Pan American League of Associations for Rheumatology Recommendations for the Treatment of Psoriatic Arthritis.

OBJECTIVE: Psoriatic arthritis (PsA) is chronic disease that compromises multiple domains and might be associated with progressive joint damage, increased mortality, functional limitation, and considerably impaired quality of life. Our objective was to generate evidence-based recommendations on the management of PsA in Pan American League of Associations for Rheumatology (PANLAR) countries. METHODS: We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to adapt the 2019 recommendations of the European Alliance of Associations for Rheumatology. A working group consisting of rheumatologists from various countries in Latin America identified relevant topics for the treatment of PsA in the region. The methodology team updated the evidence and synthesized the information used to generate the final recommendations. These were then discussed and defined by a panel of 31 rheumatologists from 15 countries. RESULTS: Theses guidelines report 15 recommendations addressing therapeutic targets, use of antiinflammatory agents and corticosteroids, treatment with disease-modifying antirheumatic drugs (conventional synthetic, biologic, and targeted synthetic), therapeutic failure, optimization of biologic therapy, nonpharmacological interventions, assessment tools, and follow-up of patients with PsA. CONCLUSION: Here we present a set of recommendations to guide decision making in the treatment of PsA in Latin America, based on the best evidence available, considering resources, medical expertise, and the patient's values and preferences. The successful implementation of these recommendations should be based on clinical practice conditions, healthcare settings in each country, and a tailored evaluation of patients.

Development of a novel clinimetric tool: PAtient Reported Disease Activity Index in Rheumatoid Arthritis (PARDAI-RA) by PANLAR, for the assessment of patients living with rheumatoid arthritis.

BACKGROUND: Clinical experience has shown that a single measure is not sufficient to assess disease activity in rheumatoid arthritis (RA). Various clinimetric tools are necessary to address the many clinical situations that can arise. METHODS: In order to develop a comprehensive measurement tool, the Pan American League of Associations for Rheumatology searched for the most frequent measures of disease activity applied in RA by means of a semi-systematic review of the available literature. RESULTS: We found that the most frequently reported measures of disease activity were the 28-joint Disease Activity Score, C-reactive protein, and the erythrocyte sedimentation rate, followed by patient-reported measures of pain and stiffness and many other composite indices and patient-reported outcome measures. The most frequent physician-reported sign of disease was the swollen joint count, and the most frequently self-reported feature was the increase in disease activity or flares. CONCLUSION: In this article, we present a new clinimetric tool developed based on expert consensus and on data retrieved from our search. Disease activity can be better assessed by combining various data sources, such as clinical, laboratory, and self-reported outcomes. These variables were included in our novel clinimetric tool. Key Points • The goal of treatment of RA is to achieve the best possible control of inflammation, or even remission; therefore, disease management should include systematic and regular evaluation of inflammation and health status. • Clinimetric tools evaluate a series of variables (e.g., symptoms, functional capacity, disease severity, quality of life, disease progression) and can reveal substantial prognostic and therapeutic differences between patients. • Our clinimetric tool, which is based on a combination of data (e.g., clinical variables, laboratory results, PROMs), can play a relevant role in patient assessment and care.

El viaje del paciente con fibromialgia en Latinoamérica / The patient journey of fibromyalgia in Latin America

Objetivos: Explorar la experiencia de las personas con fibromialgia (FM) en países latinoamericanos con objeto de identificar problemas en la atención sanitaria y otros ámbitos potencialmente solucionables. Métodos: Estudio cualitativo con enfoque fenomenológico y de análisis de contenido a través de grupos focales y metodología de viaje del paciente (Ux del inglés User Experience). Se llevaron a cabo 9 grupos focales virtuales con pacientes con FM y profesionales sanitarios en Argentina, México y Colombia reclutados a partir de informantes clave y redes sociales. Resultados: Participaron 43 personas (33 clínicos y 10 pacientes). Los agentes que interaccionan con el paciente en la enfermedad se encuentran en 3 esferas: la de la atención sanitaria, la del apoyo y vida laboral y la del contexto socioeconómico. La línea del viaje presenta 2 grandes tramos, 2 bucles y una línea discontinua delgada. Los 2 grandes tramos representan los tiempos que van desde los primeros síntomas hasta la visita médica y desde el diagnóstico hasta el seguimiento. Los bucles incluyen: 1.°) sucesión de diagnósticos, tratamientos erróneos y derivaciones a especialistas y 2.°) nuevos síntomas cada cierto tiempo, visitas a especialistas y dudas diagnósticas. Pocos pacientes logran la fase final de autonomía. Conclusión: El viaje de una persona con FM en Latinoamérica está lleno de obstáculos. La meta deseada es que todos los agentes entiendan que el automanejo por parte del paciente con FM es una parte indispensable del éxito, y solo se puede lograr accediendo a recursos de forma precoz y guiado por profesionales.(AU)

