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1.
Acta Reumatol Port ; 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-31300634

RESUMEN

INTRODUCTION/AIM: Rheumatoid Arthritis (RA) an autoimmune, chronic, and disabling disease if untreated, affects wrist joints, with a diagnostic delay of up to 2 years. Triquetral bone allows rotational movement that pivots over the rest wrist bones, and maintains physiological loads during mobility. Magnetic Resonance Imaging (MRI) is the most sensitive (96%) method for diagnosis, evidencing lesions as early as in the initial RA stages. Our aim was to determine the most frequently affected structures in the hand-wrist joint by MRI using the OMERACT-RAMRIS Score (2003) in three different RA stages, including clinically suspicious arthralgia (CSA) that haven't reported before. METHODS: We performed an exploratory, transverse, observational, descriptive study in 60 patients enrolled and classified by rheumatologists as: CSA, early rheumatoid arthritis (ERA), and established RA, prior to performing a dominant hand-wrist MRI for evaluation and descriptive analysis by an expert radiologist. RESULTS: Female predominance 83% (50), with a mean age 42+13.5 years; A total of 1,731 hand-wrist bone and joint sites were evaluated using EULAR-OMERACT Atlas (2005), identifying 56% (964 sites) with typical RA lesions: synovitis, erosions, and bone marrow edema (BME or osteitis); synovitis was the most frequent with 46% (445 site-lesion), and triquetral synovitis the most frequent each clinical group: CSA 87% (20/23), ERA 91% (20/22), and RA 93% (14/15). CONCLUSION: Synovitis and triquetral synovitis were the most prevalent lesion in three-studied phases. This could suggest the triquetrum as the first morphological site to be affected by RA; so it's assessment should be considered in the RA evaluation when it´s clinically suspected.

2.
Reumatol. clín. (Barc.) ; 15(3): 165-169, mayo-jun. 2019. tab
Artículo en Inglés | IBECS | ID: ibc-184369

RESUMEN

Background: The esophageal involvement in systemic sclerosis (SSc) causes impact in the morbidity and mortality. High resolution manometry assesses esophageal involvement. Our aim was to categorize esophageal motor disorder in patients with SSc by HRM. Methods: We carried out an observational, descriptive and cross-sectional study. All patients underwent HRM as well as semi-structured interviews to assess frequency and severity of upper GI symptoms. Patients also completed the gastroesophageal reflux questionnaire (Carlsson-Dent). Results: We included 19 patients with SSc, 1 with morphea, and 1 with scleroderma sine scleroderma. Dysphagia and heartburn were the most frequent symptoms (61% each). We found an abnormal HRM in 15 (71.4%) patients. We found no statistically significant association between clinical or demographic variables and an abnormal HRM, or between any upper GI symptom and HRM findings. Conclusion: We observed a high prevalence of esophageal symptoms and of HRM abnormalities. However, there was no clear association between symptomatology and HRM findings. HRM does not seem to accurately predict upper GI symptomatology


Antecedentes: La afectación esofágica en la esclerosis sistémica causa impacto en la morbimortalidad. La manometría de alta resolución evalúa la afectación esofágica. Nuestro objetivo fue categorizar el trastorno motor esofágico en pacientes con esclerosis sistémica por HRM. Métodos: Se realizó un estudio observacional, descriptivo y transversal. Todos los pacientes se sometieron a HRM, así como a entrevistas semiestructuradas para evaluar la frecuencia y la gravedad de los síntomas gastrointestinales. Los pacientes también completaron el cuestionario de reflujo gastroesofágico (Carlsson-Dent). Resultados: Se incluyeron 19 pacientes con esclerosis sistémica, uno con morfea y uno con esclerodermia seno esclerodermia. La disfagia y la pirosis fueron los síntomas más frecuentes (un 61% cada uno). Encontramos una HRM anormal en 15 (71,4%) pacientes. No se halló ninguna asociación estadísticamente significativa entre las variables clínicas o demográficas y una HRM anormal, o entre cualquier síntoma GI superior y los hallazgos de HRM. Conclusión: Se observó una alta prevalencia de síntomas esofágicos y de anomalías de la HRM. Sin embargo, no hubo asociación clara entre la sintomatología y los hallazgos de HRM. La HRM no parece predecir con precisión la sintomatología gastrointestinal


