RESUMO
Knee osteoarthritis (OA) diagnosis is based on symptoms, assessed through questionnaires such as the WOMAC. However, the inconsistency of pain recording and the discrepancy between joint phenotype and symptoms highlight the need for objective biomarkers in knee OA diagnosis. To this end, we study relationships among clinical and molecular data in a cohort of women (n = 51) with Kellgren-Lawrence grade 2-3 knee OA through a Support Vector Machine (SVM) and a regulation network model. Clinical descriptors (i.e., pain catastrophism, depression, functionality, joint pain, rigidity, sensitization and synovitis) are used to classify patients. A Youden's test is performed for each classifier to determine optimal binarization thresholds for the descriptors. Thresholds are tested against patient stratification according to baseline WOMAC data from the Osteoarthritis Initiative, and the mean accuracy is 0.97. For our cohort, the data used as SVM inputs are knee OA descriptors, synovial fluid proteomic measurements (n = 25), and transcription factor activation obtained from regulatory network model stimulated with the synovial fluid measurements. The relative weights after classification reflect input importance. The performance of each classifier is evaluated through ROC-AUC analysis. The best classifier with clinical data is pain catastrophism (AUC = 0.9), highly influenced by funcionality and pain sensetization, suggesting that kinesophobia is involved in pain perception. With synovial fluid proteins used as input, leptin strongly influences every classifier, suggesting the importance of low-grade inflammation. When transcription factors are used, the mean AUC is limited to 0.608, which can be related to the pleomorphic behaviour of osteoarthritic chondrocytes. Nevertheless, funcionality has an AUC of 0.7 with a decisive importance of FOXO downregulation. Though larger and longitudinal cohorts are needed, this unique combination of SVM and regulatory network model shall help to stratify knee OA patients more objectively.
Assuntos
Osteoartrite do Joelho , Máquina de Vetores de Suporte , Humanos , Feminino , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/metabolismo , Pessoa de Meia-Idade , Idoso , Redes Reguladoras de Genes , Biomarcadores , Líquido Sinovial/metabolismo , Proteômica/métodosRESUMO
It has been postulated that advanced glycation end products (AGEs) and their soluble receptor (sRAGE) may play a relevant role as inducers in the chronic inflammatory pathway in various conditions, among them, in immune-mediated diseases such as systemic lupus erythematosus (SLE). However, previous studies show conflicting results about their association with SLE characteristics and their usefulness as disease biomarkers. We aimed to study the association of specific serum AGEs (pentosidine, Nξ-(carboxymethyl)lysine (CML), Nξ-(carboxyethyl)lysine (CEL)), sRAGE levels and AGEs (specific serum AGEs and skin AGEs) to sRAGE ratios with various disease parameters, in order to clarify their potential as new biomarkers in SLE and to study their relationship with cardiovascular disease (CVD). To this aim, serum pentosidine, CML, CEL and sRAGE were measured via ELISA, and skin AGEs levels were measured by skin autofluorescence. Correlations of pentosidine levels with demographic and clinical data, indexes of activity, accrual damage and patient-reported outcomes were analyzed through multiple linear regression models, while correlations of the rest of the AGEs, sRAGE and AGE to sRAGE ratios (non-normal) were analyzed using both an OLS regression model and a GML. All of the analyses were adjusted for confounders. A total of 119 SLE patients were recruited. Serum AGEs and sRAGEs were significantly associated with SLE activity indexes and/or demographic or disease characteristics: pentosidine with pulmonary manifestations; CML with anti-dsDNA antibodies, IL-6, disease duration and non-Caucasian ethnicities; CEL with anti-dsDNA antibodies, IL-6 and accumulated number of manifestations; and sRAGE with male gender, photosensitivity and being on specific immunosuppressants. These results suggest that the AGE-sRAGE axis may serve as a novel biomarker for managing and prognosticating this disease. Its correlation with certain antibodies, demographics and disease presentations may indicate a distinct clinical phenotype associated with varying levels of AGEs and/or sRAGE. The significance of specific AGE/sRAGE ratios, introduced in this study for the first time, warrants additional investigation in forthcoming research. Our study did not confirm the link between serum AGEs and CVD, which merits further exploration through studies designed for this specific purpose.
