Clinical Diagnosis of Chikungunya Infection: An Essential Aid in a Primary Care Setting Where Serological Confirmation Is Not Available.

BACKGROUND: Chikungunya virus (CHIKV) diagnosis has become a challenge for primary care physicians in areas where the Zika virus and/or Dengue virus are present. Case definitions for the three arboviral infections overlap. METHODS: A cross-sectional analysis was carried out. A bivariate analysis was made using confirmed CHIKV infection as the outcome. Variables with significant statistical association were included in an agreement consensus. Agreed variables were analyzed in a multiple regression model. The area under the receiver operating characteristic (ROC) curve was calculated to determine a cut-off value and performance. RESULTS: 295 patients with confirmed CHIKV infection were included. A screening tool was created using symmetric arthritis (4 points), fatigue (3 points), rash (2 points), and ankle joint pain (1 point). The ROC curve identified a cut-off value, and a score ≥ 5.5 was considered positive for identifying CHIKV patients with a sensibility of 64.4% and a specificity of 87.4%, positive predictive value of 85.5%, negative predictive value of 67.7%, area under the curve of 0.72, and an accuracy of 75%. CONCLUSION: We developed a screening tool for CHIKV diagnosis using only clinical symptoms as well as proposed an algorithm to aid the primary care physician.

Evaluation of Health Outcomes with Etanercept Treatment in Patients with Early Nonradiographic Axial Spondyloarthritis.

OBJECTIVE: Analyses were conducted to examine the baseline burden of illness and compare the effect of etanercept (ETN) versus placebo (PBO) on quality of life (QOL) in patients with nonradiographic axial spondyloarthritis (nr-axSpA) who failed nonsteroidal antiinflammatory drugs (NSAID). METHODS: Patients fulfilling the Assessment of Spondyloarthritis International Society axSpA criteria, not meeting the modified New York criteria for ankylosing spondylitis (AS), who were symptomatic 3 months to 5 years, with a Bath AS Disease Activity Index score ≥ 4, and failed ≥ 2 NSAID were randomized to ETN 50 mg weekly or PBO (double-blind) for 12 weeks, followed by open-label ETN 50 mg for 92 weeks. Stable NSAID were allowed throughout our study. QOL outcomes over 24 weeks were analyzed using ANCOVA models. RESULTS: At baseline, Multidimensional Fatigue Inventory (MFI; ETN mean 14.7, PBO mean 15.0), EQ-5D utility (0.52, 0.57), EQ-5D visual analog scale (56.5, 56.4), and Medical Outcomes Study (MOS) Sleep Index II (45.5, 48.1) were worse than population norms (6.6-8.0, 0.86, 82.5, and 25.8, respectively). At Week 12, Bath AS Patient Global Score, nocturnal and average back pain, MOS Short Form-36 (SF-36) physical component, and Work Productivity and Activity Index (WPAI) presenteeism and activity impairment favored ETN (p < 0.05). Nonsignificant improvements for ETN were seen in other WPAI domains, MFI, MOS-Sleep Index I and II, Hospital Anxiety and Depression Scale, EQ-5D utility score, and SF-36 mental component (p > 0.05). At Week 24, patients in the PBO group who had switched to ETN at Week 12 showed improvement in most QOL assessments, similar to that seen in patients receiving ETN for 24 weeks. CONCLUSION: Improvements favored ETN in QOL and productivity measures, with limited improvement on general QOL measures. Short disease duration, a short PBO-controlled period, and a wide range of QOL scores at baseline may have influenced improvements.

Recomendaciones del Comité de Expertos de la Asociación Colombiana de Reumatología para el empleo de terapia biológica en las espondiloartropatías / Recommendations of the expert committee of the rheumatology Colombian association for the use of biologic therapy in the spondyloarthropathies

Las espondiloartropatías son un grupo de enfermedades que comparten ciertas características clínicas, radiológicas y de laboratorio. Estudios recientes resaltan la importancia de estas que pueden como grupo llegar a tener una prevalencia mayor que patologías frecuentes como la artritis reumatoide, con implicaciones de los aspectos sociales, laborales y fármacoeconómicos. El manejo tradicional de estas patologías no presentó avances significativos hasta hace cinco años cuando con la aparición de los inhibidores del factor de necrosis tumoral (TNF), la llamada terapia biológica se cambió las perspectivas del tratamiento de este grupo de enfermedades convirtiéndose en el día de hoy en una gran herramienta terapéutica. La Asociación Colombiana de Reumatología teniendo en cuenta el conocimiento de este gran avance y el alto impacto de éste en la parte de costos ha desarrollado unas recomendaciones para la utilización de la terapia biológica en las espondiloartropatías mediante la modalidad de consenso con la participación de especialistas expertos en esta área de la reumatología

Calidad de vida y discapacidad fisica / Quality of life and physical disability

La artritis reumatoide es una entidad que genera discapacidad física así como aumento de la mortalidad, esto debido a la progresión misma de la enfermedad pero ocasionalmente también asociado al uso inadecuado de los medicamentos disponibles para su manejo. El concepto de calidad de vida está en estrecha relación con el adecuado control de las enfermedades crónicas. A través del tiempo se han utilizado diferentes formas de evaluación y se ha logrado finalmente definir los instrumentos mínimos útiles para una adecuada evaluación de la artritis reumatoide. Dicha evaluación establecerá una visión global de la actividad de la enfermedad permitiendo así ajustar los fármacos buscando limitar (idealmente control completo) la inflamación y las consecuencias deletéreas de los tratamientos. Esta revisión intenta definir la racionalidad del uso e interpretación de algunos de estos instrumentos y esboza su verdadero papel en la correcta evaluación médica de los pacientes con artritis reumatoide