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Esclerodermia Sistémica/complicaciones , Enfermedades del Esófago/epidemiología , Manometría/métodos , Comorbilidad , Trastornos de la Motilidad Esofágica/diagnóstico , Esclerodermia Localizada/complicaciones , Trastornos de Deglución/epidemiología
3.
Reumatol Clin ; 15(3): 165-169, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-29258795

RESUMEN

BACKGROUND: The esophageal involvement in systemic sclerosis (SSc) causes impact in the morbidity and mortality. High resolution manometry assesses esophageal involvement. Our aim was to categorize esophageal motor disorder in patients with SSc by HRM. METHODS: We carried out an observational, descriptive and cross-sectional study. All patients underwent HRM as well as semi-structured interviews to assess frequency and severity of upper GI symptoms. Patients also completed the gastroesophageal reflux questionnaire (Carlsson-Dent). RESULTS: We included 19 patients with SSc, 1 with morphea, and 1 with scleroderma sine scleroderma. Dysphagia and heartburn were the most frequent symptoms (61% each). We found an abnormal HRM in 15 (71.4%) patients. We found no statistically significant association between clinical or demographic variables and an abnormal HRM, or between any upper GI symptom and HRM findings. CONCLUSION: We observed a high prevalence of esophageal symptoms and of HRM abnormalities. However, there was no clear association between symptomatology and HRM findings. HRM does not seem to accurately predict upper GI symptomatology.


Asunto(s)
Enfermedades del Esófago/etiología , Manometría/métodos , Esclerodermia Sistémica/complicaciones , Adulto , Estudios Transversales , Trastornos de Deglución/etiología , Enfermedades del Esófago/diagnóstico , Enfermedades del Esófago/fisiopatología , Femenino , Reflujo Gastroesofágico/etiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Esclerodermia Sistémica/fisiopatología , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Encuestas y Cuestionarios , Evaluación de Síntomas
5.
Rheumatol Int ; 37(9): 1507-1511, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28681250

RESUMEN

Patients with rheumatoid arthritis (RA) have a high risk for comorbid conditions which increase mortality, hospital admissions, costs of care and inability. To evaluate the prevalence of comorbidities in Mexican mestizo patients with RA and determine the associated risk factors. Cross-sectional study in which RA patients admitted to our outpatient clinic were consecutively enrolled. We collected data regarding demographics, disease characteristics and comorbidities at the time of the patient's visit to the clinic. We analyzed 225 patients. Their mean age was 55.7 ± 8.3 years; disease duration, 9.5 (3.8-15.5) years; female gender, 93.8%; Disease Activity Score using 28 joints-C-reactive protein, 3 (2-4); methotrexate use, 84.9%; use of any other conventional disease modifying anti-rheumatic drug, 65.7%; use of biological agents, 8%. The most frequently associated diseases were: hypertension, 29.8%; dyslipidemia, 27.1%; osteoporosis, 19.1%; diabetes, 12.4%; hypothyroidism, 6.2%; solid malignancies 4.4%. Risk factors were also evaluated, the most prevalent was overweight in 101 (44.9%) of our patients. A total of 71 (31.6%) had obesity. We also detected high blood pressure in 12.4%, hyperglycemia in 27.1% and hyperlipidemia in 49.8%. Due to the high frequency of comorbidities among RA patients, it is important to follow existing recommendations for their timely detection and management. Cardiovascular diseases must be evaluated with priority. The initial evaluation should include a thorough examination to prevent the deleterious effect of comorbidities in RA.


Asunto(s)
Artritis Reumatoide/etnología , Indios Norteamericanos , Adulto , Anciano , Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo
6.
Reumatol. clín. (Barc.) ; 13(3): 156-159, mayo-jun. 2017. tab, ilus
Artículo en Inglés | IBECS | ID: ibc-162471

RESUMEN

Introduction. In Mexico, other risk factors are associated with hepatitis C virus (HCV): prior heroin users, living alone, widower, and northern region residence. Rheumatoid arthritis (RA) patients are considered immunosuppressed and HCV testing is recommended before treatment. The aim of the study was to describe the characteristics of HCV testing in RA patients in three different medical care settings in a non-endemic area. Methods. A retrospective observational study was performed using medical records from 960 RA patients describing the indications for HCV testing. Results. The test was performed in 28.6% and the HCV overall frequency was 0.36%. Population characteristics were not associated with an increased risk of HCV infection; therefore, anti-HCV positivity was low. The main reason for testing was before starting biological agents. Conclusion. Due to the low pre-test probability, testing for HCV infection should be personalized; i.e., according to disease prevalence in a particular geographical location and the individual risk factors (AU)