Objectives: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. Methods: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. Results: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. Conclusion: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self-management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.(AU)

Evaluation of information provided to patients by ChatGPT about chronic diseases in Spanish language.

Introduction: Artificial intelligence has presented exponential growth in medicine. The ChatGPT language model has been highlighted as a possible source of patient information. This study evaluates the reliability and readability of ChatGPT-generated patient information on chronic diseases in Spanish. Methods: Questions frequently asked by patients on the internet about diabetes mellitus, heart failure, rheumatoid arthritis (RA), chronic kidney disease (CKD), and systemic lupus erythematosus (SLE) were submitted to ChatGPT. Reliability was assessed by rating responses as (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, (4) completely incorrect, and divided between "good" (1 and 2) and "bad" (3 and 4). Readability was evaluated with the adapted Flesch and Szigriszt formulas. Results: And 71.67% of the answers were "good," with none qualified as "completely incorrect." Better reliability was observed in questions on diabetes and RA versus heart failure (p = 0.02). In readability, responses were "moderately difficult" (54.73, interquartile range (IQR) 51.59-58.58), with better results for CKD (median 56.1, IQR 53.5-59.1) and RA (56.4, IQR 53.7-60.7), than for heart failure responses (median 50.6, IQR 46.3-53.8). Conclusion: Our study suggests that the ChatGPT tool can be a reliable source of information in spanish for patients with chronic diseases with different reliability for some of them, however, it needs to improve the readability of its answers to be recommended as a useful tool for patients.

The patient journey of fibromyalgia in Latin America.

OBJECTIVES: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. METHODS: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. RESULTS: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. CONCLUSION: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self- management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.

Prevalence of axial spondyloarthritis in Colombia: data from the National Health Registry 2017-2021.

INTRODUCTION: Registries allow ascertaining the epidemiology of chronic diseases such as axial spondyloarthritis (axSpA). The Colombian Ministry of Health has implemented a National Health Registry (SISPRO) that collects data from each medical contact in the system, which provides close to universal coverage (around 98%). OBJECTIVE: To establish the 5-year prevalence of axSpA in Colombia, and to describe its demographics, using data from January 1st, 2017, to December 31st, 2021. METHODS: We performed an observational, cross-sectional study using the International Statistical Classification of Diseases and Related Health Problems as search terms related to ax-SpA, based on SISPRO data. We estimated the prevalence using three approaches: (1) ankylosing spondylitis (AS) diagnoses; (2) diagnoses compatible with axSpA; and (3) diagnoses compatible with axSpA, including sacroiliitis. We calculated prevalence per 100,000 inhabitants. RESULTS: Based on our three approaches, patients with a primary diagnosis compatible with ax-SpA ranged between 12,684 and 117,648, with an estimated 5-year adjusted prevalence between 26.3 and 244 cases per 100,000 inhabitants (0.03-0.2%). The male-to-female ratio ranged between 1.2:1 and 0.4:1, which was markedly skewed towards a higher prevalence in women when we included the code for sacroiliitis. We found the highest frequency of cases in the 50-54 years group. A differential prevalence was observed between different regions in our country, particularly in regions known to have European ancestors. CONCLUSION: This is the first study that describes demographic characteristics of ax-SpA in Colombia and offers valuable information for stakeholders. Key Points • Using the official country-level health database, the prevalence of axSpA in Colombia ranges between 26.3 and 244 cases per 100,000 inhabitants (0.03% - 0.2%) • The prevalence of axSpA peaked among the 50-54 years patient group, suggesting an increased survival • Nations with a substantial admixture, such as Colombia, may present a differential prevalence of axSpA among regions within the country • Including the ICD-10 code for sacroiliitis (M46.1) in epidemiological studies probably overestimates the frequency of axSpA.

