An update on the study of synovial fluid in the geriatric patient.

BACKGROUND: The characteristics of synovial fluid (SF) in geriatric patients differ from those in younger patients. In Mexico, epidemiologic data on the incidence of different rheumatic diseases in geriatric patients are scarce. OBJECTIVE: To describe the physical characteristics of geriatric SF and the prevalence of crystals in knee and other joint aspirates from patients with previously diagnosed joint disease. MATERIALS AND METHODS: A retrospective study was performed with a baseline of 517 SF samples between 2011 and 2023. White blood cell count was performed by Neubauer chamber and crystals were identified by polarized light microscopy. Descriptive statistical analysis was performed and prevalence was reported as a percentage. RESULTS: The mean age of the adults was 73.5±5.0 years, 54.4% were women and 45.6% were men. The mean SF volume was 6.3±9.5mL in older adults and 15.3±24.9mL in those younger than 65 years. The mean viscosity in older adults was 9.5±4.5mm and the mean leukocyte count was 7352±16,402leukocytes/mm3. Seventy percent of the older adults' SFs were referred to the laboratory for osteoarthritis (OA), with lower proportions for rheumatoid arthritis (RA) (14.6%) and gout (5.1%). Of the crystals observed in the geriatric population, 14.6% corresponded to monosodium urate crystals (CUM) and 18.9% to calcium pyrophosphate crystals (CPP). CONCLUSIONS: The characteristics of LS in older adults were smaller volume, increased viscosity, and non-inflammatory. The main diagnoses were OA, RA, and gout. The crystal content of the SF of the geriatric population corresponded mainly to CPP.

An update on the study of synovial fluid in the geriatric patient / Panorama actual del estudio de líquido sinovial en el paciente geriátrico

Background: The characteristics of synovial fluid (SF) in geriatric patients differ from those in younger patients. In Mexico, epidemiologic data on the incidence of different rheumatic diseases in geriatric patients are scarce. Objective: To describe the physical characteristics of geriatric SF and the prevalence of crystals in knee and other joint aspirates from patients with previously diagnosed joint disease. Materials and methods: A retrospective study was performed with a baseline of 517 SF samples between 2011 and 2023. White blood cell count was performed by Neubauer chamber and crystals were identified by polarized light microscopy. Descriptive statistical analysis was performed and prevalence was reported as a percentage. Results: The mean age of the adults was 73.5±5.0 years, 54.4% were women and 45.6% were men. The mean SF volume was 6.3±9.5mL in older adults and 15.3±24.9mL in those younger than 65 years. The mean viscosity in older adults was 9.5±4.5mm and the mean leukocyte count was 7352±16,402leukocytes/mm3. Seventy percent of the older adults’ SFs were referred to the laboratory for osteoarthritis (OA), with lower proportions for rheumatoid arthritis (RA) (14.6%) and gout (5.1%). Of the crystals observed in the geriatric population, 14.6% corresponded to monosodium urate crystals (CUM) and 18.9% to calcium pyrophosphate crystals (CPP). Conclusions: The characteristics of LS in older adults were smaller volume, increased viscosity, and non-inflammatory. The main diagnoses were OA, RA, and gout. The crystal content of the SF of the geriatric population corresponded mainly to CPP.(AU)

Antecedentes: Las características del líquido sinovial (LS) en pacientes geriátricos varían en comparación con pacientes más jóvenes. En México, los datos epidemiológicos sobre la incidencia de diversas enfermedades reumáticas en el paciente geriátrico son escasos. Objetivo: Describir las características físicas del LS geriátrico y la prevalencia de cristales en aspirados de rodilla y otras articulaciones de pacientes con enfermedades articulares previamente diagnosticadas.Materiales y métodos: Se realizó un estudio retrospectivo con una base de 517 muestras de LS entre 2011 y 2023. El recuento de glóbulos blancos se realizó con cámara de Neubauer, y los cristales se identificaron por microscopia de luz polarizada. Se realizó un análisis estadístico descriptivo y la prevalencia se reportó como porcentaje. Resultados: La edad promedio en los adultos fue de 73,5±5,0 años; el 54,4% fueron mujeres y el 45,6%, hombres. El volumen promedio del LS en adultos mayores fue de 6,3±9,5ml, mientras que en menores de 65 años fue de 15,3±24,9ml. La viscosidad promedio fue de 9,5±4,5mm en los adultos mayores, y una cuenta de 7.352±16.402 leucocitos/mm3. El 70% de los LS de los adultos mayores fueron remitidos a laboratorio por osteoartritis (OA), u una proporción más baja, por artritis reumatoide (AR) (14,6%) y gota (5,1%). En cuanto a los cristales observados en los LS de la población geriátrica, el 14,6% correspondieron a cristales de urato monosódico (CUM) y el 18,9%, a cristales de pirofosfato de calcio (CPP). Conclusiones: Las características del LS en los adultos mayores fueron menor volumen, viscosidad incrementada y no inflamatorios. Los principales diagnósticos fueron OA, AR y gota. El contenido de los cristales en los LS de la población geriátrica correspondió principalmente a CPP.(AU)

Tasas de promoción, repitencia y abandono en la Carrera de Especialistas en Reumatología en la Ciudad de Buenos Aires / Specialty training in rheumatology: Promotion, repetition and dropout rates in the city of Buenos Aires

Objetivos: Evaluar la trayectoria de los alumnos de la Carrera de Especialistas en Reumatología y determinar factores asociados al resultado en el posgrado. Métodos: Análisis retrospectivo (2009-2016). Se determinaron las tasas de promoción, la repitencia y el abandono. Se realizaron análisis multivariados para determinar variables asociadas al éxito académico. Resultados: Sobre 119 alumnos, la promoción efectiva fue del 66,4%, la repitencia sin retraso fue del 14,3%, la repitencia con retraso fue del 11,8% y el abandono fue del 7,6%. La promoción efectiva de la residencia fue del 82,5% vs el 48,2% en el resto (p<0,001), la repitencia con retraso fue del 3,2% vs el 21,4% en el resto (p=0,005) y el abandono fue del 3,2% vs el 12,5% en el resto (p=0,06). El éxito en el posgrado fue mayor a mejor promedio en la carrera de Medicina (OR: 3,41; IC95%: 2,0-6,4; p<0,001). Conclusiones: La residencia se asoció a mayor éxito académico en el posgrado. El puntaje promedio en la cursada de Medicina puede ayudar a identificar a los alumnos en riesgo de fallar.(AU)

