Guías de manejo de artritis reumatoide Consenso 2016 Asociación Costarricense de Reumatología / (Management Guidelines of Rheumatoid Arthritis Consensus 2016)

ResumenLa artritis reumatoide sigue representando un importante factor de deterioro de la salud de las personas que sufren esta condición, a pesar de los avances recientes en su tratamiento. En forma adicional, se reconoce su significativo impacto a nivel social y económico. La Asociación Costarricense de Reumatología publicó en 2010, las primeras guías de manejo de esta enfermedad.En el presente trabajo, este primer documento fue actualizado, mediante la revisión exaustiva de la información científica disponible y relevante a la fecha, con el objetivo de uniformar y optimizar la atención de la artritis reumatoide en Costa Rica. Incluye las recomendaciones de evaluación de los pacientes, su seguimiento y tratamiento. También se revisan las opciones de medicamentos disponibles en el país, es decir, drogas modificadoras de los síntomas y fármacos modificadores de la enfermedad convencionales, además de agentes biológicos y moléculas pequeñas.

AbstractRheumatoid arthritis continues to represent an important factor of deterioration in the health of people suffering from this condition despite recent medical advances in their treatment. Additionally, its significant social and economic impact it is recognized. The Costa Rican Association of Rheumatology published in 2010 the first guidelines for the management of this disease. In the present work, this first document is updated, through an exhaustive review of the available and relevant scientific information to date. This review aims to standardize and optimize the care of rheumatoid arthritis in Costa Rica. It includes recommendations for evaluation of patients, follow-up and treatment. There is also a review of drug options available in the country, i.e., symptoms-modifying drugs, conventional disease modifying drugs, as well as biological agents and small molecules.

An analysis of 372 patients with anterior uveitis in a large Ibero-American cohort of spondyloarthritis: the RESPONDIA Group.

OBJECTIVES: This study analysed the frequency of anterior uveitis (AU) and its correlations in a large cohort of patients with spondyloarthritis (SpA). METHODS: A common protocol of investigation was prospectively applied to 2012 SpA patients in 85 centres from 10 Ibero-American countries. Clinical and demographic variables and disease indexes were investigated. Categorical variables were compared by χ2 and Fisher's exact test, and continuous variables were compared by ANOVA or Kruskal-Wallis test. A value of p<0.05 was considered significant. RESULTS: AU was referred by 372 SpA patients (18.5%). AU was statistically associated with inflammatory low back pain (p<0.001), radiographic sacroiliitis (p<0.001), enthesopathies (p=0.004), urethritis/acute diarrhoea (p<0.001), balanitis (p=0.002), hip involvement (p=0.002), HLA-B27 (p=0.003), and higher C-reactive protein (p=0.001), whilst it was negatively associated with the number of painful (p=0.03) and swollen (p=0.005) peripheral joints, psoriatic arthritis (p<0.001), psoriasis (p<0.001), nail involvement (p<0.001), and dactilitis (p=0.062; trend). No association with gender, race, and indices (disease activity, functionality and quality of life) was observed. Logistic regression showed that ankylosing spondylitis (p=0.001) and HLA-B27 (p=0.083; trend) was significantly associated with AU, while extra-articular manifestations (predominantly psoriasis) were negatively associated (p=0.016). CONCLUSIONS: Anterior uveitis is a frequent extra-articular manifestation in SpA patients, positively associated with axial involvement and HLA-B27 and negatively associated with peripheral involvement and psoriatic arthritis.

Drogas modificadoras de la artritis reumatoide, DMAR / Disease modifying antirheumatic drugs, DMARD

El nuevo paradigma terapéutico de la artritis reumatoide establece que todo paciente con actividad de la enfermedad debe recibir alguna droga modificadora de la artritis reumatoide. Estas drogas reciben este nombre ya que han demostrado en estudios clínicos controlados modificar el curso natural de la enfermedad.

Registro Iberoamericano de Espondiloartritis (RESPONDIA): Costa Rica / RESPONDIA. Iberoamerican spondyloarthritis registry: Costa Rica

Se analizaron 33 casos de espondiloartropatías en un hospital de Costa Rica, incluidos dentro del grupo RESPONDIA. Los casos correspondían a 19 varones y 14 mujeres, con una edad media de 41,3 años, de los cuales 22 (61,7%) eran mestizos. Las manifestaciones clínicas más frecuentes al inicio de la enfermedad fueron dolor lumbar inflamatorio, artritis de las extremidades inferiores y entesitis. Un 57,1% de los pacientes presentaba HLA-B27 positivo. La espondilitis anquilosante y la espondiloartropatía indiferenciada fueron las formas clínicas más frecuentes, con 15 casos cada una (AU)

Thirty-three patients with a diagnosis of spondyloarthropathies were analyzed in a Costa Rica Hospital, included in RESPONDIA Group. There were 19 male and 14 female patients, with a mean age of 41.3 years, and 22 (61.7%) of the patients were Hispanoamericans. Inflammatory back pain, arthritis of the lower limbs and enthesitis were the most common manifestations at disease onset. HLA-B27 was positive in 57, 1% of the cases. Ankylosing spondylitis (n = 15) and undifferentiated spondyloarthropathy (n = 15) were the most common clinical forms of disease (AU)