Reliability of Visual Analog Scale and Numeric Rating Scale for the Assessment of Disease Activity in Systemic Lupus Erythematosus.

OBJECTIVE: To determine the reliability of SLE patients' disease activity measurements. METHODS: This was a cross-sectional study conducted (August 2016-December 2017) at 2 main public Peruvian hospitals, 1 with a comprehensive lupus care program. Patients assessed their disease activity with a visual analog scale (VAS) (0-100 mm) or a numerical rating scale (NRS) (0-4) before and after their physician's (MD's) assessment. Demographic and disease-related characteristics were recorded. Reliability of patients' disease activity before and after MD's assessment was determined using Spearman rank correlation. Factors possibly associated with this variability were examined with Spearman rank correlation and Mann-Whitney U test. RESULTS: Two hundred forty, mostly Mestizo, SLE patients were included; mean (SD) age and disease duration (diagnosis) were 34.9 (12.9) years and 10.1 (7.0) years, respectively. The Mexican version of the Systemic Lupus Erythematosus Disease Activity Index was 1.9 (2.7), and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was 1.2 (1.5). The correlations between NRS and VAS before and after the MD's assessment were ρ = 0.839; p < 0.001; and ρ = 0.872; p < 0.001, respectively. Visual analog scale and NRS were higher before than after the MD's assessment (VAS 29.3 [26.5] and 26.5 [24.9], p = 0.052; and NRS (1.5 [1.2] and 1.3 [1.1], p = 0.003); only the comprehensive program explained this variability (p = 0.043). The reliability of VAS and NRS was ρ = 0.917 and ρ = 0.861, p < 0.001, before and after for the comprehensive program and ρ = 0.710 and ρ = 0.785, p < 0.001, for before and after for the regular program. CONCLUSIONS: Both VAS an NRS are highly reliable. Patients scored higher before than after their physicians' assessment but that these differences were smaller for the patients in the comprehensive care program than in the regular one.

Discrepant Perception of Lupus Disease Activity: A Comparison Between Patients' and Physicians' Disease Activity Scores.

OBJECTIVE: The aim of this study was to compare patient and physician (MD) assessment of disease activity in systemic lupus erythematosus patients. METHODS: This cross-sectional study was conducted between August 2016 and December 2017 at 2 Peruvian hospitals. One group assessed disease activity using a visual analog scale (VAS, 0-100 mm) and the other one using a numerical rating scale (NRS, 0-4), before and after their MD's visit. MDs assessed it with the Mexican Systemic Lupus Erythematosus Disease Activity (Mex-SLEDAI) (0-32) and with the SLICC/ACR Damage Index (SDI) for damage. Health-related quality of life was ascertained with the LupusQoL. Visual analog scale and NRS were compared using the Wilcoxon signed-rank test and the correlation between disease activity as assessed by the patient and the Mex-SLEDAI, SDI, and LupusQoL with the Spearman rank correlation. RESULTS: Two hundred forty patients were included; mean (SD) age at diagnosis was 34.9 (12.9) years; most patients were Mestizo. Disease duration was 10.1 (7.0) years. The Mex-SLEDAI was 1.9 (2.7) and the SDI 1.2 (1.5). Disease activity as assessed by the patient, either by VAS or NRS, did not correlate with the Mex-SLEDAI or the SDI. In contrast, patient assessment of disease activity, by VAS or NRS, significantly correlated with several components of the LupusQoL (physical health, pain, planning, emotional health, and fatigue). CONCLUSIONS: Physician's and patient's assessments of disease activity are discrepant; overall, patients score higher than their MDs. Patients score how they perceive the disease is affecting them, rather than disease activity per se. The VAS could be more useful than the NRS as a measurement of disease activity.

Long-Term Efficacy and Safety of Biosimilar CT-P10 Versus Innovator Rituximab in Rheumatoid Arthritis: 48-Week Results from a Randomized Phase III Trial.