Introducción. En México, se han descrito factores de riesgo para virus de hepatitis C (VHC), además de los conocidos como: consumo de heroína, individuos que viven solos, ser viudo y residencia en el norte del país. Los pacientes con artritis reumatoide (AR) son considerados inmunodeprimidos y se recomienda realizar pruebas de VHC antes del inicio del tratamiento. El objetivo fue describir las características de pacientes con AR a quienes se realizaron pruebas de VHC. Material y métodos. Estudio observacional, retrospectivo de 960 registros médicos donde se describieron las indicaciones para las prueba de VHC. Resultados. La prueba se realizó en el 28.6% y la frecuencia global de VHC fue de 0.36%. Las características de la población no se asociaron con un mayor riesgo de infección, por lo tanto la presencia de anti-VHC fue baja. La principal razón para realizar la prueba fue el inicio de tratamiento biológico. Conclusión. Debido a la baja probabilidad pre-test, las pruebas para el VHC deben ser personalizadas, es decir, según la prevalencia de la enfermedad de acuerdo a la zona geográfica y los factores de riesgo individuales (AU)


Asunto(s)
Humanos , Hepatitis C Crónica/diagnóstico , Artritis Reumatoide/complicaciones , Terapia Biológica , Estudios Transversales , Tamizaje Masivo/métodos , Factores de Riesgo
7.
Reumatol Clin ; 13(3): 156-159, 2017.
Artículo en Inglés, Español | MEDLINE | ID: mdl-27132481

RESUMEN

INTRODUCTION: In Mexico, other risk factors are associated with hepatitis C virus (HCV): prior heroin users, living alone, widower, and northern region residence. Rheumatoid arthritis (RA) patients are considered immunosuppressed and HCV testing is recommended before treatment. The aim of the study was to describe the characteristics of HCV testing in RA patients in three different medical care settings in a non-endemic area. METHODS: A retrospective observational study was performed using medical records from 960 RA patients describing the indications for HCV testing. RESULTS: The test was performed in 28.6% and the HCV overall frequency was 0.36%. Population characteristics were not associated with an increased risk of HCV infection; therefore, anti-HCV positivity was low. The main reason for testing was before starting biological agents. CONCLUSION: Due to the low pre-test probability, testing for HCV infection should be personalized; i.e., according to disease prevalence in a particular geographical location and the individual risk factors.


Asunto(s)
Artritis Reumatoide/virología , Adhesión a Directriz/estadística & datos numéricos , Hepatitis C/diagnóstico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Anciano , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/inmunología , Estudios Transversales , Femenino , Hepatitis C/complicaciones , Hepatitis C/epidemiología , Humanos , Masculino , México , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Prevalencia , Estudios Retrospectivos , Factores de Riesgo
11.
Rheumatol Int ; 35(12): 2037-40, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26318137

RESUMEN

The Gaenslen´s compression maneuver is the application of pressure on the metacarpophalangeal joints in order to evoke pain on a patient who has active synovitis. The results from the use of the maneuver are seen as controversial due to the lack of information describing the technique required for this procedure. The present study will aim to clarify uncertainty in regard to the form, pressure, and time required to apply the maneuver by rheumatologist. Rheumatologist were observed and monitored while performing the Gaenslen compression maneuver on a prosthetic, biomedical device. The device was shaped to mimic a human hand and equipped with a sensor to monitor the force and time of which the pressure was applied. One hundred and eight (62 %) participants gave a valid recording. From these, 121 (87.7 %) were made by certified rheumatologists. The most predominant method (104 physicians/75.4 %) of applying the maneuver was by using the right hand with superior approach. The median strength calculated in grams resulted in 299 gr (IQR 145) (range 150-741 gr). The median time expressed in milliseconds was of 956.6 ms (IQR 824.6) . This is the first study to assess a clinical maneuver in a qualitative and quantitative manner. The results from this study, more specifically the low number of usable recordings, and the wide range of force exerted in the squeeze test may explain the differences in sensitivity and specificity in clinical studies.