YouTube® as a source of information for Spanish-speaking patients with rheumatoid arthritis.

INTRODUCTION: Social media (SoMe) has reshaped access to health information, which may benefit patients with rheumatoid arthritis (RA), although an evaluation of the characteristics of contents for Spanish-speaking patients is lacking. We aimed to assess patient engagement, reliability, comprehensiveness, and quality of data uploaded to YouTube® for Spanish-speaking patients. METHODS: We evaluated the videos uploaded to YouTube® in Spanish about RA. Information about video length, engagement (i.e., views, likes, popularity index), time online, and the source was retrieved; we appraised reliability (DISCERN), comprehensiveness (content score), and quality (Global Quality Score) using standardized scores. RESULTS: We included 200 videos in the study and classified 67% of the videos as useful. These videos had a higher number of views (19,491 [10,132-61,162] vs. 11,208 [8183-20,538]), a longer time online (1156 [719-2254] vs. 832 [487-1708] days), and a shorter duration (6.3 [3.4-15.8] vs. 11.8 [7.4-20.3] min). Engagement parameters were similar between useful and misleading videos. Useful videos had higher reliability, comprehensiveness, and quality scores. Useful videos were mainly uploaded by independent users and government/news agencies; academic organizations offered only 15% of useful videos. CONCLUSIONS: Most of the information in YouTube® for Spanish-speaking patients with RA is useful; however, patient engagement is similar between useful and misleading content. More substantial involvement of academia in developing high-quality educational multimedia is warranted.

YouTube® as a source of information for Spanish-speaking patients with rheumatoid arthritis / YouTube® como fuente de información para pacientes hispanohablantes con artritis reumatoide

Introduction: Social media (SoMe) has reshaped access to health information, which may benefit patients with rheumatoid arthritis (RA), although an evaluation of the characteristics of contents for Spanish-speaking patients is lacking. We aimed to assess patient engagement, reliability, comprehensiveness, and quality of data uploaded to YouTube® for Spanish-speaking patients. Methods: We evaluated the videos uploaded to YouTube® in Spanish about RA. Information about video length, engagement (i.e., views, likes, popularity index), time online, and the source was retrieved; we appraised reliability (DISCERN), comprehensiveness (content score), and quality (Global Quality Score) using standardized scores. Results: We included 200 videos in the study and classified 67% of the videos as useful. These videos had a higher number of views (19,491 [10,132–61,162] vs. 11,208 [8183–20,538]), a longer time online (1156 [719–2254] vs. 832 [487–1708] days), and a shorter duration (6.3 [3.4–15.8] vs. 11.8 [7.4–20.3] min). Engagement parameters were similar between useful and misleading videos. Useful videos had higher reliability, comprehensiveness, and quality scores. Useful videos were mainly uploaded by independent users and government/news agencies; academic organizations offered only 15% of useful videos. Conclusions: Most of the information in YouTube® for Spanish-speaking patients with RA is useful; however, patient engagement is similar between useful and misleading content. More substantial involvement of academia in developing high-quality educational multimedia is warranted.(AU)

Introducción: Las redes sociales (ReSo) han redefinido el acceso a la información en salud, beneficiando a los pacientes con artritis reumatoide (AR). No se cuenta con una evaluación de las características de su contenido para pacientes hispanohablantes. Nuestro objetivo fue evaluar los parámetros de interacción, la confiabilidad, la exhaustividad y la calidad de la información disponible en YouTube® para pacientes hispanohablantes con AR. Métodos: Evaluamos los videos en español sobre AR disponibles en YouTube®. Se extrajo información sobre la duración del video, los parámetros de interacción (por ejemplo, vistas, likes, índice de popularidad), el tiempo en línea y la fuente generadora. Estimamos la confiabilidad (DISCERN), la exhaustividad (puntaje de contenido) y la calidad (Global Quality Score) utilizando puntajes estandarizados. Resultados: Incluimos 200 videos en el estudio y clasificamos a 67% como videos útiles. Estos videos tuvieron un mayor número de vistas (19.491 [10.132-61.162] vs. 11.208 [8.183-20.538]), un mayor tiempo en línea (1.156 [719-2.254] vs. 832 [487-1.708] días) y una menor duración (6,3 [3,4-15,8] vs. 11,8 [7,4-20,3] min). Los parámetros de interacción fueron similares entre los videos útiles y los no útiles. Los videos útiles presentaron puntajes mayores de confiabilidad, exhaustividad y calidad; en su mayoría fueron generados por usuarios independientes y por organizaciones gubernamentales/agencias de noticias. Las organizaciones académicas generaron únicamente 15% de los videos útiles. Conclusiones: La mayoría de la información en YouTube® para pacientes hispanohablantes con AR es útil. Sin embargo, los parámetros de interacción son similares entre los videos útiles y los no útiles. Se requiere una mayor participación de las organizaciones académicas en el desarrollo de multimedia educativo de alta calidad.(AU)