OBJECTIVE: The aim of this study was to investigate long-term clinical outcomes of extended treatment with CT-P10, a rituximab biosimilar, compared with rituximab reference products sourced from the USA and the EU (US-RTX and EU-RTX) in rheumatoid arthritis (RA) for up to 48 weeks. METHODS: In this multinational, randomized, double-blind trial, adults with active RA received up to two courses of CT-P10, US-RTX, or EU-RTX alongside methotrexate. Efficacy endpoints included Disease Activity Score 28-joint count (DAS28) and American College of Rheumatology (ACR) response rates. Pharmacokinetics, pharmacodynamics, immunogenicity, and safety were also assessed. RESULTS: Of 372 patients randomized to the study drug, 330 (88.7%) completed the second treatment course. Mean change from baseline to week 48 in DAS28-C-reactive protein was comparable in the CT-P10 and combined rituximab (US-RTX and EU-RTX) groups (- 2.7 and - 2.6, respectively). ACR20, ACR50, and ACR70 response rates at week 48 indicated no differences between groups (80.6%, 55.4%, and 31.7% vs. 79.8%, 53.9%, and 33.7% in the CT-P10 and combined rituximab groups, respectively). Similar improvements in the Health Assessment Questionnaire Disability Index and all medical outcomes in the Short Form 36-Item Health Survey, including physical and mental health, were seen in all groups. At week 48, antidrug antibodies were detected in 4.9%, 9.4%, and 8.6% of patients in the CT-P10, US-RTX, and EU-RTX groups, respectively. CT-P10 and rituximab displayed similar pharmacokinetic, pharmacodynamic, and safety profiles. CONCLUSION: CT-P10 was similar to EU-RTX and US-RTX in terms of efficacy, pharmacokinetics, pharmacodynamics, immunogenicity, and safety up to week 48. CLINICALTRIALS. GOV IDENTIFIER: NCT02149121.

Dislipidemia en pacientes con artritis reumatoide atendidos en un hospital general / Dyslipidemia in patients with rheumatoid arthritis attended at a general hospital

Objetivo: Determinar la frecuencia de dislipidemia en pacientes con artritis reumatoide (AR) atendidos en un hospital general. Material y métodos: Estudio observacional, descriptivo y transversal. Se incluyeron 44 pacientes a quienes se les determinó perfil lipídico sérico. Los resultados se clasificaron según el reporte modificado en el 2004 del tercer panel de tratamiento del adulto (ATP III). Además, se determinó el índice de masa corporal (IMC), la puntuación para la actividad de la enfermedad (DAS-28) y la limitación funcional medida con el cuestionario de evaluación de salud - versión peruana (HAQ-P). Resultados: La frecuencia de dislipidemia en pacientes con AR fue 75 por ciento. El 54,5 por ciento tuvo un IMC fuera de los límites normales. En el DAS-28, la mayoría de pacientes se encontraron con actividad severa de la enfermedad. Sin embargo, hubo más pacientes con dislipidemia en el grupo con moderada actividad. En la escala de HAQ-P, la mitad tuvo incapacidad funcional moderada a severa y mayor número de sujetos con dislipidemia. El 69,7 por ciento de los pacientes con alteraciones en el perfil lipídico presentó dislipidemia mixta. Conclusiones: La dislipidemia en los pacientes con AR del estudio se presentó con una alta frecuencia y con diversas formas de alteración en el perfil lipídico sin un patrón uniforme. Por lo tanto, el tratamiento de la dislipidemia sería individualizado en cada paciente para prevenir eventos cardiovasculares.