Asunto(s)
Competencia Clínica , Articulación Metacarpofalángica/fisiopatología , Examen Físico/métodos , Médicos , Reumatología/métodos , Sinovitis/diagnóstico , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Presión , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Sinovitis/fisiopatología
12.
Reumatol. clín. (Barc.) ; 11(2): 78-82, mar.-abr. 2015. tab
Artículo en Español | IBECS | ID: ibc-133342

RESUMEN

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune inflamatoria sistémica crónica; se considera que la fertilidad es normal en pacientes con LES, los factores asociados con una baja reserva folicular que condicionan falla ovárica son: actividad de la enfermedad, anticuerpos antiovario y el uso de agentes citotóxicos. La hormona anti-mülleriana (HAM) es un marcador para determinar la reserva folicular. Objetivo Determinar los niveles de HAM en mujeres con LES en edad reproductiva. Material y métodos. Incluimos a 65 mujeres, de 18 a 40 años, clasificadas como LES según los criterios ACR 1997. Se obtuvieron las características demográficas, clínicas, ginecoobstétricas y niveles séricos de HAM. Se realizó un análisis bivariado entre las pacientes con baja reserva ovárica y aquellas con reserva ovárica normal. Se realizó un análisis de correlación entre los índices de actividad y daño, así como la dosis acumulada de ciclofosfamida y los niveles de HAM. Resultados. La mediana del título de HAM fue de 0,61 ng/ml. La prevalencia de baja reserva ovárica en nuestro estudio fue del 3,07%. La mediana del MEX-SLEDAI fue de 1 punto y la de SLICC 2 puntos. Veinticinco pacientes (38,4%) habían utilizado ciclofosfamida y la dosis promedio acumulada fue de 7,5 g. Conclusiones. En nuestra población, se encontró una mediana del título de HAM de 0,61 ng/ml, similar a lo reportado anteriormente. La prevalencia de baja reserva ovárica fue del 3,07%. No se encontró correlación entre el uso de ciclofosfamida, la actividad de la enfermedad o los niveles de HAM (AU)


Systemic lupus erythematosus (SLE) is an inflammatory autoimmune systemic and chronic disease. Fertility in SLE patients is considered normal; factors that have been associated in these patients with ovarian failure are: disease activity, autoantibodies, and the use of cytotoxic agents. The anti-Müllerian hormone (AMH) is a marker that helps to determine the follicular reserve. Objective. Determinate the objective was to determine AMH levels in women of reproductive age with SLE. Material and methods. We included 65 women with SLE classified according to the 1997 ACR criteria, 18- to 40-years old. We obtained demographic, clinical, obstetric, and gynecological characteristics as well as serum levels of AMH. We performed a bivariate analysis among patients with low ovarian reserve and those with normal ovarian reserve. We also performed a correlation analysis between activity and damage index and between the cumulative cyclophosphamide dose and AMH levels. Results. We found a median of serum AMH in SLE patients of .61 ng/mL. The prevalence of low ovarian reserve in our study was 3.07%. We found a median MEX-SLEDAI score of 1 point and the median SLICC score was 2 points. Twenty-five patients (38.4%) had used cyclophosphamide and their cumulative average dose was 7.5 grams. Conclusions. We found a median of AMH of .61 ng/mL in our population. The prevalence of low ovarian reserve in SLE patients was 3.07%. We did not find a correlation between AMH levels, the use of cyclophosphamide, and disease activity (AU)


Asunto(s)
Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Hormona Antimülleriana/metabolismo , Hormona Antimülleriana/uso terapéutico , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Ciclofosfamida/uso terapéutico , Estudios Transversales/métodos , Estudios Transversales , Encuestas y Cuestionarios , Ensayo de Inmunoadsorción Enzimática/métodos
13.
Reumatol Clin ; 11(2): 78-82, 2015.
Artículo en Inglés, Español | MEDLINE | ID: mdl-24815955

RESUMEN

UNLABELLED: Systemic lupus erythematosus (SLE) is an inflammatory autoimmune systemic and chronic disease. Fertility in SLE patients is considered normal; factors that have been associated in these patients with ovarian failure are: disease activity, autoantibodies, and the use of cytotoxic agents. The anti-Müllerian hormone (AMH) is a marker that helps to determine the follicular reserve. OBJECTIVE: Determinate the objective was to determine AMH levels in women of reproductive age with SLE. MATERIAL AND METHODS: We included 65 women with SLE classified according to the 1997 ACR criteria, 18- to 40-years old. We obtained demographic, clinical, obstetric, and gynecological characteristics as well as serum levels of AMH. We performed a bivariate analysis among patients with low ovarian reserve and those with normal ovarian reserve. We also performed a correlation analysis between activity and damage index and between the cumulative cyclophosphamide dose and AMH levels. RESULTS: We found a median of serum AMH in SLE patients of .61 ng/mL. The prevalence of low ovarian reserve in our study was 3.07%. We found a median MEX-SLEDAI score of 1 point and the median SLICC score was 2 points. Twenty-five patients (38.4%) had used cyclophosphamide and their cumulative average dose was 7.5 grams. CONCLUSIONS: We found a median of AMH of .61 ng/mL in our population. The prevalence of low ovarian reserve in SLE patients was 3.07%. We did not find a correlation between AMH levels, the use of cyclophosphamide, and disease activity.