Pan American League of Associations for Rheumatology recommendations for the management of axial spondyloarthritis.

Axial spondyloarthritis (axSpA) comprises a spectrum of chronic inflammatory manifestations affecting the axial skeleton and represents a challenge for diagnosis and treatment. Our objective was to generate a set of evidence-based recommendations for the management of axSpA for physicians, health professionals, rheumatologists and policy decision makers in Pan American League of Associations for Rheumatology (PANLAR) countries. Grading of Recommendations, Assessment, Development and Evaluation-ADOLOPMENT methodology was used to adapt existing recommendations after performing an independent systematic search and synthesis of the literature to update the evidence. A working group consisting of rheumatologists, epidemiologists and patient representatives from countries within the Americas prioritized 13 topics relevant to the context of these countries for the management of axSpA. This Evidence-Based Guideline article reports 13 recommendations addressing therapeutic targets, the use of NSAIDs and glucocorticoids, treatment with DMARDs (including conventional synthetic, biologic and targeted synthetic DMARDs), therapeutic failure, optimization of the use of biologic DMARDs, the use of drugs for extra-musculoskeletal manifestations of axSpA, non-pharmacological interventions and the follow-up of patients with axSpA.

Pan American League of Associations for Rheumatology Guidelines for the Treatment of Takayasu Arteritis.

OBJECTIVE: To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK). METHODS: A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/outcome) format. A systematic literature review was performed by a team of methodologists. The evidence quality was assessed according to the GRADE (Grading of Recommendations/Assessment/Development/Evaluation) methodology. The panel of vasculitis experts voted each PICO question and made recommendations, which required ≥70% agreement among the voting members. RESULTS: Eleven recommendations were developed. Oral glucocorticoids are conditionally recommended for newly diagnosed and relapsing TAK patients. The addition of nontargeted synthetic immunosuppressants (e.g., methotrexate, leflunomide, azathioprine, or mycophenolate mofetil) is recommended for patients with newly diagnosed or relapsing disease that is not organ- or life-threatening. For organ- or life-threatening disease, we conditionally recommend tumor necrosis factor inhibitors (e.g., infliximab or adalimumab) or tocilizumab with consideration for short courses of cyclophosphamide as an alternative in case of restricted access to biologics. For patients relapsing despite nontargeted synthetic immunosuppressants, we conditionally recommend to switch from one nontargeted synthetic immunosuppressant to another or to add tumor necrosis factor inhibitors or tocilizumab. We conditionally recommend low-dose aspirin for patients with involvement of cranial or coronary arteries to prevent ischemic complications. We strongly recommend performing surgical vascular interventions during periods of remission whenever possible. CONCLUSION: The first PANLAR treatment guidelines for TAK provide evidence-based guidance for the treatment of TAK patients in Latin American countries.

Evaluation of diuretic efficiency of intravenous furosemide in patients with advanced heart failure in a heart failure clinic.