Objectives: To evaluate the trajectory of students enrolled in the specialty training in rheumatology. Methods: Retrospective analysis (2009-2016). Promotion, repetition, and dropout rates were determined. Analysis was performed to define variables associated with academic success. Results: Out of 119 students, the actual promotion rate was 66.4%, 11.8% failed an exam (at least) and completed the course after the stipulated time, and the dropout rate was 7.6%. Among residents, the promotion rate was 82.5% vs. 48.2% among the rest (P<.001), the lagging students’ repetition rate was 3.2% vs. 21.4% among the rest (P=.005), and the dropout rate was 3.2% vs. 12.5% among the rest (P=.06). A higher average score in medical school increased the chances of success in the postgraduate programme (OR: 3.41; 95%CI: 2.0-6.4; P<.001). Conclusions: The residency was associated with higher rates of academic success in postgraduate studies. The average score in medical school can help identify students at risk of failure.(AU)

Speciality training in rheumatology: Promotion, repetition and dropout rates in the city of Buenos Aires.

OBJECTIVES: To evaluate the trajectory of students enrolled in the specialty training in rheumatology. METHODS: Retrospective analysis (2009-2016). Promotion, repetition, and dropout rates were determined. Analysis was performed to define variables associated with academic success. RESULTS: Out of 119 students, the actual promotion rate was 66.4%, 11.8% failed an exam (at least) and completed the course after the stipulated time, and the dropout rate was 7.6%. Among residents, the promotion rate was 82.5% vs. 48.2% among the rest (p < 0.001), the lagging students' repetition rate was 3.2% vs. 21.4% among the rest (p 0.005), and the dropout rate was 3.2% vs. 12.5% among the rest (p = 0.06). A higher average score in medical school increased the chances of success in the postgraduate programme (OR 3.41 CI 95% 2.0-6.4; p < 0.001). CONCLUSIONS: The residency was associated with higher rates of academic success in postgraduate studies. The average score in medical school can help identify students at risk of failure.

Emerging trends in nurse-led programs of care for management of patients with established rheumatoid arthritis: Systematic literature review.

INTRODUCTION: In patients with rheumatoid arthritis (RA), nurses are considered as essential, not only to ensure pharmacological safety, but also in the promotion in self-care and decision-making, favouring the empowerment of patients. This systematic review aimed to summarize the available literature on the health education by the nurse in patients with RA. MATERIAL AND METHODS: Following Cochrane Collaboration procedures, the PRISMA statement and PRISMA checklist, relevant quantitative studies published were retrieved from the CINAHL, Scopus, PubMed and Medic databases and then systematically reviewed. The search ended in August 2021. Nineteen studies were retained for inclusion and evaluated with the Scottish Intercollegiate Guidelines Network for Systematic Reviews. RESULTS: We found statistically significant improvement in self-care (five studies), disease activity (three studies), quality of life (two studies), satisfaction (five studies) and adherence (one study) with the nursing-led management of patients with established rheumatoid arthritis. DISCUSSION: Although there is solid evidence of improvement in satisfaction and self-care, there seems to be a trend also to improve other outcomes, such as DAS28, from the EULAR recommendations, the expansion of the therapeutic arsenal for rheumatoid arthritis and shared decision-making. In addition, recently and due to the implementation of new technologies, the role of the nurse has been evaluated through virtual consultations. The results of recent studies have shown that this an effective and well-accepted novel approach for the management of patients with stable rheumatoid arthritis. CONCLUSION: Our study suggests that nurse-led health education, in addition of improvement in satisfaction and self-care, improve activity disease scores in RA patients.

Emerging trends in nurse-led programs of care for management of patients with established rheumatoid arthritis: Systematic literature review / Tendencias emergentes en los programas de atención dirigidos por enfermeras para el manejo de pacientes con artritis reumatoide establecida: Revisión sistemática de la literatura

Introduction: In patients with rheumatoid arthritis (RA), nurses are considered as essential, not only to ensure pharmacological safety, but also in the promotion in self-care and decision-making, favouring the empowerment of patients. This systematic review aimed to summarize the available literature on the health education by the nurse in patients with RA. Material and methods: Following Cochrane Collaboration procedures, the PRISMA statement and PRISMA checklist, relevant quantitative studies published were retrieved from the CINAHL, Scopus, PubMed and Medic databases and then systematically reviewed. The search ended in August 2021. Nineteen studies were retained for inclusion and evaluated with the Scottish Intercollegiate Guidelines Network for Systematic Reviews. Results: We found statistically significant improvement in self-care (five studies), disease activity (three studies), quality of life (two studies), satisfaction (five studies) and adherence (one study) with the nursing-led management of patients with established rheumatoid arthritis. Discussion: Although there is solid evidence of improvement in satisfaction and self-care, there seems to be a trend also to improve other outcomes, such as DAS28, from the EULAR recommendations, the expansion of the therapeutic arsenal for rheumatoid arthritis and shared decision-making. In addition, recently and due to the implementation of new technologies, the role of the nurse has been evaluated through virtual consultations. The results of recent studies have shown that this an effective and well-accepted novel approach for the management of patients with stable rheumatoid arthritis. Conclusion: Our study suggests that nurse-led health education, in addition of improvement in satisfaction and self-care, improve activity disease scores in RA patients.(AU)