Asunto(s)
Hormona Antimülleriana/sangre , Lupus Eritematoso Sistémico/sangre , Reserva Ovárica , Adolescente , Adulto , Biomarcadores/sangre , Estudios Transversales , Femenino , Humanos , Lupus Eritematoso Sistémico/fisiopatología , Adulto Joven
14.
Reumatol. clín. (Barc.) ; 9(3): 136-141, mayo 2013. tab, ilus
Artículo en Español | IBECS | ID: ibc-112504

RESUMEN

Objetivo. Determinar si existe una asociación entre la presencia de nódulos reumatoides y el engrosamiento de la íntima-media y de placa de las arterias carótidas. Materiales y métodos. Estudio observacional, transversal de 124 pacientes con artritis reumatoide del Servicio de Reumatología de un Hospital Universitario desde 2005 a 2006. Se dividieron los pacientes en 2 grupos, 62 con nódulos reumatoide y 62 sin nódulos reumatoides, pareados por edad y sexo. Se realizó una historia clínica completa, velocidad de sedimentación globular, medición de anticuerpos antipéptidos cíclicos citrulinados, factor reumatoide y una ecografía doppler de alta resolución de las arterias carótidas. Resultados. Las mujeres comprendieron el 89,5% de los pacientes. La prevalencia de al menos una placa en las carótidas fue del 57% en nuestra población. La presencia de placa carotídea estuvo asociada a la edad, hipertensión arterial y circunferencia abdominal. El grosor promedio de la íntima-media en pacientes con placa carotídea fue 0,085cm (±0,02). No hubo ninguna correlación entre los parámetros de laboratorio y el engrosamiento de íntima-media de la arteria carótida. Los nódulos subcutáneos estuvieron presentes en 33 (47%) de los 70 pacientes con placas de carótida y 29 (54%) de los pacientes sin una placa carótida (p=0,471). Conclusiones. No hemos encontrado una asociación entre nódulos reumatoides y la presencia de placa y/o el engrosamiento de la íntima-media de carótidas en pacientes con artritis reumatoide(AU)


Objective: To determine whether an association exists between the presence of rheumatoid nodules and thickening of the intima-media and plaque of the carotid artery, which is evidence of atherosclerosis. Materials and methods: Observational, cross-sectional study of 124 patients with rheumatoid arthritis from a University Hospital clinic from 2005 to 2006. We divided the patients into 2 groups, 62 with rheumatoid nodules and 62 without rheumatoid nodules, matched for age and sex. Medical history, erythrocyte sedimentation rate, anti-cyclic citrullinated peptide, rheumatoid factor, and a high resolution doppler ultrasound of the carotid arteries were performed. Results: Women comprised 89.5% of the patients. The prevalence of a carotid plaque was 57% in our population. The presence of a plaque was associated with age, arterial hypertension and abdominal circumference. Average intima-media thickness (IMT) in patients with a plaque was 0.085 cm (±0.02). There was no correlation between laboratory parameters and thickening of the intima-media of the carotid artery. Subcutaneous nodules were present in 33 (47%) of the 70 patients with a carotid plaque and in 29 (54%) of patients without a carotid plaque (p = .471). Conclusions: We did not find an association between rheumatoid nodules and the presence of a carotid plaque and thickening of the intima-media of the carotid in patients with rheumatoid arthritis(AU)


Asunto(s)
Humanos , Masculino , Femenino , Aterosclerosis/complicaciones , Aterosclerosis/diagnóstico , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico , Factor Reumatoide , Artritis Reumatoide/fisiopatología , Artritis Reumatoide , Arterias Carótidas/fisiopatología , Estudios Transversales/métodos , Estudios Transversales , Sedimentación Sanguínea , Encuestas y Cuestionarios
15.
Reumatol. clín. (Barc.) ; 9(2): 113-116, mar.-abr. 2013.
Artículo en Español | IBECS | ID: ibc-110343

