patients was 41.99 (13.93) years. At one year of follow up, H. pylori was eradicated in 81.01% (64/79) of the OCA group and 5.06% (4/79) of the placebo group. The difference of dyspepsia improvement (22.78%; 95% confidence interval [CI], 7.62-37.79) between the OCA group (41.77%; 95% CI, 30.77-53.41), and the placebo group (18.99%; 95% CI 11.03-29.38) was significant (p = 0.0018). Conclusion: Eradication of Helicobacter pylori in patients with functional dyspepsia is more effective improving symptoms than placebo