Calidad de vida en pacientes con esclerosis sistémica en confinamiento por pandemia de COVID-19 en Argentina / Quality of life in patients with systemic sclerosis in confinement due to the COVID-19 pandemic in Argentina

Introducción: los pacientes con enfermedades reumáticas tienen una calidad de vida significativamente deteriorada. La pandemia por COVID-19 tuvo un notable impacto sobre la población y los sistemas de salud de todo el mundo. Objetivos: en este trabajo nos proponemos conocer el impacto de la pandemia en la calidad de vida de los pacientes con esclerosis sistémica (ES) y cómo fue el acceso a la atención médica. Materiales y métodos: mediante encuestas anónimas y digitales a pacientes durante julio y agosto de 2020 se evaluó la calidad de vida utilizando el cuestionario de calidad de vida de la esclerosis sistémica (SScQoL). Además, se realizaron preguntas para evaluar el acceso al sistema de salud durante ese período. Resultados: se encuestaron 300 pacientes con ES. La mediana de afectación de la calidad de vida según el cuestionario utilizado fue de 17 (9,25-22) y el dolor fue el dominio más afectado. El 29,33% no hizo los controles médicos. El 74,33% refirió haber tenido estudios médicos pendientes al inicio de la cuarentena y solo el 25% pudo realizarlos. Conclusiones: los pacientes con ES presentaron compromiso de la calidad de vida durante la pandemia y mostraron dificultades en el acceso al sistema de salud.

Introduction: patients with rheumatic diseases have a significantly impaired quality of life. The COVID-19 pandemic has had a significant impact on the population and health systems around the world. Objectives: to analyze the impact of the pandemic on the quality of life and access to medical care of patients with systemic sclerosis (SS). Materials and methods: through anonymous and digital surveys of patients during July and August 2020, quality of life was assessed using the Systemic Sclerosis Quality of Life Questionnaire (SScQoL). In addition, questions were asked to assess access to the health system during that period. Results: 300 patients with SS were surveyed. The median quality of life affectation according to the questionnaire used was 17 (9.25-22), with pain being the most affected domain. Twenty-nine percent did not attend their medical appointments, 74.33% reported having pending medical studies at the beginning of the quarantine, and only 25% could carry them out. Conclusions: patients with SS presented compromised quality of life during the pandemic and showed difficulties in accessing the health system.

Prevalence of musculoskeletal disorders and rheumatic diseases in an Argentinean indigenous Wichi community.

OBJECTIVE: To estimate the prevalence of musculoskeletal disorders (MSK) and rheumatic diseases in an indigenous Wichi population in Argentina. METHODS: This is a cross-sectional, community-based study using the Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology in ≥ 18-year-old subjects. Validated surveys were conducted by trained interviewers. Subjects with MSK pain (positive cases) were evaluated by internists and rheumatologists for diagnosis and treatment. RESULTS: A total of 648 interviews were performed (90.4% of the census population). Mean age was 37.5 years (SD 14.8), and 379 (58.5%) were female. The mean years of education was 7.0 (SD 3.7); 552 subjects (85.2%) were covered by the public health care system. A total of 216 (33.3%) subjects had MSK pain in the last 7 days. Rheumatic disease prevalence was as follows: mechanical back pain (19.0%), rheumatic regional pain syndrome (5.2%), osteoarthritis (3.2%), rheumatoid arthritis (RA) (3.2%), inflammatory back pain (1.2%), undifferentiated arthritis (0.3%), Sjögren syndrome (0.15%), and fibromyalgia (0.15%). RA patients included 19 (90.5%) women and 9 (42.9%) with RA family history. One hundred percent were seropositive and 66.7% showed radiologic erosions. The mean of Disease Activity Score [DAS-28 (ESR)] at the time of diagnosis was 5.1 (SD 1.5) and the Health Assessment Questionnaire Disability Index (HAQ-DI) was 0.8 (SD 0.4). CONCLUSION: RA prevalence was 3.2%, one of the highest reported using the COPCORD methodology in indigenous and non-indigenous peoples in Latin America, with a high percentage of family cases. Pain and functional capacity were the variables allowing patients' early referral to a specialist. Key Points • The RA prevalence was 3.2%, one of the highest reported using COPCORD methodology in indigenous and non-indigenous peoples in Latin America. • The patients with RA had high percentage of familiar history of RA. • The pain and functional capacity were the variables associated with a diagnosis of any rheumatic disease and should be considered for early referral. • The mean of the delay in the diagnosis was 5.8 years. In this community, the lack of the "migration health" phenomenon may be a social determinant that negatively impacts their health.

Syndemic and syndemogenesis of low back pain in Latin-American population: a network and cluster analysis.

INTRODUCTION: Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. OBJECTIVE: To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. METHODS: Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. RESULTS: Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals' variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). CONCLUSIONS: LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations. Key points • Syndemic and syndemogenesis evidence health disparities in Latin-American populations, documenting the complexity of suffering from a disease such as low back pain that is associated with comorbidities, unhealthy habits, and the social and regional context where they live. • The use of network and cluster analyses are useful tools for documenting the complexity and the multifaceted impact in health in large populations as well as the differences between countries. • The variability and impact of socioeconomic indicators (e.g., Gini index) related to low back pain and comorbidities could be felt through the use of cluster analysis, which generates evidence of regional inequality in Latin America. • Populations can be studied from different models (network and cluster analysis) and grouping, presenting new interpretations beyond geographical groupings, such as syndemic and inequity in health.