RESUMEN

Los medicamentos biotecnológicos (MBT) son moléculas complejas cuyo proceso de elaboración impide replicar con gran exactitud la sustancia original, por lo que no existe una equivalencia absoluta entre el fármaco original (innovador) y el biocomparable. Los MBT han probado su eficacia en diversas afecciones reumáticas, aunque su alto coste impide su utilización en muchos pacientes. Diversas patentes de medicamentos biotecnológicos han expirado o expirarán próximamente, detonando así el desarrollo de fármacos estructuralmente similares y probablemente con eficacia y seguridad comparable a los medicamentos innovadores, aunque estas características deben ser probadas. La Ley General de Salud Mexicana actual contempla el registro de estos medicamentos para su utilización en nuestro país. Este documento es una reflexión de miembros del Colegio Mexicano de Reumatología, farmacólogos e investigadores en epidemiología, en conjunción con nuestras autoridades sanitarias, sobre los estudios científicos necesarios de los biocomparables previos y posterior a su incursión en el mercado mexicano (AU)


Biotechnological drugs (BTDs) are complex molecules whose manufacturing process precludes the ability to identically reproduce the structure of the original product, and therefore there cannot be an absolute equivalence between the original (innovative) medication and its biosimilar counterpart. BTDs have been proven useful in the treatment of several rheumatic diseases, however their high cost has prevented their use in many patients. Several BTD patents have expired or are close to expire, triggering the development of structurally similar drugs with efficacy and safety profiles comparable to the innovative compound; however, these must be evaluated through evidence based medicine. The Mexican General Health Law contemplates the registry of these biosimilar drugs for their use in our country. This document is a forethought from members of the Mexican College of Rheumatology, pharmacologists, and epidemiologists, in accordance with Mexican health authorities regarding the necessary scientific evidence required to evaluate the efficacy and safety of biosimilar drugs before and after their arrival to the Mexican market (AU)


Asunto(s)
Humanos , Masculino , Femenino , Sociedades Médicas/ética , Sociedades Médicas/legislación & jurisprudencia , Consejos de Especialidades/ética , Consejos de Especialidades/legislación & jurisprudencia , Consejos de Especialidades/organización & administración , Equivalencia Terapéutica , Farmacovigilancia , Reumatología/educación , Reumatología/organización & administración , Reumatología/normas , México/epidemiología , Antiinflamatorios no Esteroideos/uso terapéutico , Medicina Basada en la Evidencia/métodos
16.
Reumatol Clin ; 9(2): 113-6, 2013.
Artículo en Inglés, Español | MEDLINE | ID: mdl-23395225

RESUMEN

Biotechnological drugs (BTDs) are complex molecules whose manufacturing process precludes the ability to identically reproduce the structure of the original product, and therefore there cannot be an absolute equivalence between the original (innovative) medication and its biosimilar counterpart. BTDs have been proven useful in the treatment of several rheumatic diseases, however their high cost has prevented their use in many patients. Several BTD patents have expired or are close to expire, triggering the development of structurally similar drugs with efficacy and safety profiles comparable to the innovative compound; however, these must be evaluated through evidence based medicine. The Mexican General Health Law contemplates the registry of these biosimilar drugs for their use in our country. This document is a forethought from members of the Mexican College of Rheumatology, pharmacologists, and epidemiologists, in accordance with Mexican health authorities regarding the necessary scientific evidence required to evaluate the efficacy and safety of biosimilar drugs before and after their arrival to the Mexican market.


Asunto(s)
Antirreumáticos/uso terapéutico , Biosimilares Farmacéuticos/uso terapéutico , Aprobación de Drogas , Farmacovigilancia , Enfermedades Reumáticas/tratamiento farmacológico , Aprobación de Drogas/legislación & jurisprudencia , Humanos , México
17.
Reumatol Clin ; 9(3): 136-41, 2013.
Artículo en Inglés, Español | MEDLINE | ID: mdl-23273674

