Design of a Rheumatology Transition Clinic for a Resource-Constrained Setting.

OBJECTIVES: To describe the design process of a medical care program for adolescents with pediatric onset rheumatic diseases (PRD) during the transition from pediatric to adult care in a resource-constrained hospital. METHODS: The model of attention was developed in three steps: 1) the selection of a multidisciplinary team, 2) the evaluation of the state of readiness of patients and caregivers for the transition, and 3) the design of a strategy of attention according to local needs. The results of the first two steps were used in order to develop the strategy of attention. RESULTS: The transition process was structured in three stages: pretransition (at pediatric rheumatology clinic), Transition Clinic for Adolescents with Rheumatic Diseases (TCARD, the main intervention), and post-transition (at adult rheumatology clinic). Each stage was divided, in turn, into a variable number of phases (8 in total), which included activities and goals that patients and caregivers were to accomplish during the process. A multidisciplinary approach was planned by pediatric and adult rheumatologists, nutritionists, physiatrists, psychiatrist, psychologist, nurse, and social worker. During TCARD, counseling, education, nutritional, physical, and mental health interventions were considered. CONCLUSIONS: The proposed transition model for patients with rheumatic diseases can be a useful tool in developing countries.

Desempeño del índice de masa corporal para el diagnóstico de obesidad por medio de absorciometría de rayos X de energía dual (DEXA) en pacientes con artritis reumatoide / Value of body mass index in the diagnosis of obesity according to DEXA in well-controlled RA patients

Introducción. La artritis reumatoide (AR) tiene un efecto indirecto en la composición corporal. El índice de masa corporal (IMC) no se considera un predictor válido de la grasa corporal en pacientes con AR. Objetivo. Evaluar el IMC para identificar la obesidad mediante absorciometría dual por rayos X (DEXA) en pacientes con AR bien controlados. Métodos. Estudio observacional, transversal, descriptivo y analítico. Se utilizaron 3 definiciones de obesidad por DEXA:>35% de grasa total, >40% de grasa total y obesidad central>35%. Resultados. Se incluyó a 101 pacientes. Se encontró un IMC de 24kg/m2 para obesidad >35% con una sensibilidad del 90% y una especificidad del 75% (área bajo la curva [AUC] 0,917), un IMC de 25kg/m2 para obesidad >40% con una sensibilidad del 86% y una especificidad del 39% (AUC 0,822) y un IMC de 22kg/m2 para 35% de la grasa central con una sensibilidad de 97% y una especificidad del 84% (AUC 0,951). Conclusión. Existe un subdiagnóstico de obesidad con el uso de los valores de tradicionales de IMC en pacientes con AR bien controlados (AU)

Background. Rheumatoid arthritis (RA) has an indirect effect on body composition. Body mass index (BMI) is not a valid predictor of body fat in RA patients. Objective. To evaluate the accuracy of BMI in identifying obesity diagnosed according to dual energy X-ray absorptiometry (DXA) in well-controlled RA patients. Methods. An observational, cross-sectional, descriptive, analytical study. We used 3 different cutoffs for obesity as determined by DXA: >35% total fat, >40% total fat, and >35% central fat mass (central obesity). Results. One hundred one patients were included. We found that 35% total fat corresponded to a BMI of 24kg/m2, with a sensitivity of 90% and specificity of 75% (area under the curve [AUC] 0.917); 40% total fat to a BMI of 25kg/m2, with a sensitivity of 86% and specificity of 39% (AUC 0.822); and 35% central fat mass to a BMI of 22kg/m2, with a sensitivity of 97% and specificity of 84% (AUC 0.951). Conclusion. Obesity according to DXA was underdiagnosed when the classic BMI cutoffs were used in well-controlled RA patients (AU)

Value of body mass index in the diagnosis of obesity according to DEXA in well-controlled RA patients. / Desempeño del índice de masa corporal para el diagnóstico de obesidad por medio de absorciometría de rayos X de energía dual (DEXA) en pacientes con artritis reumatoide.

BACKGROUND: Rheumatoid arthritis (RA) has an indirect effect on body composition. Body mass index (BMI) is not a valid predictor of body fat in RA patients. OBJECTIVE: To evaluate the accuracy of BMI in identifying obesity diagnosed according to dual energy X-ray absorptiometry (DXA) in well-controlled RA patients. METHODS: An observational, cross-sectional, descriptive, analytical study. We used 3 different cutoffs for obesity as determined by DXA: >35% total fat, >40% total fat, and >35% central fat mass (central obesity). RESULTS: One hundred one patients were included. We found that 35% total fat corresponded to a BMI of 24kg/m2, with a sensitivity of 90% and specificity of 75% (area under the curve [AUC] 0.917); 40% total fat to a BMI of 25kg/m2, with a sensitivity of 86% and specificity of 39% (AUC 0.822); and 35% central fat mass to a BMI of 22kg/m2, with a sensitivity of 97% and specificity of 84% (AUC 0.951). CONCLUSION: Obesity according to DXA was underdiagnosed when the classic BMI cutoffs were used in well-controlled RA patients.