INTRODUCTION: Diuretic efficiency (DE) is an independent predictor of all-cause mortality in acute heart failure (HF) at long-term follow-up. The performance of DE in advanced HF and the outpatient scenario is unclear. METHODS: Survival function analysis on a retrospective cohort of patients with advanced HF followed at the outpatient clinic of Hospital Universitario San Ignacio (Bogotá, Colombia) between 2017 and 2021. DE was calculated as the average of total diuresis in milliliters divided by the dose of IV furosemide in milligrams for each 6-h session, considering all the sessions in which the patient received levosimendan and IV furosemide. We stratified DE in high or low using the median value of the cohort as the cutoff value. The primary outcome was a composite of all-cause mortality and HF hospitalizations during a 12-month follow-up. Kaplan-Meier curves and log-rank test were used to compare patients with high and low DE. RESULTS: In all, 41 patients (66.5 ± 13.2 years old, 75.6% men) were included in the study, with a median DE of 24.5 mL/mg. In total, 20 patients were categorized as low and 21 as high DE. The composite outcome occurred more often in the high DE group (13 versus 5, log-rank test p = 0.0385); the all-cause mortality rate was 29.2% and was more frequent in the high DE group (11 versus 1, log-rank test p = 0.0026). CONCLUSION: In patients with advanced HF on intermittent inotropic therapy, a high DE efficiency is associated with a higher risk of mortality or HF hospitalization in a 12-month follow-up period.

Prevalence of juvenile systemic lupus erythematosus in Colombia: An approach from the national health registry data.

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic, systemic, autoimmune disease of multifactorial origin. There are no previous studies in Colombia describing juvenile SLE (jSLE) prevalence, prompting this demographic description. OBJECTIVE: This study aimed for prevalence calculation and epidemiologic analysis of jSLE) in Colombian patients, ages 0-19, from 2015 to 2019. METHODS: This descriptive, cross-sectional study searched the Colombian Ministry of Health database for codes of the International Classification of Diseases, 10th revision (ICD-10) associated with jSLE to estimate the disease prevalence for the total population and for specific age groups at national and regional levels. Calculations used intercensal estimates of population based on the projections of the national statistics administrative department (DANE) from the most recent census. This paper presents a sociodemographic analysis of patients with jSLE. RESULTS: The study identified in Colombia, from 2015 to 2019, 3680 cases with jSLE as the principal diagnosis. Calculated prevalence of jSLE was 25 cases per 100,000 population, with highest frequency in ages 15-19 and females (84%), with a female:male ratio of 5.1:1. CONCLUSION: Estimated prevalence of jSLE in Colombia is at the highest limit of worldwide findings. Consistent with reports in the literature, the disease involves females more frequently than males.

Quality assessment of breast cancer studies conducted with the Delphi technique.

BACKGROUND: The Delphi technique is a consensus method aiming to obtain statistical estimations from a qualitative approach, through an iterative process that leads to consensus within experts. The main characteristics of the technique include iteration, anonymity, feedback, and consensus reaching. When high-quality, quantitative evidence on a particular topic is insufficient, the Delphi technique can be used for making decisions in clinical scenarios. However, the quality of studies on breast cancer conducted with this technique, has not been assessed. OBJECTIVE: We aim to evaluate the quality of studies on breast cancer which used the Delphi technique as their method. METHODS: A quality assessment tool (Quali-D) was created through consensus among experts on the Delphi technique. Then, the tool was applied to studies on breast cancer which used the Delphi technique as their method. RESULTS: Studies conducted through the Delphi technique mainly assessed for quality indicators and expressed needs in patients with breast cancer. High-quality characteristics were reported in 63.89% of the studies. 98.61% used the Delphi technique due to lack of a more adequate method to solve their research question. 98.61% summarized and presented results in a clear way. In 91.67% of the studies, at least two rounds were conducted. 86.11% described the methods for expert selection in a complete manner. Only 54.17% of the studies reported an anonymous process and 4.17% of the studies disclosed conflicts of interest thoroughly. CONCLUSIONS: A variety of topics were assessed through the Delphi technique in cases where no other technique would have been more appropriate for assessing these issues. Significant limitations are present in terms of anonymity and full disclosure of conflicts of interest. We found that the quality of studies conducted with the Delphi technique regarding breast cancer is overall good. However, the limitations of each study must be considered when applying their results to clinical practice.

Telehealth and Telemedicine in Latin American Rheumatology, a New Era After COVID-19.

ABSTRACT: Telemedicine is the delivery of health care services by health care professionals using information and communication technologies to exchange valid information for the diagnosis, treatment, and prevention of diseases. Telemedicine was further developed in Latin America during the COVID-19 (coronavirus disease 2019) pandemic, becoming the first line of defense for health professionals to stop the spread of infections and allow them to continue the care of their patients. During the pandemic, 79% of rheumatologists in Latin America reported the use of remote communication, the most frequent being the use of phone calls and WhatsApp voice messages. In contrast, 84% of the patients reported that telemedicine was appropriate for them during the pandemic, but only 54% considered telemedicine to be a valid option for rheumatic health care after the pandemic. Telemedicine and telehealth have advantages such as lower costs, improved access in rural areas, shortage of care providers, and reduction in waiting time for appointments. However, it also has some challenges, such as legal, technological, and organizational barriers. In this review, we explore the current state of telemedicine in Latin America and discuss its future.