RESUMO
Advanced glycation end-products (AGEs) may play a relevant role as inducers in the chronic inflammatory pathway present in immune-mediated diseases, such as systemic lupus erythematosus (SLE). AGEs concentrations have been associated, with discrepant results to date, with some parameters such as disease activity or accrual damage, suggesting their potential usefulness as biomarkers of the disease. Our objectives are to confirm differences in AGEs levels measured by cutaneous autofluorescence between SLE patients and healthy controls (HC) and to study their correlation with various disease parameters. Cross-sectional study, where AGEs levels were measured by skin autofluorescence, and SLE patients' data were compared with those of sex- and age-matched HC in a 1:3 proportion through a multiple linear regression model. Associations of AGEs levels with demographic and clinical data were analyzed through ANOVA tests. Both analyses were adjusted for confounders. AGEs levels in SLE patients were significantly higher than in HC (p < 0.001). We found statistically significant positive associations with SLE disease activity index (SLEDAI) and damage index (SDI), physician and patient global assessment, C-reactive protein, leukocyturia, complement C4, IL-6 and oral ulcers. We also found a negative statistically significant association with current positivity of anti-nuclear and anti-Ro60 antibodies. AGEs seem to have a contribution in LES pathophysiology, being associated with activity and damage and having a role as a new management and prognosis biomarker in this disease. The association with specific antibodies and disease manifestations may indicate a specific clinical phenotype related to higher or lower AGEs levels.
Assuntos
Lúpus Eritematoso Sistêmico , Humanos , Estudos Transversais , Biomarcadores , Complemento C4 , Índice de Gravidade de Doença , Produtos Finais de Glicação AvançadaAssuntos
Humanos , Reumatologia , Betacoronavirus , Pandemias , Pessoal de Saúde , Enfermeiras e Enfermeiros , EspanhaRESUMO
Antecedentes y objetivo: Los SYSADOA (del inglés, symptomatic slow-acting drugs for osteoarthritis) orales son compuestos naturales que han demostrado ser útiles y seguros en el tratamiento de la artrosis (AO). Sin embargo, su uso en ciertas situaciones clínicas carece aún de evidencia científica y recomendaciones claras. El objetivo de este trabajo fue conocer la opinión de un grupo de expertos sobre el uso de los SYSADOA en el tratamiento de la AO en situaciones clínicas controvertidas. Materiales y métodos: Siguiendo el método del uso apropiado mediante la técnica Delphi, se valoraron 206 consultas concretas, estructuradas en 24 preguntas clínicas. Un panel de expertos, compuesto por un total de 15 especialistas, respondió a las dos rondas de consulta a través de una plataforma online. Los resultados se analizaron y debatieron en una reunión presencial con los coordinadores y el comité científico. Según el porcentaje de panelistas que coincidieron en los mismos, se clasificaron los resultados en términos de unanimidad, consenso, mayoría y discrepancia. Resultados: Se consensuaron los siguientes puntos: (1) el fenotipo del paciente condiciona el uso de los SYSADOA orales; (2) los SYSADOA orales se consideran adecuados en la AO primaria (rodilla, mano y cadera) y en algunos tipos de AO secundaria; no se consideran adecuados en AO erosiva de manos, hombro, columna y tobillo; (3) los SYSADOA orales pueden ser prescritos a pacientes con riesgo o enfermedad cardiovascular, enfermedad digestiva, hipertensión, dislipemia, enfermedad vascular periférica, diabetes tipo 2 y, a excepción de diacereína, en pacientes con reflujo esofágico. No se obtuvo acuerdo en la prescripción de los SYSADOA orales en pacientes con enfermedad hepática y renal.(AU)