Introducción: En los pacientes con artritis reumatoide, las enfermeras se consideran esenciales, no solo para garantizar la seguridad farmacológica, sino también en la prestación de promoción en el autocuidado y la toma de decisiones, favoreciendo el empoderamiento de los pacientes. Esta revisión sistemática tuvo como objetivo resumir la literatura disponible sobre la educación sanitaria por parte de la enfermera en pacientes con artritis reumatoide. Material y métodos: Siguiendo los procedimientos de la Colaboración Cochrane, la declaración PRISMA y la lista de comprobación PRISMA, se recuperaron los estudios cuantitativos relevantes publicados en las bases de datos CINAHL, Scopus, PubMed y Medic y, a continuación, se revisaron sistemáticamente. La búsqueda finalizó en agosto de 2021. Diecinueve estudios fueron retenidos para su inclusión y evaluados con la Scottish Intercollegiate Guidelines Network for Systematic Reviews. ResultadosSe encontró una mejoría estadísticamente significativa en el autocuidado (cinco estudios), la actividad de la enfermedad (tres estudios), la calidad de vida (dos estudios), la satisfacción (cinco estudios) y la adherencia (un estudio) con el manejo dirigido por enfermería de pacientes con artritis reumatoide establecida. Discusión: Aunque siempre ha habido evidencias de mejora en la satisfacción y el autocuidado, parece haber una tendencia a mejorar también otros resultados, como el de Disease Activity Score in 28 Joints (DAS28), a partir de las recomendaciones de la European League Against Rheumatism (EULAR), la ampliación del arsenal terapéutico para la artritis reumatoide y la toma de decisiones compartida. Además, recientemente y debido a la implantación de las nuevas tecnologías, se ha evaluado el papel de la enfermera a través de las consultas virtuales. Los resultados de estudios recientes han demostrado que se trata de un nuevo enfoque...(AU)

Un paciente con... Tos / A patient with... Cough

El 3,3-10% de la población presenta tos crónica, siendo un motivo frecuente de consulta en Atención Primaria (AP). Se plantea el caso de una mujer de 61 años con tos de 3 meses de evolución. La sospecha diagnóstica es de fibrosis pulmonar en el contexto de una posible artritis reumatoide versus neumonía intersticial descamativa secundaria a aripiprazol. El caso clínico sirve de reflexión sobre la importancia de una buena anamnesis en AP, así como un correcto uso de las pruebas complementarias para valorar causas menos frecuentes de un síntoma común. Debe desarrollarse una capacidad inductiva y valorar el contexto del síntoma guía para confeccionar un diagnóstico sindrómico lo más acertado posible, lo cual es muy valioso en este nivel asistencial. (AU)

Chronic cough is a common reason for consultation in primary care (prevalence approximately 3.3% to 10.0%). We report a case of a 61-year-old woman with a three-month history of cough. The most accurate diagnosis is pulmonary fibrosis in the context of rheumatoid arthritis versus desquamative interstitial pneumonia secondary to aripiprazole. This case study serves as a reflection on the importance of a good history in primary care. Moreover, it is relevant to correctly use complementary tests. It is especially important to make a good syndromic diagnosis and evaluate the context of the patient in front of us. (AU)

Utilidad de la consulta electrónica entre los centros de atención primaria y el Servicio de Reumatología de un hospital terciario / Usefulness of an electronic consultation system between primary care health centres and the rheumatology department of a tertiary hospital

Introducción y objetivo: Las enfermedades reumáticas representan casi el 30% de las consultas atendidas en los centros de atención primaria españoles. El objetivo principal fue analizar la demanda de consultas reumatológicas desde atención primaria y su resolución mediante el sistema de consulta electrónica. Pacientes y métodos: Estudio descriptivo retrospectivo de las consultas electrónicas procedentes de los centros de atención primaria del área sanitaria al Servicio de Reumatología de un hospital terciario, entre los meses de julio de 2020 y mayo de 2021. Resultados: Se recogieron las últimas 500 consultas consecutivas. La media de edad de los pacientes fue 59 años; el 74% eran mujeres. Los principales motivos de consulta fueron la osteoporosis y el tratamiento de pacientes en seguimiento por el servicio por artritis reumatoide y espondiloartritis. El tiempo medio de respuesta fue de dos días; el 57% necesitaron ser citados en consulta externa. Discusión: La consulta electrónica permitió resolver, en una media de dos días, las consultas del 42,6% de los pacientes.(AU)

Background and objective: Rheumatic diseases account for almost 30% of consultations attended in Spanish primary care centres. The main objective was to analyse the demand for rheumatology consultations from Primary Care and their resolution using the electronic consultation system. Patients and methods: Retrospective descriptive study of electronic consultations from primary care centres in the health area to the Rheumatology service of a tertiary hospital, between July 2020 and May 2021. Results: The last 500 consecutive consultations were collected. Mean age of patients was 59.5 years; 74.2% were women. Main reasons for consultation were osteoporosis and treatment of patients with rheumatoid arthritis and spondyloarthritis under follow-up by the department. Mean response time was 2 days. Fifty-seven per cent of patients required outpatient appointments. Discussion: Over 40% of queries were resolved thanks to the electronic consultation system in an average of 2 days, otherwise patients would have been referred to specialized care.(AU)

Sesgos de género en la reumatología española: Percepciones y realidad / Gender biases in Spanish rheumatology: Perception and facts