Characterization of patients with dermatomyositis in a university hospital in Colombia

Introduction: Dermatomyositis is an idiopathic inflammatory myopathy characterized by the presence of skin lesions; it is considered a heterogeneous disease, due to its clinical presentation, course, and prognosis. In Colombia there are few records that describe the clinical characteristics of these patients. Methods: Cross-sectional study. Medical records of patients who consulted a university hospital in Colombia between January 2004 and December 2019 were reviewed. The records were obtained using databases from the dermatology, rheumatology, dermatopathology, and electrophysiology units, and CIE10 diagnostic codes. Results: Seventy patients with a dermatomyositis diagnosis were found, 63 (90%) fulfilled the Bohan and Peter diagnostic criteria and 7 (10%) had amyopathic dermatomyositis, with an average age of 43 years (SD ± 15.3). Forty-eight were women (68.5%). The most frequent clinical signs were Gottron's papules 80%, periorbital violaceous (heliotrope) erythema with edema 78.5% (n = 55) and poikiloderma 75.7% (n = 53). The most frequently found systemic manifestations were dysphagia (21.4%, n = 15), interstitial lung disease (11.4%, n = 8), and pulmonary hypertension (8.5%, n = 6). Cancer was documented in 8.5% (n = 6) of patients. Conclusion: We showed clinical information of patients with dermatomyositis in a referral hospital in Colombia. The data obtained is consistent with information from other case series worldwide.

Introducción: La dermatomiositis es una miopatía inflamatoria idiopática que se caracteriza por presentar lesiones en la piel; por su presentación clínica, su curso y su pronóstico, se la considera una enfermedad heterogénea. En Colombia existen pocos registros que describan las características clínicas de los pacientes afectados por esta enfermedad. Métodos: Estudio descriptivo de corte transversal, se revisaron las historias clínicas de pacientes que consultaron a un hospital universitario en Colombia entre enero del 2004 y diciembre del 2019. Los registros se obtuvieron utilizando bases de datos de las unidades de dermatología, reumatología, dermatopatología, electrofisiología y códigos diagnósticos CIE10 asociados con dermatomiositis. Resultados: Se obtuvieron 70 pacientes con diagnóstico de dermatomiositis, 63 (90%) de los cuales cumplían criterios de clasificación de Bohan y Peter, en tanto que 7 (10%) presentaban dermatomiositis amiopática. El promedio de edad fue de 43 arios (DS ± 15,3); 48 fueron mujeres (68,5%); los signos clínicos más frecuentes fueron: pápulas de Gottron (80%, n = 56), eritema heliotropo (78,5%, n = 55) y poiquilodermia (75,7%, n = 53). Las manifestaciones sistêmicas más comúnmente encontradas fueron: disfagia (21,4%, n = 15), enfermedad pulmonar intersticial (11,4%, n = 8) e hipertensión pulmonar (8,5%, n = 6). Se documentó cáncer en el 8,5% (n = 6) de los pacientes. Conclusión: Se presenta información clínica de pacientes con dermatomiositis en un centro hospitalario de referencia en Colombia; los datos obtenidos concuerdan con la información de otros estudios de series de casos a escala mundial.

Prevalencia de las cardiopatías congénitas en relación con la altura sobre el nivel del mar en una región de Colombia / Prevalence of congenital heart disease in relation to height above sea level in a region of Colombia