Background and objective: SYSADOAs (symptomatic slow-acting drugs for osteoarthritis) are natural compounds that have been shown to be useful and safe in the treatment of osteoarthritis (OA). However, their use in certain clinical situations still lacks scientific evidence and clear recommendations. The objective of this work was to learn the opinion of a group of experts regarding the appropriate use of SYSADOA in the treatment of OA in controversial clinical situations. Materials and methods: Following the Delphi technique, 206 specific consultations, structured in 24 clinical questions, were evaluated. A panel of experts composed of a total of 15 specialists, answered the two rounds of consultation through an online platform. The results were analysed and discussed in a face-to-face meeting with the coordinators and the scientific committee. According to the percentage of panellists who agreed on their findings, the results were classified in terms of unanimity, consensus, majority and discrepancy. Results: The following points were agreed upon: (1) the patient's phenotype determines the use of SYSADOAs; (2) SYSADOAs are considered appropriate in primary OA (knee, hand and hip) and in some types of secondary OA; they are not considered appropriate in OA of the shoulder, spine, ankle and erosive OA of the hands; (3) SYSADOAs may be prescribed for patients at risk of or with cardiovascular disease, digestive disease, hypertension, dyslipaemia, peripheral vascular disease, type 2 diabetes and, excluding diacerein, for patients with oesophageal reflux. No agreement was obtained on the prescription of SYSADOAs for patients with hepatic and renal disease. Conclusions: There is limited literature on the use of SYSADOAs for the treatment of OA in controversial situations. Through this work it has been possible to establish the position of a group of experts regarding clinical situations for which there is no scientific evidence concerning their use.(AU)
Assuntos
Humanos , Masculino , Feminino , 36448 , Prova Pericial , Artropatias/terapia , Consenso , Anti-Inflamatórios/uso terapêutico , Sulfatos de Condroitina , Glucosamina , Reumatologia , Doenças ReumáticasAssuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Lesões do Quadril , Quadril , Lipoma , Dor , Pacientes Internados , Exame Físico , Reumatologia , Doenças ReumáticasRESUMO
ANTECEDENTES: El lupus eritematoso sistémico (LES) es una enfermedad crónica autoinmune que afecta a múltiples órganos y sistemas. Las células B tienen un papel crítico en la patogénesis del LES. El rituximab (RTX) es un fármaco compuesto por anticuerpos monoclonales quiméricos contra la proteína CD20, produciendo una depleción de linfocitos B. OBJETIVO: Analizar la efectividad y la seguridad de RTX en pacientes con LES en práctica clínica. MÉTODOS: Recogida de variables retrospectiva de los historiales médicos de 20 pacientes con LES tratados con RTX en 2centros hospitalarios (Hospital de la Santa Creu I Sant Pau y Hospital del Mar, en Barcelona). Se evaluaron variables demográficas, clínicas, serológicas y de tratamiento. RESULTADOS: Hubo asociación estadísticamente significativa entre las variables a estudio pre y postratamiento siguientes: descenso de SLEDAI (p < 0,001), de VSG (p = 0,017), en uso de glucocorticoides (p = 0,025), de IgM (p = 0,031) y aumento de C4 (p = 0,014) tras el tratamiento con RTX. Un paciente con LES, síndrome antifosfolipídico, importante comorbilidad y afectación lúpica multiorgánica falleció tras un proceso séptico meses después de haber recibido un único ciclo de tratamiento con RTX. CONCLUSIONES: A pesar de que actualmente RTX no tiene indicación aprobada en ficha técnica para LES, podemos indicar que es efectivo en cuanto a la reducción de la actividad de la enfermedad, ahorrador de corticoides y con un perfil de seguridad aceptable. Se necesitan mayor tiempo de seguimiento y mayor número de pacientes para resolver las dudas todavía existentes sobre el uso de RTX en LES
BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs and systems. B cells have a critical role in the pathogenesis of SLE. Rituximab (RTX) is a drug composed of chimeric monoclonal antibodies against the CD20 protein, producing a depletion of B lymphocytes. OBJECTIVE: To analyze the effectiveness and safety of RTX in patients with SLE in clinical practice. METHODS: Collection of retrospective variables of the medical records of 20 patients with SLE treated with RTX in 2hospitals (Hospital de la Santa Creu I Sant Pau, and Hospital del Mar, in Barcelona, Spain). We evaluated demographic, clinical, serological and treatment variables. RESULTS: There was a statistically significant association in the following variables collected in the study before and after treatment: there was a decrease in the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (P<.001), erythrocyte sedimentation rate (P=.017), use of glucocorticoids (P=.025) and IgM values (P=.031), as well as an increase in the C4 values (P=.014) after treatment with RTX. A patient with SLE, antiphospholipid syndrome, complex comorbidity and multiorgan lupus involvement died after developing a septic process, months after receiving a single treatment cycle with RTX. CONCLUSIONS: Although RTX currently has no official indication approved for SLE, our data suggest that it may be effective in reducing the activity of the disease and as a steroid-sparing agent, with an acceptable safety profile. However, larger follow-up periods with a greater number of patients are needed to solve the remaining doubts about the use of RTX in SLE
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Rituximab/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Antígenos CD20/efeitos dos fármacos , Segurança do Paciente/estatística & dados numéricos , Anticorpos Monoclonais/uso terapêutico , Estudos Retrospectivos , Doenças Autoimunes/tratamento farmacológico , Resultado do TratamentoRESUMO
La infección por virus Chikungunya (CHIKV) presenta afectación articular en la mitad de las ocasiones. Esta afectación puede derivar en una artritis erosiva que, dada la elevada intervariabilidad en la presentación tanto clínica como serológica y el probable papel del condicionamiento genético en la gravedad y cronificación del cuadro, supone un gran reto diagnóstico y terapéutico. Existe una importante falta de evidencia científica que nos permita caracterizar la variabilidad del paciente y decidir el abordaje más adecuado
Chikungunya virus infection (CHIKV) is associated with joint involvement in half of the cases. This can lead to erosive arthritis which, given the high intervariability of clinical and serological presentations, and the probable role of genetic conditioning in the severity and chronification of the condition, represents a great diagnostic and therapeutic challenge. There is an important lack of scientific evidence that would enable us to characterize the variability of the patient and choose the most appropriate approach
Assuntos
Humanos , Feminino , Adulto , Febre de Chikungunya/complicações , Artrite/virologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Hemangioblastoma/complicações , Ciática/etiologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Cauda Equina/patologia , Hemangioblastoma/terapia , Dor Lombar/etiologia , Parestesia/etiologiaRESUMO
Objetivo: Evaluar mediante ecografía el efecto del condroitín sulfato (CS) en la sinovitis de pacientes con artrosis (OA) de rodilla, y colaborar en el conocimiento de los mecanismos bioquímicos involucrados en la inflamación sinovial. Métodos: Estudio controlado, aleatorizado, ciego simple de 70 pacientes con OA de rodilla tratados durante 6 meses con CS o paracetamol (PCT). Los pacientes fueron visitados a tiempo basal, a las 6 semanas, y a los 3 y 6 meses para valorar el estado de su OA según los siguientes parámetros: sinovitis evaluada mediante ecografía (según definición de expertos OMERACT); dolor y función, mediante la escala visual analógica y el índice de Lequesne; y concentración de mediadores inflamatorios en suero y líquido sinovial, mediante ELISA. Resultados: El tratamiento con CS redujo en un 50% el número de individuos que presentaban sinovitis; sin embargo, se observó un incremento de un 123% en el grupo tratado con PCT. En los pacientes sin sinovitis inicial, se observó el establecimiento de esta en un 85,71 y 25% de los casos tratados con PCT y CS, respectivamente. Ambas terapias mejoraron la función articular, pero únicamente el tratamiento con CS produjo una mejora significativa del dolor al final del tratamiento. Se observó una asociación entre el tratamiento con CS y los cambios en la concentración de RANTES y UCN en el líquido sinovial. Conclusiones: El tratamiento con CS tiene un efecto mantenido beneficioso, previniendo la aparición de sinovitis o disminuyendo su presencia, así como reduciendo los síntomas de la artrosis. El PCT también mejora los síntomas clínicos, pero no tiene ningún efecto sobre la inflamación. Las variaciones observadas en la concentración de RANTES y UCN podrían estar relacionadas con el efecto antiinflamatorio asociado al tratamiento con CS (AU)
