Percepción del profesional sanitario sobre el paciente con síndrome de sensibilidad central-fibromialgia / Health personnel perception about central sensitivity syndrome-fibromyalgia patients

Antecedentes y objetivos: La fibromialgia se caracteriza por dolor musculoesquelético y astenia de curso crónico. Los pacientes con fibromialgia suelen ser todo un desafío para los sanitarios en su conjunto. Los estudios existentes suelen estar limitados a la opinión de médicos reumatólogos o de familia. Con este estudio buscamos conocer cuáles son las actuaciones, las percepciones y los conocimientos del conjunto de los profesionales sanitarios al atender pacientes con esta enfermedad. Materiales y métodos: Estudio descriptivo de corte transversal, mediante una encuesta autoadministrada y anónima, distribuida principalmente en plantas hospitalarias y centros de atención primaria. Se realizó análisis estadístico de las variables recogidas (p˂0,05). Resultados: Se recogieron 200 encuestas, la mayoría de médicos (63,5%; n=127) o de enfermeros (25,5%; n=51). El 71% de los médicos refirieron utilizar la escala analgésica de la OMS. El 53% (n=59) utilizan AINE o paracetamol. Los antidepresivos son el tercer fármaco de elección. La mayoría cree que los especialistas de referencia deben ser los reumatólogos o los médicos de atención primaria, y un porcentaje similar, que el manejo debe ser multidisciplinar. El 52% se sienten desanimados o molestos al abordar a estos pacientes. Los médicos tienen mayores connotaciones negativas y creen que la atención que el paciente recibe está mayormente influenciada por el diagnóstico de fibromialgia, frente a los enfermeros y otros profesionales. Conclusiones: Nuestro estudio demuestra que la falta de conocimiento y de herramientas terapéuticas genera en gran medida frustración y malestar en el personal sanitario. Es importante desarrollar nuevos enfoques sobre esta entidad.(AU)

Background and objectives: Fibromyalgia is characterized by musculoskeletal pain and asthenia of chronic course. Fibromyalgia patients are often a challenge for the health care community as a whole. Existing studies are often limited to the opinion of rheumatologists or family physicians. With this study we seek to know what are the actions, perceptions and knowledge of health professionals as a whole when caring for patients with this disease. Materials and methods: Descriptive cross-sectional study, by means of a self-administered and anonymous survey. Distributed mainly in hospital wards and primary care centers. Statistical analysis of the variables collected was performed (P˂.05). Results: Two hundred surveys were collected, most of them physicians (63.5%; n=127) or nurses (25.5%; n=51). 71% of physicians reported using the WHO analgesic scale. 53% (n=59) use NSAIDs or paracetamol. Antidepressants are the third drug of choice. Most believe that the referral specialists should be rheumatologists or primary care physicians, a similar percentage, that management should be multidisciplinary. Fifty two percent feel discouraged or annoyed when dealing with these patients. Physicians have more negative connotations and believe that the care that the patient receives is mostly influenced by the diagnosis of fibromyalgia, compared to nurses and other professionals. Conclusions: Our study shows that the lack of knowledge and therapeutic tools generates, to a large extent, frustration and discomfort in health personnel. It is important to develop new approaches to this entity.(AU)

Health personnel perception about central sensitivity syndrome-fibromyalgia patients.

BACKGROUND AND OBJECTIVES: Fibromyalgia is characterized by musculoskeletal pain and asthenia of chronic course. Fibromyalgia patients are often a challenge for the health care community as a whole. Existing studies are often limited to the opinion of rheumatologists or family physicians. With this study we seek to know what are the actions, perceptions and knowledge of health professionals as a whole when caring for patients with this disease. MATERIALS AND METHODS: Descriptive cross-sectional study, by means of a self-administered and anonymous survey. Distributed mainly in hospital wards and primary care centers. Statistical analysis of the variables collected was performed (p < 0.05). RESULTS: 200 surveys were collected, most of them physicians 63.5% (n = 127) or nurses 25.5% (n = 51). 71% of physicians reported using the WHO analgesic scale. 53% (n = 59) use NSAIDs or Paracetamol. Antidepressants are the third drug of choice. Most believe that the referral specialists should be rheumatologists or primary care physicians, a similar percentage, that management should be multidisciplinary. 52% feel discouraged or annoyed when dealing with these patients. Physicians have more negative connotations and believe that the care that the patient receives is mostly influenced by the diagnosis of fibromyalgia, compared to nurses and other professionals. CONCLUSIONS: Our study shows that the lack of knowledge and therapeutic tools generates, to a large extent, frustration and discomfort in health personnel. It is important to develop new approaches to this entity.

High incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis. A case-control study.

OBJECTIVES: To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture. METHODS: Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients. RESULTS: Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37). CONCLUSION: Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.

Threshold indicators of primary production in the north-east Atlantic for assessing environmental disturbances using 21 years of satellite ocean colour.

Primary production (PP) is highly sensitive to changes in the ecosystem and can be used as an early warning indicator for disturbance in the marine environment. Historic indicators of good environmental status of the north-east (NE) Atlantic and north-west (NW) European Seas suggested that daily PP should not exceed 2-3 g C m-2 d-1 during phytoplankton blooms and that annual rates should be <300 g C m-2 yr-1. We use 21 years of Copernicus Marine Service (CMEMS) Ocean Colour data from September 1997 to December 2018 to assess areas in the NE Atlantic with similar peak, climatology, phenology and annual PP values. Daily and annual thresholds of the 90th percentile (P90) of PP are defined for these areas and PP values above these thresholds indicate disturbances, both natural and anthropogenic, in the marine environment. Two case studies are used to test the validity and accuracy of these thresholds. The first is the eruption of the volcano Eyjafjallajökull, which deposited large volumes of volcanic dust (and therefore iron) into the NE Atlantic during April and May 2010. A clear signature in both PP and chlorophyll-a (Chl a) was evident from 28th April to 6th May and from 18th to 27th May 2010, when PP exceeded the PP P90 threshold for the region, which was comparatively more sensitive than Chl a P90 as an indicator of this disturbance. The second case study was for the riverine input of total nitrogen and phosphorus, along the Wadden Sea coast in the North Sea. During years when total nitrogen and phosphorus were above the climatology maximum, there was a lag signature in both PP and Chl a when PP exceeded the PP P90 threshold defined for the study area which was slightly more sensitive than Chl a P90. This technique represents an accurate means of determining disturbances in the environment both in the coastal and offshore waters in the NE Atlantic using remotely sensed ocean colour data.

Increasing picocyanobacteria success in shelf waters contributes to long-term food web degradation.

Continental margins are disproportionally important for global primary production, fisheries and CO2 uptake. However, across the Northeast Atlantic shelves, there has been an ongoing summertime decline of key biota-large diatoms, dinoflagellates and copepods-that traditionally fuel higher tropic levels such as fish, sea birds and marine mammals. Here, we combine multiple time series with in situ process studies to link these declines to summer nutrient stress and increasing proportions of picophytoplankton that can comprise up to 90% of the combined pico- and nanophytoplankton biomass in coastal areas. Among the pico-fraction, it is the cyanobacterium Synechococcus that flourishes when iron and nitrogen resupply to surface waters are diminished. Our field data show how traits beyond small size give Synechococcus a competitive edge over pico- and nanoeukaryotes. Key is their ability to grow at low irradiances near the nutricline, which is aided by their superior light-harvesting system and high affinity to iron. However, minute size and lack of essential biomolecules (e.g. omega-3 polyunsaturated fatty acids and sterols) render Synechococcus poor primary producers to sustain shelf sea food webs efficiently. The combination of earlier spring blooms and lower summer food quantity and quality creates an increasing period of suboptimal feeding conditions for zooplankton at a time of year when their metabolic demand is highest. We suggest that this nutrition-related mismatch has contributed to the widespread, ~50% decline in summer copepod abundance we observe over the last 60 years. With Synechococcus clades being prominent from the tropics to the Arctic and their abundances increasing worldwide, our study informs projections of future food web dynamics in coastal and shelf areas where droughts and stratification lead to increasing nutrient starvation of surface waters.

Association of apolipoprotein B/apolipoprotein A1 ratio and cardiovascular events in rheumatoid arthritis: results of the CARMA study.