RESUMEN

OBJECTIVE: To determine whether an association exists between the presence of rheumatoid nodules and thickening of the intima-media and plaque of the carotid artery, which is evidence of atherosclerosis. MATERIALS AND METHODS: Observational, cross-sectional study of 124 patients with rheumatoid arthritis from a University Hospital clinic from 2005 to 2006. We divided the patients into 2 groups, 62 with rheumatoid nodules and 62 without rheumatoid nodules, matched for age and sex. Medical history, erythrocyte sedimentation rate, anti-cyclic citrullinated peptide, rheumatoid factor, and a high resolution doppler ultrasound of the carotid arteries were performed. RESULTS: Women comprised 89.5% of the patients. The prevalence of a carotid plaque was 57% in our population. The presence of a plaque was associated with age, arterial hypertension and abdominal circumference. Average intima-media thickness (IMT) in patients with a plaque was 0.085 cm (± 0.02). There was no correlation between laboratory parameters and thickening of the intima-media of the carotid artery. Subcutaneous nodules were present in 33 (47%) of the 70 patients with a carotid plaque and in 29 (54%) of patients without a carotid plaque (p=.471). CONCLUSIONS: We did not find an association between rheumatoid nodules and the presence of a carotid plaque and thickening of the intima-media of the carotid in patients with rheumatoid arthritis.


Asunto(s)
Enfermedades de las Arterias Carótidas/etiología , Nódulo Reumatoide/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Grosor Intima-Media Carotídeo , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven
18.
Reumatol. clín. (Barc.) ; 8(2): 63-67, mar.-abr. 2012. tab, ilus
Artículo en Español | IBECS | ID: ibc-97837

RESUMEN

Objetivo: El síndrome anserino es una causa frecuente de dolor de rodilla. La infiltración con glucocorticoides ha sido evaluada en estudios con bajo nivel de evidencia y no se han publicado ensayos clínicos para determinar su utilidad. El objetivo del estudio es determinar la eficacia y la seguridad de la infiltración de metilprednisolona para el tratamiento del síndrome anserino. Métodos: Efectuamos un ensayo clínico en 58 pacientes adultos con síndrome anserino, a los que se les descartó patología intraarticular que reflejara dolor en la cara medial de la rodilla. Se evaluó la escala WOMAC basal y se aleatorizaron a recibir una infiltración de xilocaína más 40 mg de acetato de metilprednisolona (grupo 1) versus xilocaína más agua destilada (grupo 2). Ambos grupos recibieron 100 mg de diclofenaco sódico durante 10 días. Se realizó la escala WOMAC a las 4 semanas y el registro de eventos adversos. Resultados: Se demostró equivalencia en ambos grupos para las variables demográficas y en la evaluación clínica inicial. No hubo diferencias estadísticas en los tres dominios de evaluación de la escala WOMAC basal. La mediana del WOMAC basal en el grupo 1 fue de 32 y en el grupo 2 de 25,5 puntos. A las 4 semanas fue de 8 y 6,5 puntos, que correspondió a una mejoría del 61,6 y 62,8%, respectivamente. Conclusión: La infiltración con metilprednisolona en el síndrome anserino no es superior al placebo en pacientes que toman diclofenaco medidos por la escala WOMAC a las 4 semanas. La incidencia de eventos adversos tampoco difirió (AU)


Objective: The anserine syndrome is a common cause of knee pain. Infiltration with glucocorticoids has been evaluated in studies with low level of evidence and there are no published clinical trials to determine its usefulness. The objective of this study was to determine the efficacy and safety of the infiltration of methylprednisolone in the treatment of Anserin Syndrome. Methods: We conducted a clinical trial in 58 adult patients with anserin syndrome, which presented intra-articular pathology ruled that reflected pain in the medial aspect of the knee. The WOMAC scale was assessed at baseline and patients were randomized to receive an infiltration of lidocaine plus 40 mg methylprednisolone acetate (group 1) versus xylocaine plus distilled water (group 2). Both groups received 100 mg of diclofenac sodium for 10 days. The WOMAC scale was applied at 4 weeks and adverse events were recorded. Results: Equivalence was demonstrated in both groups for demographic variables and initial clinical evaluation. There was no statistical difference in the three domains of assessment of the baseline WOMAC score. The median baseline WOMAC in group 1 was 32 and in group 2 was 25.5 points. At 4 weeks it was 8 and 6.5 points, which corresponded to an improvement of 61.6 and 62.8% respectively. Conclusion: The infiltration with methylprednisolone in anserin syndrome is not superior to placebo in patients taking diclofenac measured by the WOMAC scale at 4 weeks. The incidence of adverse events did not show any differences either (AU)


