Influence of prognosis factors on the prescription of targeted treatments in rheumatoid arthritis: A Delphi survey.

OBJECTIVES: To explore current evidence on the management of poor prognostic factors in rheumatoid arthritis (RA) and to investigate whether this evidence is taken into account by clinicians when deciding on treatment in daily clinical practice. METHODS: We performed a systematic literature review (SLR) to analyse the effects of currently available biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi) on the classically accepted poor prognostic factors of RA. All randomized controlled trials reporting subgroup analyses about effects on prognostic factors were identified and synthesized. In a second phase, a two-round Delphi survey was carried out to contrast the SLR results with the grade of agreement of a large group of rheumatologists about the effectiveness of each drug class on each prognostic factor. RESULTS: According to the Delphi results, the only prognostic factor that significantly influenced the selection of treatment was the presence of interstitial lung disease (ILD), being the preferred treatment in this scenario abatacept or rituximab. The rest of the poor prognostic factors (including high disease activity at baseline, disability as measured by the Health Assessment Questionnaire index, seropositivity, elevated acute-phase reactants, and evidence of erosions based on plain radiography or ultrasonography) did not seem to significantly influence rheumatologists when choosing a treatment. The results of the SLR results did not show solid evidence regarding the use of any specific therapy in the management of patients with specific poor factors, except in the case of RA-ILD, although the data in the literature in this regard are not free of bias. CONCLUSIONS: The only prognostic factor that seems to significantly influence the selection of treatment is the presence of RA-ILD.

Combinación del injerto libre de tejido conectivo y la técnica de Allen en el tratamiento de la recesión gingival / Combination of connective tissue-free wound and a technique in the treatment of gingival recession

Objetivos: Comparar la recesión clase II de Miller en el post test entre el tratamiento combinado de injerto libre de tejido conectivo y la técnica de Allen con el injerto libre de tejido conectivo. Material y métodos: Para lo cual se conformaron dos grupos de estudio, uno experimental y otro control, en los cuales se midieron y evaluaron las recesiones, el tamaño de los grupos se determinaron mediante formula y la asignación de las unidades de estudio a los grupos fue intencional. Para el procesamiento y análisis de los datos se empleó la estadística descriptiva mediante frecuencias absolutas y relativas y la estadística inferencial a través del chi2, igualmente se utilizó ANOVA para medidas repetidas y para la comparación final de los postest se utilizó T de muestras independientes. Resultados: Se encontró diferencia estadística significativa en las medidas de la recesión vertical entre los últimos pos test de ambos grupos experimental y control. Conclusiones: Se rechaza la hipótesis nula y se acepta la hipótesis alterna donde se refiere a que exista diferencia en la recesión gingival clase II de Miller entre el grupo experimental y control en pacientes de consulta privada, con una significancia de 0,05. (AU)

Objectives: to compare the recession class II of miller in the post test and the combined treatment of free connective tissue graft technique of Allen with free connective tissue graft. Material and Methods: For which formed two groups of study, one pilot and another control, which were measured and assessed the recessions, the size of the groups were determined by formula and the allocation of units of study groups was intentional. For the processing and analysis of the data was used by absolute and relative frequencies descriptive statistics and inferential statistics through the chi2, also used ANOVA for repeated measurements and T independent samples was used for the final comparison of the posttest. Results: There is significant statistical difference in measures of vertical recession among the last pos experimental test between the two groups and control, therefore the null hypothesis is rejected and accepted the alternate hypothesis. Conclusions: There is difference in gingival recession class Miller II between the experimental group and control in patients of private consultation with a 0.05 significance. (AU)

Eficacia de bioacondicionadores cementarios en el nivel de cobertura e inserción radicular / Efficacy of bioconditioners inserted in the level of coverage and root inclusion

Introducción: La presente investigación tuvo por objeto determinar la eficacia de la cefalexina, la terramicina y del ácido cítrico como bioacondicionadores en los niveles de cobertura radicular y de inserción en pacientes con recesión gingival clase II de Miller intervenidos a colgajo desplazado coronalmente. Materiales y método: Se trata de un ensayo clínico randomizado intergrupo, con pretest y postest múltiple, se conformaron 3 grupos: dos experimentales (1 y 2) que recibieron respectivamente la cefalexina y la terramicina; y un grupo control en el que se le aplicó ácido cítrico, como bioacondicionadores cementarios. Cada grupo estuvo constituido por 20 recesiones gingivales clase II de Miller, con indicación básica de colgajo desplazado coronalmente, los datos se evluaron mediante las pruebas Chi Cuadrado de Pearson y ANOVA. Resultados: No hubo diferencia estadística significativa en el efecto de la cefalexina, la terramicina y en el ácido cítrico en el nivel de cobertura radicular a los 30 días. El contraste ANOVA mostró en cambio, a los 60 días una diferencia estadística significativa, en el efecto de dichos bioacondicionadores en la ganancia de inserción. Conclusiones:El uso de bioacondicionares genera resultados significativos en el manejo de recesiones gingivales, siendo más afectivos a largo plazo. (AU)

Introduction: The present study was designed to determine the efficacy of cefalexin, the terramycin and citric acid as bioconditioners in root coverage and levels of insertion in patients with class II Miller gingival recession intervened to displaced face flap. Materials and method: is of a trial clinical randomized Intergroup, with pretest and posttest multiple, is formed 3 groups: two experimental (1 and 2) that received respectively the cephalexin and the terramycin; and a group control in which is it applied acid citric, as bioconditioners inserted. Each group was made up of 20 gingival recessions class Miller II, with basic indication of flap displaced face, the data is evluaron using ANOVA and Pearson Chi square tests. Results: There was No statistical significant difference in the effect of cefalexin, the terramycin and citric acid at the level of root coverage within 30 days. The contrast ANOVA showed instead, to them 60 days a difference statistical significant, in the effect of such bioconditioners in the gain of inclusion. Conclusions: the use of bioconditioners generates results significant at the handling of recessions gingival, being more affec tive to long term. (AU)