OBJECTIVES: To assess the plasma apolipoprotein B/apolipoprotein A1 ratio and its potential association with cardiovascular events (CVE) in patients with rheumatoid arthritis (RA). METHODS: A baseline analysis was made of the CARdiovascular in rheuMAtology Project (CARMA), a 10-year prospective study evaluating the presence of at least one CVE in 775 Spanish patients with RA. Of them, 29 had already experienced CVE prior to the inclusion in the study. We assessed the association between the elevation of the apoB/apoA1 ratio with the presence of CVE according to a logistic regression model for possible confounding factors. We also analysed the main parameters of activity of RA and parameters related to lipid metabolism. RA patients were classified according to treatment: patients treated with disease-modifying anti-rheumatic drugs without biologics and those undergoing biologic therapy (anti-TNF-α, anti-IL-6 receptor, and other biologic agents). RESULTS: The apoB/apoA1 ratio of patients who had experienced CVE was higher than that of patients without previous CVE (0.65 vs. 0.60). However, the difference between both subgroups did not reach statistical significance (p=0.197). It was also the case after the multivariate analysis [OR: 1.48 (95% CI: 0.15-14.4); p=0.735]. RA patients from the group with CVE were more commonly receiving lipid-lowering treatment with statins than those without CVE history (41.4% vs. 20%, p=0.005). High HAQ and high atherogenic index were significantly associated with the presence of CVE. There was no statistical association between the type of biologic therapy used in RA and the presence of CVE. CONCLUSIONS: No association between ApoB/apoA1 ratio and CVE was found at the baseline visit of patients with RA from the CARMA study.

Perfil de pacientes con fibromialgia que acuden a los centros de atención primaria en Terrassa / Profile of patients with fibromyalgia being treated in primary care centers in Terrassa, a city in northeastern Spain

Objetivo. Realizar una amplia caracterización clínica y epidemiológica de nuestra población afectada de fibromialgia. Pacientes, material y método. Estudio observacional a lo largo de 2 años realizado en 3 centros de atención primaria de Terrassa. Muestra de 235 personas diagnosticadas de fibromialgia visitadas en consultas de atención primaria o de reumatología a las que se ofrece la asistencia al programa multidisciplinar y aceptan completar los datos iniciales del programa. Las mediciones principales fueron: datos sociodemográficos; hábitos tóxicos y ejercicio físico; comorbilidades; tratamientos para la fibromialgia; cuestionario de impacto de la fibromialgia (FIQ); escala hospitalaria de ansiedad-depresión (HADS), y cuestionario de funcionalidad familiar (APGAR familiar). Principales resultados. El 97,8% son mujeres; edad media, 54,6 años. Predominio de pacientes con estudios primarios y en situación de baja laboral. El 94% tienen comorbilidad asociada y solo el 3% no consumen ningún fármaco para su patología, a la vez que hay un elevado consumo de fármacos sin evidencia de efectividad en la fibromialgia. La mayoría puntúan como nivel moderado en el cuestionario de Impacto de la fibromialgia (FIQ); tienen patología ansiosa y/o depresiva probable en el 63 y el 53%, respectivamente, según la Escala hospitalaria de ansiedad y depresión (HADS) y soporte familiar correcto en el 62%, según el test APGAR familiar. Conclusiones. Se confirman como datos principales y coincidiendo con la bibliografía la gran prevalencia de la fibromialgia en mujeres, con elevada comorbilidad especialmente psiquiátrica-psicológica, con moderado impacto de la enfermedad y con importante consumo de fármacos sin eficacia demostrada (AU)

Objective. To perform an extensive clinical and epidemiological characterization of our fibromyalgia patients. Patients, material, and method. Two-year observational study in 3 primary care centers in Terrassa, Spain. We recruited a sample of 235 individuals diagnosed with fibromyalgia being treated in primary care or rheumatology clinics who, when offered inclusion in a multidisciplinary program, agreed to provide the initial data we requested. The main measures were sociodemographic data, unhealthy habits and physical activity, comorbidities, treatment for fibromyalgia, Fibromyalgia Impact Questionnaire (FIQ), Hospital Anxiety and Depression Scale (HADS), and a family functioning scale (family APGAR). Main results. In all, 97.8% were women and the average age was 54.6 years. Most of the patients had a primary school education and the majority was on sick leave. Ninety-four percent had associated comorbidity and only 3% were not taking any medication for their disease. Many were taking drugs with no proven efficacy in fibromyalgia. The majority had intermediate scores on the FIQ, the HADS showed that 63% and 53% had an anxious and/or probable depressive disorder, respectively, and, according to the family APGAR score, 62% received proper family support. Conclusions. In agreement with the literature, the major findings in our fibromyalgia patients were a marked predominance of women, a high incidence of comorbidities-mainly psychiatric disorders-a moderate impact of the disease and widespread use of drugs with no demonstrated efficacy (AU)

Profile of patients with fibromyalgia being treated in primary care centers in Terrassa, a city in northeastern Spain. / Perfil de pacientes con fibromialgia que acuden a los centros de atención primaria en Terrassa.