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Metilprednisolona/metabolismo , Metilprednisolona/uso terapéutico , Manejo del Dolor/instrumentación , Manejo del Dolor , Muestreo Aleatorio y Sistemático , Rodilla/patología , Eficacia/métodos , Resultado del Tratamiento , Evaluación de Eficacia-Efectividad de Intervenciones , Método Doble Ciego , Consentimiento Informado/normas
19.
Reumatol Clin ; 8(2): 63-7, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22317851

RESUMEN

OBJECTIVE: The anserine syndrome is a common cause of knee pain. Infiltration with glucocorticoids has been evaluated in studies with low level of evidence and there are no published clinical trials to determine its usefulness. The objective of this study was to determine the efficacy and safety of the infiltration of methylprednisolone in the treatment of Anserin Syndrome. METHODS: We conducted a clinical trial in 58 adult patients with anserin syndrome, which presented intra-articular pathology ruled that reflected pain in the medial aspect of the knee. The WOMAC scale was assessed at baseline and patients were randomized to receive an infiltration of lidocaine plus 40 mg methylprednisolone acetate (group 1) versus xylocaine plus distilled water (group 2). Both groups received 100mg of diclofenac sodium for 10 days. The WOMAC scale was applied at 4 weeks and adverse events were recorded. RESULTS: Equivalence was demonstrated in both groups for demographic variables and initial clinical evaluation. There was no statistical difference in the three domains of assessment of the baseline WOMAC score. The median baseline WOMAC in group 1 was 32 and in group 2 was 25.5 points. At 4 weeks it was 8 and 6.5 points, which corresponded to an improvement of 61.6 and 62.8% respectively. CONCLUSION: The infiltration with methylprednisolone in anserin syndrome is not superior to placebo in patients taking diclofenac measured by the WOMAC scale at 4 weeks. The incidence of adverse events did not show any differences either.


Asunto(s)
Antiinflamatorios/uso terapéutico , Bursitis/tratamiento farmacológico , Articulación de la Rodilla , Metilprednisolona/análogos & derivados , Adulto , Anciano , Anestesia Local , Antiinflamatorios/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Bursitis/complicaciones , Diclofenaco/administración & dosificación , Diclofenaco/uso terapéutico , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Inyecciones Intraarticulares , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Acetato de Metilprednisolona , Persona de Mediana Edad , Dimensión del Dolor , Recuperación de la Función , Índice de Severidad de la Enfermedad
20.
J Rheumatol Suppl ; 86: 9-14, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21196593

RESUMEN

OBJECTIVE: To estimate the prevalence of rheumatic diseases in rural and urban populations using the WHO-ILAR COPCORD questionnaire. METHODS: We conducted a cross-sectional home survey in subjects > 18 years of age in the Mexican state of Nuevo Leon. Results were validated locally against physical examination in positive cases according to an operational definition by 2 rheumatologists. We used a random, balanced, and stratified sample by region of representative subjects. RESULTS: We surveyed 4713 individuals with a mean age of 43.6 years (SD 17.3); 55.9% were women and 87.1% were from urban areas. Excluding trauma, 1278 individuals (27.1%, 95% CI 25.8%-28.4%) reported musculoskeletal pain in the last 7 days; the prevalence of this variable was almost twice as frequent in women (33% vs 17% in men); 529 (11.2%) had pain associated with trauma. The global prevalence of pain was 38.3%. Mean pain score was 2.4 (SD 3.4) on a pain scale of 0-10. Most subjects classified as positive according to case definition (99%) were evaluated by a rheumatologist. Main diagnoses were osteoarthritis in 17.3% (95% CI 16.2-18.4), back pain in 9.8% (95% CI 9.0-10.7), undifferentiated arthritis in 2.4% (95% CI 2.0-2.9), rheumatoid arthritis in 0.4% (95% CI 0.2-0.6), fibromyalgia in 0.8% (95% CI 0.6-1.1), and gout in 0.3% (95% CI 0.1-0.5). CONCLUSION: This is the first regional COPCORD study in Mexico performed with a systematic sampling, showing a high prevalence of pain. COPCORD is a useful tool for the early detection of rheumatic diseases as well as for accurately referring patients to different medical care centers and to reduce underreporting of rheumatic diseases.


Asunto(s)
Planificación en Salud Comunitaria , Tamizaje Masivo/métodos , Enfermedades Reumáticas/epidemiología , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Agencias Internacionales , Masculino , México/epidemiología , Dolor/epidemiología , Dolor/etiología , Dolor/fisiopatología , Prevalencia , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/fisiopatología
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