Objective: To determine the frequency of dyslipidemia in patients with rheumatoid arthritis (RA) attended at a general hospital. Material and methods: Observational, descriptive and cross-sectional study. 44 patients were included and lipid profiles were taken from them. The results were classified according to the third Adult Treatment Panel (ATP III) report modified in 2004. Also, we determined the body mass index (BMI), disease activity score (DAS-28) and the functional limitation with the Health Assessment Questionnaire - Peruvian version (HAQ-P). Results: The frequency of dyslipidemia in patients with rheumatoid arthritis was 75 percent. 54,7 percent had an BMI out of normal limits. In DAS-28, most patients were found with high disease activity. However, there were more patients with dyslipidemia in the group with moderate activity. In HAQ-P, half of sample had moderate to severe functional limitation and greater number of patients with dyslipidemia Conclusions: There was a high frequency of dyslipidemia in patients with RA in this study and various forms of alteration in lipid profile without a uniform pattern. Therefore, the treatment for dyslipidemia should be individualized in each patient in order to prevent cardiovascular events.

Niveles de vitamina D en mujeres posmenopáusicas con osteoporosis primaria / Levels of vitamin D in posmenopausal women with primary osteoporosis

La osteoporosis es un problema de salud pública a nivel mundial, particularmente en mujeres posmenopáusicas, jugando la deficiencia de vitamina D un importante rol en su génesis. Objetivo: Determinar los niveles de Vitamina D en mujeres posmenopáusicas con osteoporosis primaria. Material y métodos: Estudio descriptivo tipo serie de casos. Se incluyeron 40 mujeres posmenopáusicas con diagnóstico de osteoporosis primaria; se excluyeron las que habían recibido suplemento de calcio o vitamina D, terapia para osteoporosis o tenían alguna causa de osteoporosis secundaria. A todas las mujeres incluidas se les determinó el nivel sérico de 25 OH vitamina D. Resultados: La edad promedio fue 65,9 ± 10,22 años, y el promedio del Score T L1-L4 fue -2,82 ± 0,71, Score T en Cadera Total -1,59 ±1,05 y el Score T en radio 33% -3,10 ± 0,97 en la densitometría ósea. El nivel de vitamina D sérico fue 13,98 ± 5,95 ng/ml; 87,5% (35 pacientes) tuvieron niveles de vitamina D deficientes, 7,5% (3 pacientes) tenían niveles insuficientes y sólo 2 pacientes tuvieron niveles normales de vitamina D. Conclusión: La mayoría de mujeres posmenopáusicas con osteoporosis primaria tuvieron niveles de vitamina D en rangos de deficiencia e insuficiencia. Podría ser necesario dar suplementos de calcio y vitamina D a todas las pacientes posmenopáusicas con osteoporosis.

Osteoporosis is a public health problem in the world, mostly in postmenopausal women, low levels of vitamin D play an important role in its origin. Objective: To get the levels of vitamin D in postmenopausal women with primary osteoporosis. Material and methods: Descriptive study case series. We included a total of 40 postmenopausal women with diagnosis of primary osteoporosis, we excluded those women who received calcium and/or vitamin D supplement, treatment for osteoporosis or those women with a secondary osteoporosis. The serum level of 25 OH vitamin D was determined in all women. Results: 40 patients with primary osteoporosis were included, average age was 65.9 ± 10.22 years old, and with average T score L1-L4 of -2.82 ±0.71, T Score in total hip of -1.59 ±1.05 and a T score in radius 33% of -3.10 ± 0.97 by bone densitometry. The average level of serum vitamin D was 13.98 ± 5.95 ng/ml, 87.5% (35 patients) had deficient levels of vitamin D, 7.5% (3 patients) had insufficient levels and only the 5% (2 patients) had normal levels of vitamin D. Conclusion: Most postmenopausal women with primary osteoporosis had low levels of vitamin D; 87.5%. It could be necessary to supplement with calcium and vitamin D to all postmenopausal women patients with osteoporosis.