Objetivo: Identificar percepciones en cuanto a sesgos de género en la reumatología española y cuantificar la implicación de ambos sexos en todos los ámbitos de la especialidad. Métodos: Se envió una encuesta a todos los miembros de la SER, sobre participación y percepción de sesgos y de la propia capacitación y se revisaron los datos reales de participación en órganos directivos, congresos, comités y de los servicios de reumatología españoles en los últimos cinco años. Resultados: La encuesta fue respondida por 95 personas, 4,8% de los miembros de la SER (14 hombres y 81 mujeres). No se detectaron diferencias por sexo en edad, nivel académico, puesto, centro de trabajo, reparto de tareas laborales y del ámbito familiar; tampoco en las invitaciones a puestos de poder en los cinco últimos años, ni en la percepción de capacidad para ocupar los distintos puestos de poder. Los hombres encuestados consideran con mayor frecuencia que actividades como la participación en un comité científico o dar una ponencia no dan poder. Un tercio de los participantes de ambos sexos considera que la SER debería revisar sus procesos con perspectiva de género y menos de un tercio cree que debe hacerse por cuotas. Tras revisar los datos de 2015 a 2020, los ratios hombre a mujer en las principales actividades de liderazgo en reumatología en España son: 1) juntas directivas de la SER 3:2 sin presidenta ni tesorera; 2) comités científicos de los congresos 2:1; 3) ponentes y moderadores: simposios satélites, 4:1; 4) editores jefes de revistas científicas 9:1; 5) puestos académicos global 1,7:1, catedráticos 9:1, profesores titulares 100% hombres y 6) jefes de servicio: 75% son hombres a pesar de representar 40% de reumatólogos en España. Conclusión: A pesar de un creciente número de mujeres en la reumatología española, estas no están suficientemente representadas en puestos de liderazgo, existiendo un sesgo de género no percibido.(AU)

Objective: To identify perceptions of gender bias in Spanish rheumatology and to quantify the involvement of both sexes in all areas of the specialty. Methods: A survey was sent to all members of the SER on participation and perception of biases and of their own competencies, and actual data on participation in governing bodies, congresses, committees, and Spanish rheumatology departments in the last 5 years were reviewed. Results: The survey was answered by 95 rheumatologist, 4.8% of SER members (14 men and 81 women), both groups being similar in terms of age, academic level, and position and work centre. No differences were detected in the distribution of work and non-work tasks between sexes, nor in invitations to positions of power in the last five years, nor in the perception of capacity to occupy the different positions of power, which was high for both sexes. Male respondents more frequently consider that activities such as participating in a scientific committee or giving a conference are not empowering. A third of both sexes consider that the SER should review its processes with a gender perspective but less than a third believe that this should be done by quotas. The reality of the last 5 years is that 1) there is a male to female ratio of 3:2 on SER boards of directors and in this period there has been no female president or treasurer; 2) in the scientific committees of the congresses men predominate (2:1) although slightly less in the local organizing committee; 3) there are more male speakers and moderators than women (very striking in satellite symposia, 4: 1); 4) 9 out of 10 editors-in-chief are men; 5) in academic positions there are 3 men for every 2 women, 9 to 1 in professorships or emeritus positions; although more women supervise residents; and 6) there are more women (60%) than men (40%) in Spanish rheumatology departments, although 75% of department chiefs are men. Conclusion: Although not perceived by either the men or the women...(AU)

Takayasu's arteritis as an incidental finding in a patient with celiac disease: the importance of positron emission computed tomography.

BACKGROUND: Takayasu arteritis is a large-vessel vasculitis which affects large-caliber elastic arteries, primarily the aorta and its main branches. It mainly affects women between 20-30 years, so it is rare in children. CASE REPORT: We describe the case of a 15-year-old female who was followed up since she was 9 years old due to celiac disease. At the age of 13, anaemia of chronic disorders associated to elevated C-reactive protein and erythrocyte sedimentation were detected. The patient remained asymptomatic. After excluding other diseases, we requested a positron emission computed tomography (PET-CT); lesions compatible with large-vessel vasculitis were detected. Cardiology evaluation showed an aneurysm in the right coronary artery. Angio-CT suggested Takayasu type III arteritis. CONCLUSIONS: The delay in the diagnosis of Takayasu arteritis in pediatric patients is quite common. In this case, we have found phase II lesions, with no previous phase I symptoms. However, PET-CT allowed the diagnosis of vasculitis, key to the diagnosis of the patient.

INTRODUCCIÓN: La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a las arterias elásticas de gran calibre, fundamentalmente la aorta y sus ramas principales. Ocurre frecuentemente en mujeres entre los 20-30 años, por lo que es muy infrecuente en la edad pediátrica. CASO CLÍNICO: Se presenta el caso de una paciente de 15 años en seguimiento desde los 9 años por enfermedad celiaca. A los 13 años se detectó anemia de trastornos crónicos, elevación de proteína C reactiva y velocidad de sedimentación globular. La paciente permaneció en todo momento asintomática. Tras descartar otros procesos, se solicitó tomografía computarizada por emisión de positrones (PET-TC), donde se detectaron lesiones compatibles con vasculitis de grandes vasos. La valoración por Cardiología evidenció un aneurisma en coronaria derecha. Se realizó angio-TC, que sugirió arteritis de Takayasu tipo III. CONCLUSIONES: Es frecuente un retraso en el diagnóstico de la arteritis de Takayasu en los pacientes pediátricos. En este caso se encontraron lesiones de la fase II sin la presencia de síntomas correspondientes a la fase I. El PET-TC permitió el diagnóstico de vasculitis, clave para el diagnóstico de la paciente.

Publication outcomes of abstracts presented at the Argentine Congress of Rheumatology / Tasa de publicación de los resúmenes presentados al Congreso Argentino de Reumatología

Objective: To analyse the outcome of scientific abstracts submitted to the Argentine Congress of Rheumatology (ACOR) in 2000, 2005, 2010, and 2015. Methods: Every abstract submitted to the ACOR was analysed. The number of these manuscripts published was determined through Google Scholar and PubMed searches. The impact of the scientific journals was established through the SCImago Journal (SJR) indicator. Results: Considering the 727 abstracts evaluated, 10.2% of the articles were found in journals indexed by Google Scholar, and 6.6% in PubMed: 4.7% were published in 2000, 9.4% in 2005, 14.6% in 2010, and 11.9% in 2015 (Log Rank test 0.008), with a statistically significant increase between 2010 and 2015 compared to 2000 (HR 3.3; 95% CI 1.5–7; p 0.002 and HR 2.9; CI 1.4–6.3; p 0.005 respectively). The median SJR of the journals was 0.46 and 67.6% had SJR available. Conclusions: The publication rate was low, and only a few articles were published in the most prestigious journals within the speciality.(AU)

