Different clinical expression of patients with ankylosing spondylitis according to gender in relation to time since onset of disease. Data from REGISPONSER.

OBJECTIVE: To describe the differential characteristics by gender and time since disease onset in patients diagnosed with ankylosing spondylitis (AS) attending the Spanish rheumatology clinics, including those on the "Spanish Registry of spondyloarthritis" (REGISPONSER), as well as the diagnostic and therapeutic implications that this entails. PATIENTS AND METHODS: This is a transversal and observational study of 1514 patients with AS selected from 2367 spondyloarthritis cases included in REGISPONSER. For each patient, the demographics, epidemiology, geriatric, clinical, laboratory, radiological, and therapeutic aspects were were evaluated and comprehensively recorded under the aegis of REGISPONSER, constituting the Minimum Basic identifying data for the disease. Physical function was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Clinical activity was evaluated using erythrocyte sedimentation rate, C reactive protein and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Each patient underwent pelvic anteroposterior, anteroposterior and lateral lumbar spine as well as lateral cervical spine x rays; they were scored according to the Bath Ankylosing Spondylitis Spine Radiographic Index, which measures structural damage. RESULTS: Of the 1514 patients screened, 1131 (74.7%) were men. We found significant differences in age at onset of symptoms as well as in the day of inclusion, between the two groups, being lower in men. We also obtained differences in the duration of the disease, which was lower in women. As for the existence of a history of AS among first-degree relatives, family forms were more common among women. The mean BASDAI score was also higher in women, regardless of time since onset of disease. In contrast, the improvement of pain with the use of NSAID's and radiological severity were higher in men, both reaching statistical significance. CONCLUSIONS: Among the Spanish AS patients, there are some differences in the clinical manifestations, even when the time since onset of disease was controlled; we also found radiological differences by gender; men showing more structural damage, while women were more active. These data suggest that the phenotype of AS differs between genders. This can influence the subsequent diagnostic approach and therapeutic decisions.

Alendronato en la osteoporosis posmenopáusica grave / Usefulness of alendronate in the treatment of the severe postmenopausal osteoporosis

Antecedentes: El alendronato (ALN) es un fármaco eficaz para la prevención de la osteoporosis posmenopáusica, pero su uso clínico está limitado por su coste y su tolerancia. El empleo del ALN en pacientes de alto riesgo de fractura podría mejorar su perfil de coste-beneficio. Material y método: Se estudió a 34 pacientes con osteoporosis posmenopáusica, definida de alto riesgo de fractura por cumplir alguno de los siguientes criterios: a) densidad mineral ósea (DMO) en cuello de fémur o en columna lumbar con una escala T 1 g de calcio elemento. El seguimiento de la DMO se realizó mediante absorciometría dual de rayos X. La aparición de nuevas fracturas se evaluó mediante estudio radiológico. La pérdida de altura se evaluó mediante mediciones periódicas. Resultados: Todas las pacientes experimentaron un incremento significativo de la DMO en columna lumbar desde los primeros 12 meses. La ganancia máxima se alcanzó al segundo año de tratamiento. Los incrementos de DMO observados en el cuello de fémur resultaron significativos a partir del segundo año, alcanzando el máximo en el tercer año. Sólo aparecieron nuevas fracturas en 2 pacientes que ya habían tenido fractura previa. Dichas fracturas fueron apendiculares, y no se han detectado nuevas fracturas vertebrales. Ninguna paciente sin fractura previa presentó nuevas fracturas. No se detectó pérdida de altura significativa en ninguna paciente. Dos pacientes (5,88 por ciento) abandonaron el tratamiento. Ambos casos se produjeron por intolerancia digestiva que revirtió al suspenderlo. Conclusión: El ALN incrementa de forma significativa la DMO de poblaciones osteoporóticas de mal pronóstico. Este incremento de masa ósea puede tener importantes, repercusiones clínicas, en forma de prevenir futuras fracturas vertebrales (AU)

Mujer joven con dolor lumbar y fiebre en imágenes / Young women with lumbar pain and fever rheumatology

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