Objective: To evaluate by ultrasonography the effect of chondroitin sulfate (CS) on synovitis in patients with knee osteoarthritis (KOA). To collaborate in the understanding of the biochemical mechanisms involved in the synovial inflammation process. Methods: Randomized, single-blind, controlled trial involving 70 patients with primary KOA treated for 6 months with CS or acetaminophen (ACT). Evaluation of KOA status at baseline, 6 weeks, 3 and 6 months included: ultrasonography to assess synovitis (following the OMERACT expertise group definition), visual analogue scale and Lequesne index to measure pain and function, and ELISA to quantify inflammatory mediators in serum and synovial fluid. Results: Synovitis presence was reduced by 50% in the CS group while a 123% increase was observed in ACT group. Conversely, patients without initial synovitis and treated with ACT reached 85.71% synovitis onset, but only 25% in CS group. Both therapies improved articular function, but only CS resulted in significant pain improvement at the end of the treatment. Changes in RANTES and UCN synovial fluid concentration were associated with CS treatment. Conclusions: Treatment with CS had a sustained beneficial effect, preventing synovitis onset or reducing its presence as well as reducing KOA symptoms. ACT ameliorated clinical symptoms but had no effect on inflammation. The CS anti-inflammatory effect could be related to the observed changes in RANTES and UCN concentration (AU)
Assuntos
Humanos , Sulfatos de Condroitina/farmacocinética , Osteoartrite do Joelho/complicações , Sinovite/tratamento farmacológico , Sinovite , Mediadores da Inflamação/análise , Inflamação/fisiopatologiaRESUMO
Introducción: La artrosis de rodilla es causa de dolor e incapacidad funcional. Uno de los problemas para evaluar la eficacia de los analgésicos ha sido la falta de medidas objetivas de dolor, aunque la resonancia magnética funcional (RMf) ha surgido como un medio útil para objetivar la respuesta del cerebro a la estimulación dolorosa. Hemos investigado el efecto del condroitín sulfato (CS) sobre la respuesta del cerebro a la estimulación dolorosa de la rodilla en pacientes con artrosis mediante RMf. Métodos: Veintidós pacientes recibieron CS (800mg/día) y 27 placebo y fueron evaluados inicialmente y después de 4 meses de tratamiento. En cada sesión de RMf se aplicó presión dolorosa sobre la interlínea de la rodilla y en la superficie de la rótula. El resultado se cuantificó como la atenuación de la respuesta cerebral a la estimulación dolorosa de la rodilla. Resultados: La RMf de la maniobra rotuliana mostró una reducción de la activación en la región de la sustancia gris periacueductal del mesencéfalo significativamente mayor durante el tratamiento con CS que en la condición de placebo. El grupo de CS, pero no el de placebo, mostró además una reducción de la activación en la representación cortical de la pierna tras el tratamiento. No se observaron efectos del CS con presión dolorosa sobre la interlínea de la rodilla. Conclusiones: La RMf fue sensible para objetivar los efectos del CS sobre la respuesta del cerebro a la presión dolorosa sobre el cartílago rotuliano-femoral, que es un resultado coherente con la acción conocida del CS sobre la regeneración de los condrocitos. El presente trabajo muestra nuevamente la utilidad de la RMf para objetivar los efectos del tratamiento en el dolor de origen artrósico (AU)