Objetivo: Analizar la tasa de publicación de los resúmenes presentados al Congreso Argentino de Reumatología (ACOR) en 2000, 2005, 2010 y 2015. Métodos: Todos los resúmenes enviados al ACOR fueron evaluados. Se determinó la tasa de publicación mediante una búsqueda en Google Scholar y PubMed. Se examinó la relevancia de las revistas científicas a través del indicador SCImago Journal (SJR). Resultados: Se evaluaron 727 resúmenes. Se encontró un 10,2% de artículos publicados en revistas indexadas por Google Scholar y un 6,6% en PubMed. El 4,7% fueron publicados en 2000, el 9,4% en 2005, el 14,6% en 2010 y el 11,9% en 2015 (Log Rank test: 0,008), con un aumento estadísticamente significativo entre 2010 y 2015 frente al 2000 (HR: 3,3; IC95%: 1,5-7; p=0,002 y HR: 2,9; IC95%: 1,4-6,3; p=0,005, respectivamente). La mediana del SJR de dichas revistas fue de 0,46, y el 67,6% tenían SJR disponible. Conclusiones: La tasa de publicación es baja, y solo unos pocos trabajos fueron publicados en las revistas más prestigiosas de la especialidad.(AU)

Publication outcomes of abstracts presented at the Argentine Congress of Rheumatology.

OBJECTIVE: To analyse the outcome of scientific abstracts submitted to the Argentine Congress of Rheumatology (ACOR) in 2000, 2005, 2010, and 2015. METHODS: Every abstract submitted to the ACOR was analysed. The number of these manuscripts published was determined through Google Scholar and PubMed searches. The impact of the scientific journals was established through the SCImago Journal (SJR) indicator. RESULTS: Considering the 727 abstracts evaluated, 10.2% of the articles were found in journals indexed by Google Scholar, and 6.6% in PubMed: 4.7% were published in 2000, 9.4% in 2005, 14.6% in 2010, and 11.9% in 2015 (Log Rank test 0.008), with a statistically significant increase between 2010 and 2015 compared to 2000 (HR 3.3; 95% CI 1.5-7; p 0.002 and HR 2.9; CI 1.4-6.3; p 0.005 respectively). The median SJR of the journals was 0.46 and 67.6% had SJR available. CONCLUSIONS: The publication rate was low, and only a few articles were published in the most prestigious journals within the speciality.

Usefulness of an electronic consultation system between primary care health centres and the rheumatology department of a tertiary hospital.

BACKGROUND AND OBJECTIVE: Rheumatic diseases account for almost 30% of consultations attended in Spanish primary care centres. The main objective was to analyse the demand for rheumatology consultations from Primary Care and their resolution using the electronic consultation system. PATIENTS AND METHODS: Retrospective descriptive study of electronic consultations from primary care centres in the health area to the Rheumatology service of a tertiary hospital, between July 2020 and May 2021. RESULTS: The last 500 consecutive consultations were collected. Mean age of patients was 59.5 years; 74.2% were women. Main reasons for consultation were osteoporosis and treatment of patients with rheumatoid arthritis and spondyloarthritis under follow-up by the department. Mean response time was 2 days. Fifty-seven per cent of patients required outpatient appointments. DISCUSSION: Over 40% of queries were resolved thanks to the electronic consultation system in an average of 2 days, otherwise patients would have been referred to specialized care.

Gender biases in Spanish rheumatology: Perception and facts.

OBJECTIVE: To identify perceptions of gender bias in Spanish rheumatology and to quantify the involvement of both sexes in all areas of the specialty. METHODS: A survey was sent to all members of the SER on participation and perception of biases and of their own competencies, and actual data on participation in governing bodies, congresses, committees, and Spanish rheumatology departments in the last 5 years were reviewed. RESULTS: The survey was answered by 95 rheumatologists, 4.8% of SER members (14 men and 81 women), both groups being similar in terms of age, academic level, and position and work centre. No differences were detected in the distribution of work and non-work tasks between sexes, nor in invitations to positions of power in the last five years, nor in the perception of capacity to occupy the different positions of power, which was high for both sexes. Male respondents more frequently consider that activities such as participating in a scientific committee or giving a conference are not empowering. A third of both sexes consider that the SER should review its processes with a gender perspective but less than a third believe that this should be done by quotas. The reality of the last 5 years is that 1) there is a male to female ratio of 3:2 on SER boards of directors and in this period there has been no female president or treasurer; 2) in the scientific committees of the congresses men predominate (2:1) although slightly less in the local organizing committee; 3) there are more male speakers and moderators than women (very striking in satellite symposia, 4: 1); 4) 9 out of 10 editors-in-chief are men; 5) in academic positions there are 3 men for every 2 women, 9 to 1 in professorships or emeritus positions; although more women supervise residents; and 6) there are more women (60%) than men (40%) in Spanish rheumatology departments, although 75% of department chiefs are men. CONCLUSION: Although not perceived by either the men or the women, there are biases in the involvement of women in important and leadership positions in the specialty.

Acercamiento teórico al uso de la imagenología en el diagnóstico temprano de la artritis reumatoide / Theoretical approach to the use of imaging in the early diagnosis of rheumatoid arthritis

La artritis reumatoide es una enfermedad progresiva, con manifestaciones clásicas y tempranas como es la afectación de las articulaciones pequeñas de las manos y los tobillos. Se realizó una revisión bibliográfica de los documentos publicados entre 2017 y 2022. Se realizó una lectura preliminar de 37 artículos que cumplían con los criterios de inclusión, y finalmente se seleccionaron 23 artículos, de los cuales se tomó el contenido de mayor importancia. La ecografía es una técnica fiable y más sensible que la exploración clínica en el estudio de la enfermedad músculo-esquelética, pues permite una exploración multiplanar y dinámica, lo que resulta en un diagnóstico más exacto. La técnica Doppler constituye un complemento útil en el seguimiento de estos pacientes. Esta enfermedad es recurrente en las consultas de Reumatología, por tanto, en su valoración inicial, la utilidad de los medios diagnósticos, especialmente la ecografía, tiene gran importancia.