OBJECTIVE: To perform an extensive clinical and epidemiological characterization of our fibromyalgia patients. PATIENTS, MATERIAL, AND METHOD: Two-year observational study in 3 primary care centers in Terrassa, Spain. We recruited a sample of 235 individuals diagnosed with fibromyalgia being treated in primary care or rheumatology clinics who, when offered inclusion in a multidisciplinary program, agreed to provide the initial data we requested. The main measures were sociodemographic data, unhealthy habits and physical activity, comorbidities, treatment for fibromyalgia, Fibromyalgia Impact Questionnaire (FIQ), Hospital Anxiety and Depression Scale (HADS), and a family functioning scale (family APGAR). MAIN RESULTS: In all, 97.8% were women and the average age was 54.6 years. Most of the patients had a primary school education and the majority was on sick leave. Ninety-four percent had associated comorbidity and only 3% were not taking any medication for their disease. Many were taking drugs with no proven efficacy in fibromyalgia. The majority had intermediate scores on the FIQ, the HADS showed that 63% and 53% had an anxious and/or probable depressive disorder, respectively, and, according to the family APGAR score, 62% received proper family support. CONCLUSIONS: In agreement with the literature, the major findings in our fibromyalgia patients were a marked predominance of women, a high incidence of comorbidities-mainly psychiatric disorders-a moderate impact of the disease and widespread use of drugs with no demonstrated efficacy.

Nailfold capillaroscopic findings in primary Sjögren's syndrome with and without Raynaud's phenomenon and/or positive anti-SSA/Ro and anti-SSB/La antibodies.

The aim of this study was to assess nailfold capillaroscopic (NC) findings in patients with primary Sjögren's syndrome (PSS) with and without Raynaud's phenomenon (RP) as well as in the presence of positive anti-SSA/Ro and anti-SSB/La antibodies. Videocapillaroscopy was performed in 150 patients with PSS. Data collected included demographics, presence of RP, PSS symptoms, antinuclear antibodies, rheumatoid factor, anti-Ro, anti-La, anti-CCP, salivary scintigraphy, labial biopsy, and NC findings. RP was present in 32% of PSS, keratoconjunctivitis sicca in 91%, oral xerosis in 93%, and skin or genital xerosis in 53%. In patients with positive anti-SSA/Ro (75%) and positive anti-SSB/La (40%), NC showed normal findings in 53% of cases and non-specific in 36%. In patients with PSS, NC was normal in 51% of cases and non-specific in 34%. Scleroderma pattern was found in 14 patients. RP associated with PSS had non-specific capillaroscopy in 40% of cases (p = 0.1). Pericapillary haemorrhages (p = 0.06) and capillary thrombosis (p = 0.2) were not increased, but more dilated capillaries were detected in 48% of cases. Patients with positive anti-Ro and/or anti-La have not a distinct NC profile. Patients with RP associated with PSS had more dilated capillaries, but neither pericapillary haemorrhages nor capillary thrombosis was observed.

Elaboración, implantación y seguimiento de un protocolo de osteoporosis posmenopáusica: colaboración entre Atención Primaria y el Servicio de Reumatología / Elaboration, implementation and follow-up of a postmenopausal osteoporosis protocol: Collaboration between the Primary care and Rheumatology departments