Introduction: Knee osteoarthritis is causing pain and functional disability. One of the inherent problems with efficacy assessment of pain medication was the lack of objective pain measurements, but functional magnetic resonance imaging (fMRI) has emerged as a useful means to objectify brain response to painful stimulation. We have investigated the effect of chondroitin sulfate (CS) on brain response to knee painful stimulation in patients with knee osteoarthritis using fMRI. Methods: Twenty-two patients received CS (800mg/day) and 27 patients placebo, and were assessed at baseline and after 4 months of treatment. Two fMRI tests were conducted in each session by applying painful pressure on the knee interline and on the patella surface. The outcome measurement was attenuation of the response evoked by knee painful stimulation in the brain. Results: fMRI of patella pain showed significantly greater activation reduction under CS compared with placebo in the region of the mesencephalic periaquecductal gray. The CS group, additionally showed pre/post-treatment activation reduction in the cortical representation of the leg. No effects of CS were detected using the interline pressure test. Conclusions: fMRI was sensitive to objectify CS effects on brain response to painful pressure on patellofemoral cartilage, which is consistent with the known CS action on chondrocyte regeneration. The current work yields further support to the utility of fMRI to objectify treatment effects on osteoarthritis pain (AU)
Assuntos
Humanos , Sulfatos de Condroitina/farmacocinética , Dor/tratamento farmacológico , Osteoartrite do Joelho/complicações , Espectroscopia de Ressonância Magnética/métodos , Placebos/uso terapêutico , Método Duplo-Cego , Neuroimagem Funcional/métodosRESUMO
No disponible
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Humanos , Artrite Infecciosa/etiologia , Propionibacterium acnes/patogenicidade , Artrite Infecciosa/microbiologia , Infecções por Bactérias Gram-Positivas/etiologiaRESUMO
Fundamento y objetivo: Adaptación lingüística y validación al castellano del cuestionario ARTS (Arthritis Treatment Satisfaction Questionnaire), instrumento autoadministrado que mide cuatro dimensiones de satisfacción con el tratamiento de la artrosis: eficacia, conveniencia, tolerabilidad y cuidado médico. Material y método: La adaptación se llevó a cabo mediante equivalencia conceptual, fue supervisado por 6 expertos y 4 traductores que tradujeron y retrotradujeron los ítems. Se utilizó una muestra de pacientes con artrosis de rodilla, cadera o columna cervical para estimar las propiedades psicométricas de factibilidad, fiabilidad, validez y sensibilidad al cambio. Se identificaron 3 grupos: escaso efecto analgésico, escasa tolerabilidad y adecuado efecto analgésico y tolerabilidad. El ARTS se administró basalmente, a la semana, y después de 4 semanas de tratamiento con antiinflamatorios no esteroideos o con inhibidores de la ciclooxigenasa 2. Resultados: Se incluyó a 163 pacientes de edad media (DE) de 67,7 (9,2) años. No se observó efecto suelo o techo, los ítems se entendieron correctamente y las tasas de ausencia de respuesta resultaron inferiores al 1%, con un * de Cronbach de 0,85 y coeficiente de correlación intraclase de 0,81. El análisis factorial exploratorio mostró cuatro dimensiones coherentes con la versión original. La validez concurrente se evaluó con la escala SF-36, la escala EVA de dolor, la escala EVA de cumplimiento terapéutico y el cuestionario de Morisky-Green. El cuestionario adaptado mostró también una buena validez discriminante, y fue capaz de distinguir entre pacientes que requieren cambio de tratamiento. También demostró sensibilidad al cambio en la efectividad del tratamiento tras 30 días de seguimiento. Conclusiones: La versión adaptada del cuestionario ARTS es psicométricamente válida y conceptualmente equivalente para explorar la satisfacción con el tratamiento de la artrosis en lengua española