Rheumatoid arthritis is a progressive disease, with classic and early manifestations such as involvement of the small joints of the hands and ankles. We conducted a bibliographic review of the documents published between 2017 and 2022. A preliminary reading of 37 articles that met the inclusion criteria was carried out, and 23 articles were finally selected, from which the most important content was taken. Ultrasound is a more sensitive and reliable technique than clinical examination for the study of musculoskeletal disease, since it allows a multiplanar and dynamic examination, which results in a more accurate diagnosis. Doppler technique is a useful complement in the follow-up of these patients. This disease is recurrent in Rheumatology consultations, that's why in its initial assessment, the usefulness of diagnostic means, especially ultrasound, is of great importance.

Current status of musculoskeletal ultrasound in Colombian rheumatology

Introduction: Ultrasound is very useful in the management of rheumatological pathology today. Despite this, in Colombia, progress towards its implementation is limited and entails great difficulties. This deficit is also related to the difficulties in training new human talent. In Colombia, there is no study that identifies the current status of ultrasound among rheumatologists in the country. Methods: This is a descriptive cross-sectional study where medical specialists in Rheumatology practising in Colombia were surveyed through an online form. They were asked about general aspects and for their opinion regarding ultrasound in rheumatology and, if they practiced it, they were asked about specific aspects of its application in clinical practice. Additionally, questions were asked of the rheumatologists who are part of the specialist training processes in the country. Closed multiple-choice or Likert scale assessment questions were presented as required. The main objective was to describe the current use and opinion of musculoskeletal ultrasound in Colombian rheumatologists, as well as the limitations for its implementation. Frequency measurements were performed of the categorical variables of nominal type and ordinal type. The intention was to survey all rheumatologists in the country, who according to Colombian Society of Rheumatology data for the end of 2019 totalled 186. Results: Taking into account the number of rheumatologists of the Colombian Association of Rheumatology (Asoreuma) for 2019 totalling 186, a participation of 139 specialists (74.7%) was obtained, of which 22 of the respondents performed ultrasound in their daily practice (15.8%) the majority in this group being trained in Colombian territory (80.6%). Of the 139 respondents, 64.7% have received some type of training in ultrasound, generally pre-congress courses (22.5%), EULAR courses (16.7%) and training included in their residency curriculum outside the rheumatology service (9.8%). The acceptance of ultrasound is high among rheumatologists practicing in Colombia, 75.5% consider it important or very important and 84.9% indicated that for a comprehensive rheumatology service it is important or very important to have ultrasound. From the responses, however, they consider that its use could change their behaviour frequently, and very frequently in less than half of the cases at 46.7%. Regarding the opinion on the use of ultrasound in specific pathologies, rheumatoid arthritis (77.7%) and crystal arthropathies (72.7%) were considered the highest and most important, as well as in the performance of procedures at 87%. For decision-making in the inflammatory pathology study, 60.4% would consider performing ultrasound compared to 28.8% who responded MRI. Regarding the limitations for implementation, the lack of training in the country (25.6%), followed by the lack of resources to procure equipment (17.9%) and ignorance and lack of interest on the part of the health entities (17.1%) were the most recognized. Conclusion: Musculoskeletal ultrasound is only practiced by a minority of rheumatologists practicing in Colombia, even though the majority consider it important. Its importance lies in its use to treat patients with rheumatoid arthritis, crystal arthropathies and psoriatic arthropathy, as well as for the performance of procedures. More than half of the rheumatologists have received some type of training in ultrasound, usually very few hours' education and without practical or informal training, this being the main problem for its implementation.

Introducción: En la actualidad, la ecografía es de gran utilidad en el manejo de la patología reumatológica. A pesar de esto, en Colombia, los avances para su implementación son escasos y han enfrentado grandes dificultades. Este déficit también se encuentra relacionado con las complicaciones para la formación del nuevo talento humano. En Colombia no se dispone de ningún estudio en el que se identifique el estado actual de la ecografía entre los reumatólogos del país. Métodos: Se trata de un estudio descriptivo de carácter transversal en el cual se encuestó, por medio de un formulario on-line, a médicos especialistas en reumatología que hacen su práctica en el territorio colombiano. Se les preguntó acerca de los aspectos generales y su opinión sobre la ecografía en la reumatología, si la practicaban, como también en torno a los aspectos específicos de su aplicación en la práctica clínica. De manera adicional, se formularon preguntas dirigidas a aquellos reumatólogos que hacen parte de los procesos de capacitación de especialistas en el país; se presentaron preguntas cerradas de opción múltiple o de valoración por escala de Likert según se requirió. El objetivo principal fue describir el uso y la opinión actual sobre la ecografía musculoesquelética en reumatólogos colombianos, así como las limitantes para su implementación. A las variables categóricas de tipo nominal y de tipo ordinal se les hicieron medidas de frecuencia. Se pretendía encuestar a la totalidad de los reumatólogos en el país, los cuales, según información de la Asociación Colombiana de Reumatología (Asoreuma) de finales del 2019, eran 186. Resultados: De acuerdo con el número de reumatólogos proporcionado por la Asoreuma, de 186 especialistas en el año 2019, se obtuvo una participación de 139 de estos (74,7%), de los cuales 22 realizaban ecografía en su práctica diaria (15,8%), siendo este grupo en su mayoría formado en Colombia (80,6%). De los 139 encuestados, el 64,7% había recibido algún tipo de estudios en ecografía, generalmente cursos precongreso (22,5%), cursos de la Liga Europea Contra el Reumatismo (EULAR) (16,7%) y formación incluida en el pensum de su residencia fuera del servicio de reumatología (9,8%). La aceptación de la ecografía es alta entre los reumatólogos que ejercen en Colombia, el 75,5% la consideraron importante o muy importante. Asimismo, el 84,9% indicó que para un servicio de reumatología integral es importante o muy importante contar con ecografía. Sin embargo, los encuestados consideraron que su uso podría llegar a cambiar su conducta de manera frecuente, y muy frecuentemente en menos de la mitad de los casos (46,7%). Con respecto a la opinión sobre el uso de la ecografía en patologías específicas, se consideró con importancia y mucha importancia en artritis reumatoide (77,7%) y artropatías por cristales (72,7%), que fueron las más altas, así como para la realizaron de procedimientos (87%). Para la toma de decisiones en estudio de patología inflamatoria, el 60,4% consideraría realizar ecografía, comparado con 28,8% que se inclina por la resonancia. En relación con las limitaciones para la implementación, la falta de entrenamiento en el país (25,6%), seguida de la carencia de recursos para la consecución del equipo (17,9%) y el desconocimiento y la falta de interés por parte de los entes de salud (17,1%) fueron las más reconocidas. Conclusiones: La ecografía musculoesquelética solamente es practicada por una minoría de los reumatólogos que ejercen en Colombia, a pesar de que la mayoría la considera importante. Su relevancia radica en su uso para tratar a los pacientes con artritis reumatoide, artropatías por cristales y por artropatía psoriásica, así como para la realización de procedimientos. Más de la mitad de los reumatólogos ha recibido algún tipo de formación en ecografía, la mayoría de las veces educación de muy pocas horas o sin entrenamiento práctico, o no formal, lo cual constituye el principal problema para su implementación.

