Efectos de la intervención desde terapia ocupacional sobre la percepción del dolor crónico y la calidad de vida en pacientes con artritis reumatoide / Effects of an occupational therapy intervention in chronic pain perception and quality of life of patients with rheumatoid arthritis

Objetivos: determinar si una propuesta de intervención experimental desarrollada desde el campo de trabajo de la terapia ocupacional, dirigida a la reestructuración del desempeño ocupacional en pacientes con artritis reumatoide, reduce los niveles de dolor percibidos y mejora la autoeficacia y la calidad de vida de los mismos. Esta intervención se llevó a cabo de forma grupal, utilizando modelos de formación y enseñanza de estrategias a los pacientes. Material y método: estudio de intervención controlado aleatorizado de un programa grupal de terapia ocupacional de siete sesiones, de dos horas cada una, realizadas en cinco semanas. Resultados: se detectó una mejora en las puntuaciones de autoeficacia (p < 0,001) y de calidad de vida (p = 0,001; p = 0,08), así como de las puntuaciones de intensidad de dolor medidas con MPQ (McGill Pain Questionnaire), aunque los valores recogidos con EVA (escala visual analógica) se mantienen en el tiempo. Conclusiones: el programa resultó eficaz en la modificación de las variables estudiadas, apreciándose cambios significativos tanto en intensidad de dolor, como en los valores referidos a autoeficacia y calidad de vida. Es recomendable repetir el trabajo con una muestra mayor que permita obtener datos más consistentes (AU)

Objectives: To determine if an occupational therapy based intervention focused on performance reorganization on patients with rheumatoid arthritis reduces pain and improves self-efficacy and quality of life. Material and methods: Randomized controlled intervention study through a group program of seven occupational therapy sessions, conducted in five weeks. Results: We found an improvement in self-efficacy (p<0,001) and quality of life scores (p = 0,001, p = 0,08), as well as pain intensity MPQ (McGill Pain Questionnaire) measures, although the values collected with VAS (visual analogue scale) maintained over time. Conclusions: The program was effective in changing the studied variables, although a new study with a larger sample is required (AU)

Aceclofenac vs paracetamol in the management of symptomatic osteoarthritis of the knee: a double-blind 6-week randomized controlled trial.

OBJECTIVE: To evaluate the efficacy and tolerability of aceclofenac, 200 mg/day, and paracetamol, 3000 mg/day, in the treatment of osteoarthritis (OA) of the knee. METHODS: This was a double-blind, parallel-group, multicentre clinical trial involving patients with symptomatic OA of the knee, conducted in Spain. Patients were randomly allocated to aceclofenac 100 mg twice daily (n=82) or paracetamol 1000 mg three times daily (n=86). Patients were assessed at baseline and 6 weeks. Primary efficacy measures were severity of pain (visual analogue scale, VAS), Lequesne OA knee index, and patient's and physician's global assessment of disease activity. Severity of knee pain at rest or walking, stiffness, knee swelling and tenderness, and assessment of health-related quality of life (Health Assessment Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form 36) were included as secondary endpoints. RESULTS: Both treatment groups showed significant improvement compared with their baseline values in the four primary endpoints. Mean between-treatment differences favoured aceclofenac over paracetamol on pain (VAS, 7.64 mm [95% confidence interval (CI), 0.44-14.85 mm]), Lequesne OA index (1.41 [95% CI, 0.45-2.36]), and patient's (0.33 [95% CI, 0.06-0.61]) and physician's (0.23 [95% CI, 0.01-0.47]) global assessments. Adverse events were similar for both drugs (paracetamol, 29% patients vs aceclofenac, 32%; P=0.71). Four patients withdrew in each group due to adverse events. Patients tended to prefer aceclofenac to paracetamol (P=0.001), and more treated with paracetamol withdrew from the study due to lack of efficacy (n=8 vs n=1, P=0.035, for paracetamol and aceclofenac, respectively). CONCLUSION: At 6 weeks, patients with symptomatic OA of the knee showed a greater improvement in pain and functional capacity with aceclofenac than paracetamol with no difference in tolerability.