Background and objective: Linguistic adaptation and validation into Spanish of the ARTS questionnaire, a self reported instrument designed to measure four osteoarthritis treatment satisfaction dimensions: treatment advantages, treatment convenience, apprehension about treatment and satisfaction with medical care. Material and method: Adaptation was performed using conceptual equivalence, supervised by a panel of 6 experts and 4 independent translators, who were in charge of performing translation and back-translation of the items. A sample of patients suffering from knee, hip or column osteoarthritis was used to estimate the psychometric properties of feasibility, reliability, validity and sensitivity to change. Three groups were identified: adequate analgesic effect and tolerability, treatment-switch because of a weak analgesic effect, and treatment- switch due to poor tolerability. The ARTS was administered at baseline, 1 week later for retest, and after 4 weeks of treatment with NSAIDs or Cox II-inhibitors. Results: A sample of 163 patients was formed (67.7 [9.2] years old). No floor or ceiling effects were found, items were well understood and non- response rates were below 1%. Cronbach's alpha for the total scales was 0.85, and the intraclass correlation coefficient was 0.81. Exploratory factor analysis yielded 4 dimensions which were coherent with those proposed by the original authors. Concurrent validity was measured with SF-36, a pain VAS instrument, a treatment compliance VAS, and the Morisky-Green compliance questionnaire. The adapted instrument showed a good discriminatory validity, and it was able to distinguish between patients needing a change in treatment and those who did not need it. It was also sensitive to changes in patients' treatment effectiveness after a 30 days follow up. Conclusions: A psychometrically valid and conceptually equivalent ARTS questionnaire has been produced to explore satisfaction with treatment in patients with osteoarthritis in Spanish speaking countries
Assuntos
Masculino , Feminino , Humanos , Osteoartrite/tratamento farmacológico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Satisfação do Paciente , Inquéritos e Questionários , Qualidade de VidaRESUMO
No disponible
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Masculino , Adulto , Humanos , Osteomielite/microbiologia , Mergulho/lesões , Pseudomonas aeruginosa/patogenicidadeRESUMO
FUNDAMENTO: Describir las características clínicas y analíticas de los pacientes con enfermedad ósea de Paget en el momento del diagnóstico. PACIENTES Y MÉTODO: Estudio multicéntrico y retrospectivo que ha incluido a 314 pacientes. El diagnóstico se realizó mediante gammagrafía con polifosfato de 99Tc y radiografía simple. Se analizaron los datos epidemiológicos, motivo del diagnóstico, huesos afectados, grado de extensión mediante el índice de Coutris, complicaciones durante la evolución y actividad de la enfermedad con el índice de Renier. Los resultados se han analizado con el paquete estadístico SPSS.RESULTADOS: Ciento cincuenta y nueve (50,5 per cent) eran varones y la media (DE) de edad de 64,9 (12,6) años; en 288 (72,6 per cent) el diagnóstico fue casual y 201 (63,9 per cent) presentaron una enfermedad poliostótica; las localizaciones más frecuentes fueron el hueso coxal, cráneo y columna lumbar. La afectación del sacro fue más frecuente en el varón que en la mujer (p < 0,05), mientras que para el cráneo ocurría lo contrario (p < 0,05). El número medio de huesos afectados fue de 3,1 (3) y el porcentaje de esqueleto involucrado fue de 8,7 (6,5 per cent). Las vértebras, el sacro y el cráneo fueron los huesos que estaban más extensamente afectados en el momento del diagnóstico. Ciento noventa y ocho pacientes (63 per cent) presentaron complicaciones durante la evolución. En 242 casos (77 per cent) la enfermedad estaba activa con una fosfatasa alcalina (FA) de 377 (493) UI/l. Los pacientes con afectación craneal tenían un valor de FA mayor que aquellos en que no existía (701 [753] frente a 237 [201] UI/l; p < 0,001); la actividad de la enfermedad según el índice de actividad de Renier fue de 34 (46); el cráneo y el húmero fueron los huesos donde la actividad del hueso patético fue mayor. CONCLUSIONES: Aunque con frecuencia la enfermedad de Paget es asintomática, en el momento del diagnóstico se presenta en muchas ocasiones de forma poliostótica y activa. El conocimiento de la extensión y la actividad de la enfermedad mediante una simple fórmula matemática son útiles para tomar una decisión terapéutica (AU)