Use of a mobile platform in rheumatology by undergraduate medical students during the COVID-19 pandemic / Uso de uma plataforma móvel em reumatologia por acadêmicos de Medicina durante a pandemia por Covid-19

Abstract: Introduction: Mobile applications are considered relevant in the health area. As rheumatology is a complex and prevalent specialty in clinical practice, the development of tools that favor learning becomes necessary. Objective: To evaluate the impact of a mobile platform on learning, obtaining the degree of satisfaction with the teaching tool and the effects on different scenarios of educational practice, including performance evaluation regarding questions about the theoretical contents of the platform. Methods: Quantitative, descriptive study, carried out in Christus University Center, located in Fortaleza, Brazil. Questionnaires prepared by the authors were used to assess the impact on the different active methodologies used in the institution and the degree of student satisfaction regarding their use. The estimate of the students' cognitive gain was measured through pre-test and post-test, using the multiple-choice format. Results: The questionnaires were applied to 71 students to assess the effects and satisfaction. A total of 90 students participated in the pre-test and 32 in the post-test phase. The platform showed a positive perception of learning for 83.1% of the students, with greater impact on lectures, although there was a greater impact on the simulation scenarios in the eighth semester. A good degree of satisfaction was observed in 94.4% of the answers, with improved performance in the tests, increasing from 43.7% to 63.3% (P < 0.001). Conclusions: The development and application of the mobile platform in rheumatology showed excellent results, with favorable effects on the teaching of the specialty, disclosing a good degree of satisfaction regarding its use and better performance on the questioning about the theoretical contents of the platform.

Resumo: Introdução: Aplicativos móveis são considerados relevantes na área da saúde. Sendo a reumatologia uma especialidade complexa e prevalente na prática clínica, torna-se necessário o desenvolvimento de ferramentas que favoreçam a aprendizagem. Objetivo: Este estudo teve como objetivo avaliar o impacto no aprendizado que uma plataforma móvel proporcionou, obtendo o grau de satisfação com a ferramenta de ensino e a repercussão nos diferentes cenários de prática educacional, incluindo avaliação de performance quanto a questionamentos do conteúdo teórico da plataforma. Método: Trata-se de estudo transversal com delineamento descritivo e abordagem quantitativa do tipo analítico, realizado no Centro Universitário Christus, localizado em Fortaleza, Brasil. Pesquisaram-se, por meio de questionários elaborados pelos autores, a repercussão nas diferentes metodologias ativas presentes na instituição e o grau de satisfação dos alunos quanto ao uso. A estimativa do ganho cognitivo dos alunos foi mensurada por meio de pré-teste e pós-teste, no formato de múltiplas escolhas. Resultado: Participaram 71 alunos durante do questionário sobre a repercussão e a satisfação. Nas questões de múltiplas escolhas, 90 alunos participaram do pré-teste e 32 do pós-teste. A plataforma apresentou percepção positiva na aprendizagem para 83,1% dos alunos, havendo maior impacto nas aulas expositivas, embora no oitavo semestre tenha havido maior repercussão nos cenários de simulação. Houve boa satisfação em 94,4% das respostas, com melhora no aproveitamento quanto às questões de múltiplas escolhas, evoluindo de 43,7% para 63,3% (p < 0,001). Conclusão: A elaboração e a aplicação da plataforma móvel em reumatologia obtiveram excelentes resultados, com repercussão favorável no ensino da especialidade e boa satisfação quanto ao uso e melhor performance no que concerne ao questionamento sobre os conteúdos teóricos da plataforma.

Arteritis de Takayasu como hallazgo incidental en un paciente con enfermedad celiaca: la importancia de la tomografía computarizada por emisión de positrones / Takayasu's arteritis as an incidental finding in a patient with celiac disease: the importance of positron emission computed tomography

Resumen Introducción: La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a las arterias elásticas de gran calibre, fundamentalmente la aorta y sus ramas principales. Ocurre frecuentemente en mujeres entre los 20-30 años, por lo que es muy infrecuente en la edad pediátrica. Caso clínico: Se presenta el caso de una paciente de 15 años en seguimiento desde los 9 años por enfermedad celiaca. A los 13 años se detectó anemia de trastornos crónicos, elevación de proteína C reactiva y velocidad de sedimentación globular. La paciente permaneció en todo momento asintomática. Tras descartar otros procesos, se solicitó tomografía computarizada por emisión de positrones (PET-TC), donde se detectaron lesiones compatibles con vasculitis de grandes vasos. La valoración por Cardiología evidenció un aneurisma en coronaria derecha. Se realizó angio-TC, que sugirió arteritis de Takayasu tipo III. Conclusiones: Es frecuente un retraso en el diagnóstico de la arteritis de Takayasu en los pacientes pediátricos. En este caso se encontraron lesiones de la fase II sin la presencia de síntomas correspondientes a la fase I. El PET-TC permitió el diagnóstico de vasculitis, clave para el diagnóstico de la paciente.