Respuesta a tuberculina en Artritis Reumatoide. Un estudio con controles intradomiciliarios / Tuberculin response in rheumatoid arthritis. A study with household contacts

La Tuberculina evalúa la infección por tuberculosis que depende de la inmunidad celular; se informa en nuestro país baja prevalencia de PPD positivo en pacientes con AR frente a controles sanos; este procedimiento perdería validez en nuestro medio como tamizaje adecuado antes de usar agentes biológicos; el uso indiscriminado de la profilaxis TBC con isoniacida traería hepatotoxicidad que se incrementa hasta en un 50 por ciento cuando se asocia a metotrexate, sulfazalasina o agentes anti-TNF sin dejar de lado la posibilidad de desarrollo de resistencia a la medicación. Objetivo: evaluar la positividad del PPD en AR frente a controles intradomiciliarios. Métodos: se estudiaron 47 pacientes AR, 45 de sexo femenino (95,8 por ciento) y dos varones (4,2 por ciento), y 47 controles contacto intradomiciliario. Fueron utilizadas 2UT contenidas en 0.1 ml. Para evitar booster no hubo PPD en el último mes. Se tomó positividad del PPD en AR³5 mm y controles³10 mm. Se usó la versión 7,5 de SPSS. Las medias de la edad y la medición de la reacción al PPD se analizaron por ANOVA, correlación de Spearman, X² y prueba Z para comparar proporciones. Resultados: la edad promedio de los pacientes fue 51,7 años y de los contactos fue 41,1 años; el tiempo de enfermedad promedio fue 12,74 años, la lectura promedio en AR fue 6,62 mm y en contacto intradomiciliario, 9,55mm (ANOVA= 0,189). El porcentaje de pacientes AR con PPD (+) fue similar a los controles, 46,80 por ciento vs. 51,10 por ciento(p<0,02). PPD (+) entre los pacientes AR inmunosuprimidos y no inmunosuprimidos, 40,50 por ciento vs. 70,00 por ciento (p< 0,03); hubo correlación entre lecturas de 53,20 por ciento, así para PPD (+) coincidieron los resultados en 25,50 por ciento y para PPD (-) en 27,70 por ciento (Spearman= 0.4), (p< 0,04), correlación significativa de positividad o negatividad (X² 0,021). Conclusiones: encontramos una proporción PPD(+) de 51,10 por ciento en los controles en comparación de 46,80 por ciento de los pacientes AR. La proporción de PPD (-) es mayor en los pacientes AR inmunosuprimidos que en los no inmunosuprimidos 59,50 por ciento vs. 30,00 por ciento

Detection of bacterial DNA in Latin American patients with reactive arthritis by polymerase chain reaction and sequencing analysis.

OBJECTIVE: Bacteria and/or their antigens are thought to play a role in the pathogenesis of reactive arthritis (ReA). Polymerase chain reaction (PCR) using the 16S ribosomal RNA-PCR method was used to identify bacterial DNA in synovial fluid (SF) and tissue (ST) in a well defined group of patients with chronic ReA. In addition, species found were identified by means of sequence analysis. METHODS: We examined 15 ST and 5 SF samples of 15 patients with ReA, 5 ST samples of 5 patients with osteoarthritis (OA), and 8 SF from 8 patients with closed traumatic knee injuries using a nested PCR with universal 16S rRNA primers. In addition, a nested PCR was developed to detect DNA sequences of Salmonella sp. and Mycoplasma sp. Automated sequencing and comparative data analysis (GenBank) were also performed to identify the species. RESULTS: Bacterial DNA was identified in 8 cases, 5 ST and 3 SF; Chlamydia trachomatis (n = 2), Pseudomonas sp. (n = 3), and Bacillus cereus (n = 2) were the most common microorganisms identified. A variety of microorganisms including Clostridium sp., Lactobacillus sp., Pseudomonas migulae, P. fluorescens, and P. putida, and Neisseria meningitidis serogroup B were also identified. In half of the cases (4/8) 2 to 3 bacterial antigens were identified simultaneously. CONCLUSION: Bacterial DNA is present in the joints in patients with chronic ReA. A wide spectrum of bacteria including some not previously associated with ReA were identified. Further studies are needed to establish their exact role in the pathogenesis of ReA and related arthritides.