Objetivo Con el objetivo de mejorar la gestión clínica de la osteoporosis posmenopáusica, se ha realizado una intervención basada en la implantación y seguimiento de un protocolo consensuado entre la Atención Primaria y la Especializada de la Mútua de Terrassa. Métodos Estudio descriptivo y de intervención. La intervención consistió en la elaboración de un protocolo consensuado, que fue presentado en todos los centros. Los datos se han evaluado a partir de densitometrías óseas solicitadas por los médicos de familia durante 1 año. Resultados Se han solicitado un total de 1.165 densitometrías, de las cuales 689 son para diagnóstico de nuevas pacientes. Para la evaluación del protocolo se han obtenido datos de 560. 502 densitometrías realizadas (89,6%, IC95%: 87,1–92,2) cumplían con los criterios de indicación marcados por el protocolo. Del total de pacientes que recibieron tratamiento con fármacos antirresortivos (43 osteopénicas y 167 osteoporóticas), el 83,7% (IC95%: 69,3–93,2) y el 89,8% (IC95%: 85,2–94,4), respectivamente, cumplía con las recomendaciones de primera elección. El consumo de fármacos durante el año 2007 se ha reducido en 152.745 euros (−6,3%), aunque el número de pacientes tratadas ha aumentado en 565 (+4,9%) respecto al año anterior. 442 (78,9%, IC95%: 75,6–82,3) densitometrías presentaron un resultado de osteopenia u osteoporosis. Se observan diferencias estadísticamente significativas de los resultados según la edad de las pacientes y el motivo de solicitud. Conclusiones La puesta en marcha del protocolo ha permitido gestionar de forma eficiente el proceso clínico de la osteoporosis en nuestro ámbito (AU)

Objective To improve the clinical management of postmenopausal osteroporosis, an intervention based on the implementation of a guideline agreed to between the Primary Care and Specialized departments of all centers at “Mutua of Terrassa” was carried out. Methods Descriptive and interventional study. The intervention consisted of the elaboration of a consensus guideline that was presented in all centers. Results were assessed from bone densitometry studies requested by family physicians over 1 year. Results 1.165 densitometric studies were requested, of which 689 were for the diagnosis of new patients. For the evaluation of the guidelines, details were obtained from 560. 502 studies (89,6% IC95% 87,1–92,2) complied with indication criteria established in the guideline. Of the total of patients who received bisphosphonates and other drugs affecting bone metabolism (43 osteopenic and 167 osteoporotic), 83,7% (IC95% 69,3–93,2) and 89,8% (IC95% 85,2–94,4) respectively complied with drug recommendations. Drug consumption during the year 2007 was reduced by 152.745 euros (−6,3%) although the number of patients increased in 565 (+4,9%) with respect to the previous year. 442 (78,9% IC95% 75,6–82,3) densitometries presented a result in the osteopenia or osteroporosis category. There were statistically significant differences of the results according to the patients' age and the motive for the bone densitometry request. Conclusions Implementation of the guideline allowed for the effective management of the clinical process of osteroporosis in our field (AU)

[Elaboration, implementation and follow-up of a postmenopausal osteoporosis protocol: Collaboration between the Primary care and Rheumatology departments]. / Elaboración, implantación y seguimiento de un protocolo de osteoporosis posmenopáusica: colaboración entre Atención Primaria y el Servicio de Reumatología.

OBJECTIVE: To improve the clinical management of postmenopausal osteroporosis, an intervention based on the implementation of a guideline agreed to between the Primary Care and Specialized departments of all centers at "Mutua of Terrassa" was carried out. METHODS: Descriptive and interventional study. The intervention consisted of the elaboration of a consensus guideline that was presented in all centers. Results were assessed from bone densitometry studies requested by family physicians over 1 year. RESULTS: 1.165 densitometric studies were requested, of which 689 were for the diagnosis of new patients. For the evaluation of the guidelines, details were obtained from 560. 502 studies (89,6% IC95% 87,1-92,2) complied with indication criteria established in the guideline. Of the total of patients who received bisphosphonates and other drugs affecting bone metabolism (43 osteopenic and 167 osteoporotic), 83,7% (IC95% 69,3-93,2) and 89,8% (IC95% 85,2-94,4) respectively complied with drug recommendations. Drug consumption during the year 2007 was reduced by 152.745 euros (-6,3%) although the number of patients increased in 565 (+4,9%) with respect to the previous year. 442 (78,9% IC95% 75,6-82,3) densitometries presented a result in the osteopenia or osteroporosis category. There were statistically significant differences of the results according to the patients' age and the motive for the bone densitometry request. CONCLUSIONS: Implementation of the guideline allowed for the effective management of the clinical process of osteroporosis in our field.