Resumen Introducción: Las cardiopatías congénitas son los trastornos congénitos más frecuentes en la población mundial, se manifiestan generalmente después del nacimiento. Las altitudes entre 2,500 y 3,500 metros sobre el nivel del mar se han relacionado con la alta incidencia de cardiopatías congénitas como el ductus arterioso persistente, los defectos del septum auricular y los defectos del septum ventricular. Objetivo: Caracterizar clínica y sociodemográficamente los pacientes con diagnóstico de cardiopatías congénitas procedentes de altitudes bajas, moderadas y altas en un hospital regional de Colombia. Metodología: Estudio observacional, descriptivo retrospectivo. Se incluyeron todos los pacientes menores de 18 años con diagnóstico de cardiopatías congénitas, atendidos en el Hospital Universitario San Rafael de Tunja entre el 2015 y 2021. Resultados: El 51.9% de los pacientes eran de sexo masculino, el 16.3% tenían antecedente de prematurez y el 9.1% tenían diagnóstico de síndrome de Down. Las cardiopatías más frecuentes fueron: ductus arterioso persistente (35.1%), seguido de comunicación interventricular (21.6%) y comunicación intrauricular (19.7%). Conclusiones: Se deben establecer estrategias como el tamizaje y diagnóstico oportuno de las cardiopatías congénitas en poblaciones de riesgo con el fin de mejorar el pronóstico de vida de los pacientes y desenlace de la enfermedad.

Abstract Introduction: Congenital heart diseases are the most common congenital disorders in the world population, they generally manifest after birth. Altitudes between 2,500-3,500 meters above sea level have been linked to the high incidence of congenital heart diseases such as patent ductus arteriosus, atrial septum defects, and ventricular septum defects. Objetives: To characterize clinically and sociodemographically the patients diagnosed with congenital heart disease from low, moderate and high altitudes in a regional hospital in Colombia. Methodology: Observational, descriptive retrospective study. All patients under 18 years of age with a diagnosis of congenital heart disease, treated at the San Rafael de Tunja University Hospital between 2015 and 2021, were included. Results: 51.9% of the patients were male, 16.3% had a history of prematurity and 9.1% had a diagnosis of Down syndrome. The most frequent heart diseases were: persistent ductus arteriosus 35.1%, followed by ventricular communication representing 21.6% and intra-atrial communication with 19.7%). Conclusions: They must eestablish strategies such as screening and timely diagnosis of congenital heart disease in at-risk populations in order to improve the life prognosis of patients and the outcome of the disease.

Prevalence of congenital heart disease in relation to height above sea level in a region of Colombia.

INTRODUCTION: Congenital heart diseases are the most common congenital disorders in the world population, they generally manifest after birth. Altitudes between 2,500-3,500 meters above sea level have been linked to the high incidence of congenital heart diseases such as patent ductus arteriosus, atrial septum defects, and ventricular septum defects. OBJETIVES: To characterize clinically and sociodemographically the patients diagnosed with congenital heart disease from low, moderate and high altitudes in a regional hospital in Colombia. METHODOLOGY: Observational, descriptive retrospective study. All patients under 18 years of age with a diagnosis of congenital heart disease, treated at the San Rafael de Tunja University Hospital between 2015 and 2021, were included. RESULTS: 51.9% of the patients were male, 16.3% had a history of prematurity and 9.1% had a diagnosis of Down syndrome. The most frequent heart diseases were: persistent ductus arteriosus 35.1%, followed by ventricular communication representing 21.6% and intra-atrial communication with 19.7%). CONCLUSIONS: They must eestablish strategies such as screening and timely diagnosis of congenital heart disease in at-risk populations in order to improve the life prognosis of patients and the outcome of the disease.

INTRODUCCIÓN: Las cardiopatías congénitas son los trastornos congénitos más frecuentes en la población mundial, se manifiestan generalmente después del nacimiento. Las altitudes entre 2,500 y 3,500 metros sobre el nivel del mar se han relacionado con la alta incidencia de cardiopatías congénitas como el ductus arterioso persistente, los defectos del septum auricular y los defectos del septum ventricular. OBJETIVO: Caracterizar clínica y sociodemográficamente los pacientes con diagnóstico de cardiopatías congénitas procedentes de altitudes bajas, moderadas y altas en un hospital regional de Colombia. METODOLOGÍA: Estudio observacional, descriptivo retrospectivo. Se incluyeron todos los pacientes menores de 18 años con diagnóstico de cardiopatías congénitas, atendidos en el Hospital Universitario San Rafael de Tunja entre el 2015 y 2021. RESULTADOS: El 51.9% de los pacientes eran de sexo masculino, el 16.3% tenían antecedente de prematurez y el 9.1% tenían diagnóstico de síndrome de Down. Las cardiopatías más frecuentes fueron: ductus arterioso persistente (35.1%), seguido de comunicación interventricular (21.6%) y comunicación intrauricular (19.7%). CONCLUSIONES: Se deben establecer estrategias como el tamizaje y diagnóstico oportuno de las cardiopatías congénitas en poblaciones de riesgo con el fin de mejorar el pronóstico de vida de los pacientes y desenlace de la enfermedad.