Neurobehcet pediátrico: presentación de un caso y revisión de la literatura / Pediatric Neurobehcet: a case report and review of the literature

The first peruvian pediatric case of neuro-Behcet, who had seizures, hemiparesis and a magnetic nuclear resonance with a pseudotumoral imagine is here presented.

Infección osteoarticular salmonelósica / Salmonelosis osteoarticular infection

Se reportan 11 pacientes con infección osteoarticular salmonelósica (8 por S. thypi y 3 por S. no thypi), atendidos en el Hospital Nacional Cayetano Heredia entre 1982-1983. La articulación más afectada fue la rodilla (3 casos), observándose osteomielitis en 3 pacientes; 3/11 tuvieron factores predisponentes como talasemia (uno) u lupus eritematoso sistémico (dos casos). Dos pacientes requirieron debridación quirúrgica y todos los casos tratados evolucionaron favorablemente.

Artitris séptica esternoclavicular / Sternoclavicular septic arthritis

Reportamos nueve pacientes con artritis séptica esternoclavicular (ASEC), dos de los cuales fueron adictos a drogas endovenosas, pero en ningún caso a heroína. La edad promedio fue de 34.5 años. El sexo más frecuente fue el masculino. En seis pacientes se aisló el microorganismo causal, siendo el más frecuente aislado el Stafilococo aureus. Ocho pacientes fueron tratados y tuvieron excelente respuesta

Lupus eritematoso sistémico e infección herpética / Herpetic infection in sistemic lupus erithematosus

Comunicamos la experiencia en el manejo de pacientes con Lupus Eritematoso Sistémico (LES) e infección herpética (IH), de la Unidad de Inmunología y Reumatología del Hospital Nacional Cayetano Heredia, en el período 1985-1991. En esos años se atendieron 135 pacientes lúpicos, de los cuales 15 (11.1 por ciento) presentaron cuadro clínico compatible con IH, trece fueron mujeres. Tres pacientes tenían LES activo; de los doce inactivos ninguno se activó al presentarse la IH. Catorce pacientes se encontraban en tratamiento con prednisona y/o inmunosupresores. Se encontró compromiso dermatomal a nivel cervical, dorsal y lumbar; siendo más frecuente a nivel dorsal bajo y lumbar alto (10/14). En un caso se realizó serología para investigar IH, la cual fue positiva por Elisa para VHS-1, negativa para VHS-2 y VHZ. Concluimos que las IH se presentan mayormente en pacientes con LES inactivo y no modifican el curso de la enfermedad lúpica, tienen un curso clínico favorable, no se observa diseminación de la IH

Compromiso osteoarticular asociado a Falciformismo / Osteoarticular involvement associated to sickle cell syndromes

Se reportan 6 pacientes con anemia falciforme (4 con Hb SS, 1 con Hb SC y 1 con Hb SB-talasemia), atendidos en el Hospital Nacional Cayetano Heredia entre 1983 y 1990, que presentaron diversas manifestaciones musculoesqueléticas en el curso de su evolución, resaltando dos casos de necrosis aséptica y un paciente con osteomielitis del fémur por Salmonella tiphy. se discuten los casos en relación a la literatura

Compromiso reumatológico (CR) en infección meningocócica / Rheumatological involvement in meningococcal infection

Se comunica la experiencia en el manejo del compromiso reumatológico en infección por Neisseria meningitidis en el HCH entre 1968 y 1988. Tuvimos 9 pacientes con compromiso musculoesquelético: poliartritis, oligoartritis y reumatismo extraarticular, con tiempo de aparición y duración variable. En todos, el cultivo de líquido sinovial fué negativo. El manejo divide a los pacientes en dos grupos, uno que responde con tratamiento antibiótico y drenaje articular y otro que requiere antiinflamatorios no esteroideos. El pronóstico fué bueno en todos.