[Pain in Spanish rheumatology outpatient offices: EPIDOR epidemiological study]. / El dolor en las consultas de Reumatología españolas: estudio epidemiológico EPIDOR.

OBJECTIVE: To establish the prevalence and characteristics of rheumatologic pain in Spanish adult population cared in specialized rheumatology offices. DESIGN: Cross selection study in a population of patients cared in rheumatology offices of public Spanish hospitals. SUBJECTS: 1,134 patients selected through random sampling based on waiting lists of patients, during a period of 1 week, in rheumatology offices of each participating hospital. MAIN OUTCOMES OF THE STUDY: Reason behind the consultation (a new patient [NP] or a patient for revision [RP]), characteristics of the patient (sex, age, habits [alcohol/tobacco], marital status), location, type, intensity, duration, tolerance and management of pain; treatment (pharmacological or non-pharmacological) carried out; satisfaction with the treatment; and association with fibromyalgia. RESULTS: The prevalence of pain in NP was 98.6% and in RP 95.1%, with a global prevalence of 96%, predominating mainly in adult sedentary women with fibromyalgia. The frequency of acute pain was 20.9% and this of chronic pain 79.1% [corrected] The prevalence of fibromyalgia was 12% (2.2% in men, and 15.5% in women). The most prevalent pattern of current dominant pain was this of the mechanical type. More frequent associated pathologies were: hypertension (21.7%), depression (14.4%), gastrointestinal diseases (13.8%) and anxiety (13.4%). All variables analyzed in the study showed changes according to age, sex, and type of patient (NP or RP). Most used treatment was pharmacological; more than 57.6% of patients were receiving NSAIDs. In NP, medical prescriber of the treatment was first the general practitioner (56.1%) followed by the rheumatologist (14.1%); in PR the first one was the rheumatologist (69.9%) followed by the general practitioner (16.5%). CONCLUSIONS: Our results show that the prevalence of the rheumatologic pain is very high, predominating mainly in adult women with fibromyalgia. Pain location, intensity, and type, associated pathology, and treatment vary according to age, sex, and type of patient. The most commonly used drugs for pain management were NSAIDs (58%); opiodes were only used in 6.4% of patients even though pain was intense in more than two-thirds.

El dolor en las consultas de Reumatología españolas: estudio epidemiológico EPIDOR / Pain in spanish Rheumatology outpatient offices: EPIDOR epidemiological study

Objetivo. Estimar la prevalencia y características del dolor reumatológico en la población adulta española atendida en consultas especializadas de Reumatología. Diseño. Estudio transversal de prevalencia en una población de pacientes atendidos en consultas de Reumatología de hospitales públicos españoles. Sujetos. Mil ciento treinta y cuatro elegidos mediante muestreo aleatorio a partir de listados de pacientes citados, durante un período de una semana, en consultas reumatológicas de cada uno de los hospitales participantes. Variables principales del estudio. Motivo de consulta (paciente de nuevo diagnóstico [PND] o de revisión [PR]), características del paciente (sexo, edad, hábitos [alcohol/tabaco], estado civil), localización, tipo, intensidad, duración, tolerancia y manejo del dolor, tratamiento (farmacológico o no farmacológico) realizado y satisfacción con el tratamiento. Resultados. La prevalencia de dolor en PND fue del 98,6% y en PR del 95,1%, con una prevalencia global del 96%, predominando principalmente en mujeres adultas, sedentarias y con fibromialgia. La frecuencia de dolor agudo fue del 80% y crónico del 20%. La prevalencia de fibromialgia fue del 12% (2,2% en hombres y 15,5% en mujeres). El patrón de dolor dominante actual que prevaleció fue de tipo mecánico. Las patologías asociadas más frecuentes fueron: hipertensión arterial (21,7%), depresión (14,4%), enfermedades digestivas (13,8%) y ansiedad (13,4%). Todas las variables del estudio analizadas cambiaron según edad, sexo y tipo de paciente (PND o PR). El tratamiento más usado fue farmacológico con antiinflamatorios no esteroideos (AINE) en más del 57,6%. El médico prescriptor del tratamiento fue primero el médico general (56,1%) seguido del reumatólogo (14,1 %) en PND y el primero fue el reumatólogo (69,9%) seguido del médico general (16,5 %) en PR. Conclusiones. Los resultados muestran que la prevalencia del dolor reumatológico es muy elevada, predominando principalmente en mujeres adultas con fibromialgia La localización, intensidad, tipo, patología asociada y tratamiento varían según edad, sexo y tipo de paciente. Los fármacos más utilizados para el manejo del dolor son los AINE (58%); los opioides tan sólo se utilizaron en el 6,4% de los pacientes a pesar de que el dolor fue intenso en más de dos tercios