Effectiveness of mobile telemonitoring applications in heart failure patients: systematic review of literature and meta-analysis.

Close and frequent follow-up of heart failure (HF) patients improves clinical outcomes. Mobile telemonitoring applications are advantageous alternatives due to their wide availability, portability, low cost, computing power, and interconnectivity. This study aims to evaluate the impact of telemonitoring apps on mortality, hospitalization, and quality of life (QoL) in HF patients. We conducted a registered (PROSPERO CRD42022299516) systematic review of randomized clinical trials (RCTs) evaluating mobile-based telemonitoring strategies in patients with HF, published between January 2000 and December 2021 in 4 databases (PubMed, EMBASE, BVSalud/LILACS, Cochrane Reviews). We assessed the risk of bias using the RoB2 tool. The outcome of interest was the effect on mortality, hospitalization risk, and/or QoL. We performed meta-analysis when appropriate; heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses are offered. We screened 900 references and 19 RCTs were included for review. The risk of bias for mortality and hospitalization was mostly low, whereas for QoL was high. We observed a reduced risk of hospitalization due to HF with the use of mobile-based telemonitoring strategies (RR 0.77 [0.67; 0.89]; I2 7%). Non-statistically significant reduction in mortality risk was observed. The impact on QoL was variable between studies, with different scores and reporting measures used, thus limiting data pooling. The use of mobile-based telemonitoring strategies in patients with HF reduces risk of hospitalization due to HF. As smartphones and wirelessly connected devices are increasingly available, further research on this topic is warranted, particularly in the foundational therapy.

Management of Dactylitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations.

OBJECTIVE: This literature review aimed to identify the most efficacious current interventions for dactylitis and provide up-to-date scientific evidence to support the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recommendations on the management of psoriatic arthritis. METHODS: Original articles published from 2013 to 2020, registered in MEDLINE, Embase, and Cochrane Library, describing interventional trials and reporting dactylitis-related outcomes were included. The 20 members of the GRAPPA dactylitis group were divided into 9 subgroups according to treatment, and members of each group independently extracted data from articles/abstracts corresponding to their group by using a standardized data extraction form. RESULTS: Forty-nine publications were analyzed, representing 40 randomized clinical trials (RCTs) and including 16,752 patients. Dactylitis was assessed as a secondary outcome in 97.5% of these trials and more than 40% of RCTs did not employ a specific dactylitis measure or instrument. CONCLUSION: The emergence of agents with novel mechanisms of action in recent years, such as interleukin 17 (IL-17), IL-12/23, IL-23, and Janus kinase inhibitors, has significantly expanded the available treatment options for dactylitis. This article points out the lack of consensus regarding dactylitis assessment and the paucity of data concerning the effect of local steroid injections, nonsteroidal antiinflammatory drugs, and conventional disease-modifying antirheumatic drugs. Clinical trials evaluating the effect of these traditional and low-cost medications used to treat dactylitis should be encouraged.

Inicio de artritis reumatoide posterior a infección por SARS-CoV-2

Se han descrito casos de patologías autoinmunes de inicio posterior a la infección por el virus SARS-CoV-2. La relación causal aún no es clara, por lo que es importante la construcción de la literatura frente a esta incógnita. Reportamos el caso de una mujer de 44 años que 18 días luego de cursar con infección por SARS-CoV-2 sin hipoxemia, presenta poliartralgias inflamatorias y paraclínicos compatibles con un diagnóstico de artritis reumatoide. Este caso refuerza la posibilidad de una relación causal entre ambas entidades.

Cases of autoimmune pathologies with onset after infection by the SARS-CoV-2 virus have been described. The causal relationship is not yet clear. We report the case of a 44-year-old woman who, 18 days after presenting with SARS-CoV-2 infection without hypoxaemia, presented with a clinical picture compatible with a diagnosis of rheumatoid arthritis. This case reinforces the possibility of a causal relationship between both entities.