Abstract Background: Takayasu arteritis is a large-vessel vasculitis which affects large-caliber elastic arteries, primarily the aorta and its main branches. It mainly affects women between 20-30 years, so it is rare in children. Case report: We describe the case of a 15-year-old female who was followed up since she was 9 years old due to celiac disease. At the age of 13, anaemia of chronic disorders associated to elevated C-reactive protein and erythrocyte sedimentation were detected. The patient remained asymptomatic. After excluding other diseases, we requested a positron emission computed tomography (PET-CT); lesions compatible with large-vessel vasculitis were detected. Cardiology evaluation showed an aneurysm in the right coronary artery. Angio-CT suggested Takayasu type III arteritis. Conclusions: The delay in the diagnosis of Takayasu arteritis in pediatric patients is quite common. In this case, we have found phase II lesions, with no previous phase I symptoms. However, PET-CT allowed the diagnosis of vasculitis, key to the diagnosis of the patient.

Qualidade de vida em pacientes com espondiloartrites: análise comparativa entre as formas axial, periférica pura e mista / Quality of life in spondyloarthritis: a comparison among axial, peripheric and mixed forms

Introdução: As espondiloartrites são doenças musculoesqueléticas crônicas que podem ter envolvimento axial, periférico ou misto. Devido ao grande comprometimento físico esta doença causa importante redução da qualidade de vida, mas não se sabe se isto acontece de igual maneira nas 3 formas. Objetivo: Estudar a associação entre qualidade de vida e formas de espondiloartrites. Método: Coletaram-se dados acerca de epidemiologia, perfil clínico, comorbidades e de qualidade de vida (através do SF-12 ou Short Form Health Survey­12 questions). Resultados: Incluíram-se 120 indivíduos: 60 EpA e 60 controles. O SF-12 físico tinha mediana de 38,05 para espondiloartrites e 55,1 para controle (p<0,0001). No quesito mental as medianas foram de 42,1 e 50,1 com p=0,04. Não foi possível demonstrar diferenças nos subgrupos de espondiloartrites, tanto no aspecto físico como mental (p=0,33 e 0,30 respectivamente). Conclusão: Existem diferenças significativas na qualidade de vida entre espondiloartrites e controles, mas não entre os subgrupos das espondiloartrites.

Introduction: Spondyloarthritis are chronic musculoskeletal diseases divided as axial, peripherical and mixed diseases. Due to a great physical involvement, it reduces patients' quality of life, but it is unknown how the 3 forms of the disease behave in such context. Objective: To study the quality of life association with spondyloarthritis forms. Methods: Data collection included: epidemiologic data, clinical profile, and quality of life data evaluated through the SF-12 (Short Form Health Survey­12 questions). Results: About 120 individuals were included: 60 spondyloarthritis and 60 controls. The physical SF-12 showed median of 38.05 for spondyloarthritis and 55.1 for controls (p<0.0001). The medians in mental SF-12 were 42.1 and 50.1 with p= 0.04. No differences in quality of life in the spondyloarthritis subgroups could be detected (with p=0.33 and 0.30 for physical and mental aspects). Conclusion: There was a significant difference in quality of life between spondyloarthritis sample and controls but not among the spondyloarthritis subgroups.

Lúpus eritematoso sistêmico juvenil: manifestações clínicas, diagnóstico e tratamento / Juvenile systemic lupus erythematosus: clinical manifestations, diagnosis and treatment

Introdução: Lúpus eritematoso sistêmico juvenil é doença autoimune que se inicia em crianças e jovens com menos de 18 anos. Em comparação com a forma em adultos, ele geralmente apresenta maior morbidade, altas taxas de nefrite lúpica, manifestações reumatológicas e dermatológicas e envolvimento de mucosas. Objetivo: Revisão narrativa envolvendo alguns dos principais aspectos que concernem na doença. Métodos: Busca ativa no PubMed e Scielo, com textos em inglês e português entre 2016 e 2022, utilizando os seguintes descritores: lupus, pediatric, childhood, diagnosis. Foram eliminados artigos que não abordavam a população pediátrica ficando selecionados 12 artigos. Foram focados os aspectos gerais da doença, métodos diagnósticos, diagnósticos diferenciais, investigação laboratorial, manifestações clínicas e tratamento. Conclusão: Lúpus é doença que acomete tanto a população pediátrica quanto a adulta, mas há necessidade de mais estudos em crianças para o melhor entendimento das sutilezas que envolvem a doença em questão. Diante disso, é fundamental que os protocolos tanto de diagnóstico e tratamento, que hoje estão vigentes, sejam melhor entendidos e que mais estudos sejam realizados para aprimorar o manejo desses pacientes.

Introduction: Juvenile systemic lupus erythematosus is an autoimmune disease that begins in children and younger than 18 years. Compared with the disease in the adult, it usually has a higher morbidity, with high rates of lupus nephritis, rheumatologic and dermatologic manifestations, and mucosal involvement. Objective: To carry out a bibliographic review involving some of the main aspects concerning the disease. Methods: The research was carried out using articles in the PubMed and Scielo databases, with texts in English and Portuguese between 2016 and 2022. The search was carried out using the descriptors: lupus, pediatric, childhood, diagnosis. Articles that did not address the pediatric population were excluded. Thus, 12 articles were selected. Searched topics were: general aspects, diagnostic methods, differential diagnoses, laboratory investigation, clinical manifestations and treatment. Conclusion: Lupus is a disease that affects both the pediatric and adult populations, but there is a need for further studies in children to better understand the subtleties surrounding the disease in question. In view of this, it is essential that the protocols for both diagnosis and treatment, which are in force today, be better understood and more studies must be carried out to improve the management of these patients.