Objective. To establish the prevalence and characteristics of rheumatologic pain in Spanish adult population cared in specialized rheumatology offices. Design. Cross selection study in a population of patients cared in rheumatology offices of public Spanish hospitals. Subjects. 1,134 patients selected through random sampling based on waiting lists of patients, during a period of 1 week, in rheumatology offices of each participating hospital. Main outcomes of the study. Reason behind the consultation (a new patient [NP] or a patient for revision [RP]), characteristics of the patient (sex, age, habits [alcohol/tobacco], marital status), location, type, intensity, duration, tolerance and management of pain; treatment (pharmacological or non-pharmacological) carried out; satisfaction with the treatment; and association with fibromyalgia. Results. The prevalence of pain in NP was 98.6% and in RP 95.1%, with a global prevalence of 96%, predominating mainly in adult sedentary women with fibromyalgia. The frequency of acute pain was 80% and this of chronic pain 20%. The prevalence of fibromyalgia was 12% (2.2% in men, and 15.5% in women). The most prevalent pattern of current dominant pain was this of the mechanical type. More frequent associated pathologies were: hypertension (21.7%), depression (14.4%), gastrointestinal diseases (13.8%) and anxiety (13.4%). All variables analyzed in the study showed changes according to age, sex, and type of patient (NP or RP). Most used treatment was pharmacological; more than 57.6% of patients were receiving NSAIDs. In NP, medical precriber of the treatment was first the general practitioner (56.1%) followed by the rheumatologist (14.1%); in PR the first one was the rheumatologist (69.9%) followed by the general practitioner (16.5%). Conclusions. Our results show that the prevalence of the rheumatologic pain is very high, predominating mainly in adult women with fibromyalgia. Pain location, intensity, and type, associated pathology, and treatment vary according to age, sex, and type of patient. The most commonly used drugs for pain management were NSAIDs (58%); opiodes were only used in 6.4% of patients even though pain was intense in more than two-thirds

Segunda actualización del consenso de la Sociedad Española de Reumatología sobre la terapia biológica en la artritis reumatoide / II Update of the Consensus of the Spanish Society of Rheumatology on Biological Therapy in Rheumatoid Arthritis

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Nuevos datos y enfoques en el tratamiento de la artritis reumatoide con etanercept / New data ana approaches in the treatment of rheumatoid arthritis with etanercept

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Etanercept / Etanercept

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Infiltraciones en la patología de la rodilla / Local injection in knee diseases

Las artropatías inflamatorias, la gonartrosis y los reumatismos inflamatorios de las partes blandas de la rodilla pueden beneficiarse de la infiltración local, siempre y cuando se respeten sus indicaciones y contraindicaciones. Se revisan estos aspectos, así como las técnicas aplicables, los materiales necesarios y el coste del procedimiento, referidos especialmente al empleo de glucocorticoides. Finalmente, se informa sobre complicaciones y normas de seguimiento de la intervención, así como de los datos disponibles sobre eficacia (AU)