Caso Clínico: Diastomatomielia, una Forma Rara de Disrafia Espinal Oculta / Case Report: Diastomatomyelia, a Rare Form of Hidden Spinal Disraphy

INTRODUCCIÓN: La diastematomielia es una malformación raquimedular, un desdoblamiento sagital de la médula espinal, frecuentemente por debajo de la quinta vértebra dorsal; siendo una presentación rara de disrafismo espinal (menos del 3 %), más frecuente en el sexo femenino (3:1), se presenta entre los 10 y 76 años de edad. Puede ser asintomática y un descubrimiento incidental. Su diagnóstico es básicamente radiológico. CASO CLÍNICO: Paciente de sexo masculino de 20 años de edad, con cuadro de lumbalgia crónica, habiendo sido tratado por diferentes especialistas y tratamientos. Se solicitó estudios de imagen con la finalidad de esclarecer el diagnóstico; en la exploración física reportó zona de hipertricosis localizada a nivel lumbosacro y escoliosis dorsolumbar leve. EVOLUCIÓN: Los estudios radiológicos, tomográficos y de resonancia magnética evidenciaron la fusión de los cuerpos vertebrales L2 - L3 (espolón óseo), asociando anomalías de fusión de los elementos posteriores con división del canal raquídeo, y en médula espinal dos hemimédulas. Al momento el paciente se encuentra en controles periódicos por el servicio de traumatología con tratamiento clínico. CONCLUSIONES: No es sencillo el diagnóstico, frecuentemente se realiza en etapas tardías, cuando las alteraciones neurológicas son explícitas. Es preciso permanecer alerta ante alteraciones cutáneas de la línea media; dado que puede ser indicadora de diastematomielia o de cualquier disrafismo oculto.

BACKGROUND: Diastematomyelia is a spinal cord malformation consisting of a sagittal split spinal cord, often below the fifth thoracic vertebra and being a rare presentation of occult spinal dysraphism (less than 3 %), and it is more common in females (3:1), in the age of 10 and 76 years old. It can be asymptomatic and be discovered incidentally. It is basically radiological diagnosis. CASE REPORT: A 20 - years old, male patient presents chronic and unwilling back pain treatment, which has been treated by different specialists and treatments. If was requested image exams in order to clarify the diagnosis. Physical examination zone localized hypertrichosis and lumbosacral thoracolumbar scoliosis reported. EVOLUTION: The computed tomography and magnetic resonance showed the fusion of the L2 - L3 (bone spurs) associated with abnormalities fusion of the posterior elements with division of the spinal canal into two compartments, vertebral bodies and spinal cord in two hemicords. At present, the patient is under periodic controls by the traumatology service with clinical treatment. CONCLUSIONS: It is not easy diagnosis diastematomyelia often is performed in later stages, when neurological disorders are already flowered. Because of this, must remain alert to any skin disorder midline, it can be indicative of diastematomyelia or any of the hidden dysraphisms.

Work disability is related to the presence of arthritis and not to a specific diagnosis. Results from a large early arthritis cohort in Argentina.

UNLABELLED: The objective of the study was to evaluate work disability and its main associated factors in patients with early arthritis. Argentine Consortium for Early Arthritis (CONAART) is the first early arthritis cohort in Argentina. Patients with one or more swollen joints and less than 2 years of symptoms duration were followed up prospectively in 13 departments of rheumatology. Social, demographic, familiar, clinical, and laboratory data were recollected. At first year and every year, X-rays of hands and feet were performed and working status and pharmaco-economic data were recollected. Work status (employed, unemployed, retired) and type of work were assessed by direct interview using a predesigned questionnaire. Eight hundred forty-eight patients were included, rheumatoid arthritis (RA) = 483 (57 %)and undifferentiated arthritis (UA) = 365 (43 %), 694 (81.8 %) were women, median age was 46 years (interquartile range (IQR) 35-55.7) and median symptoms duration 7 months (IQR 3-12). Patients with RA had significantly higher disease activity, worse functional capacity and quality of life, and more severe radiological damage compared to UA patients. However work disability (unemployed patient) was comparable between groups (RA = 21 % versus UA = 18.6 % p = NS). In both groups, unemployed patients had higher disease activity score of 28 joints (DAS28), worse Health Assessment Questionnaire (HAQ) values, and less years of formal education (p value <0.005 in all comparisons). Radiological damage was greater in unemployed patients but this difference did not reach statistical significance. In multivariate analysis, disease activity was the main variable associated with unemployment in both groups. Joint involvement was the main cause of work disability in this cohort of patients with early arthritis, independently of the final diagnosis. KEY MESSAGES: 1. Work disability is higher in patients with inflammatory arthritis as compared to the general population. 2. Prevalence of work disability is comparable among patients with undifferentiated and rheumatoid arthritis. 3. Disease activity is the main disease variable associated with work disability.